Articles related to PANCREATIC CANCER

Zev Wainberg, MD, professor of medicine and co-director of the UCLA GI Oncology Program at the University of California, Los Angeles, presented the results of the NAPOLI-3 trial at the ASCO Gastrointestinal Cancers Symposium last month, and in this podcast, he discusses the data with Bob Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer. In addition, the physicians discuss what advances might be on the horizon in the metastatic setting and in earlier disease, as well as what factors influence Dr. Wainberg’s treatment decisions.

NAPOLI-3 began recruiting 770 patients with metastatic pancreatic ductal adenocarcinoma at the start of the COVID-19 pandemic. Until the disease progressed, there was unacceptable toxicity, or the patient withdrew from the study, the patients were randomly randomized to receive the combination of liposomal irinotecan with 5-fluorouracil/leucovorin and oxaliplatin (NALIRIFOX) or nab-paclitaxel plus gemcitabine therapy. OS served as the study’s primary endpoint, whereas progression-free survival (PFS) and the objective response rate (ORR) served as secondary objectives. The main goal of the study—prolonged overall survival—was achieved with NALIRIFOX. The survival curves split at around 3 months, and this divergence was maintained for the duration of the investigation. NALIRIFOX also increased the median PFS. Moreover, NALIRIFOX therapy was preferred in all previously identified categories in terms of both OS and PFS. The ORR with NALIRIFOX was 41.8%, and the ORR with nab-paclitaxel/gemcitabine was 36.2%, virtually entirely made up of incomplete responses.

In this multi-institutional study, AT significantly increased progression-free and overall survival in 430 patients with node-negative (N0) disease after NAT for localized pancreatic cancer (4.1 vs 2.1 and 5.3 vs 3.5 years, respectively). Patients who received neoadjuvant radiation had their overall survival benefit scaled back, while patients with perineural invasion saw an increase.

The final results of this randomized clinical trial of 493 patients with pancreatic ductal adenocarcinoma (PDAC) showed that treatment with modified FOLFIRINOX as opposed to gemcitabine significantly increased overall survival (median survival, 53.5 vs. 35.5 months). Younger age, well-differentiated tumors, lower-stage tumors, larger-volume centers, and finishing the prescribed course of therapy all predicted better survival; early disease relapse was an adverse prognostic factor for overall survival from relapse.

The authors engaged in research to attempt to identify circulating biomarkers for pancreatic NETs, to improve tumor surveillance and quality of life. They examined the expression of circulating miRNA in the serum of MEN1 patients and found an inverse relationship between miR-3156-5p and MORF4L2 expression, representing a potential serum biomarker that could facilitate the detection of NET occurrence in MEN1 patients.

This 1.25-credit CME course provides a review and update of current practice on minimally invasive vs. open pancreaticoduodenectomy, including trends and outcomes in robotic and laparoscopic pancreaticoduodenectomy.