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Chemotherapy for Pancreatic Cancer

Chemotherapy for Pancreatic Cancer, Part 5: Chemotherapy for Metastatic Pancreatic Cancer

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Gemcitabine Registration StudyDr. Colin Weekes, pancreatic cancer specialist from the University of Colorado, discusses the history of and recent developments in chemotherapy for metastatic pancreatic cancer.

 

Chemotherapy for Pancreatic Cancer, Part 5: Chemotherapy for Metastatic Pancreatic Cancer Audio Podcast


Chemotherapy for Pancreatic Cancer, Part 3: Pre-Operative Treatment for Pancreatic Cancer

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Gemcitabine-based Chemoradiation TherapyDr. Colin Weekes, pancreatic cancer specialist from the University of Colorado, covers the rationale and evidence for pre-operative (neoadjuvant) therapy for resectable pancreatic cancer.

 

Chemotherapy for Pancreatic Cancer, Part 3: Pre-Operative Treatment for Pancreatic Cancer Audio Podcast


Chemotherapy for Pancreatic Cancer, Part 1: Background and Molecular Biology

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PancreasDr. Colin Weekes, pancreatic cancer specialist from the University of Colorado, covers the role of chemotherapy in pancreatic cancer, beginning with the molecular biology of pancreatic cancer.

 

Chemotherapy for Pancreatic Cancer, Part 1: Background and Molecular Biology Audio Podcast


Dr West

Dr. Matthew Katz on the Role of Systemic Therapy for Even Apparently Localized Pancreatic Cancer

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Katz Multiphase Rx Fig

Dr. Matthew Katz, pancreatic cancer expert surgeon at the MD Anderson Cancer Center in Houston, TX, finished his comprehensive webinar presentation on management of potentially resectable pancreatic cancer with a discussion of the need for systemic therapy (in this setting, chemotherapy) alongside “local” treatments that focus on the location of the primary cancer, such as surgery and/or radiation.  Chemotherapy is considered a beneficial component in the management of nearly all cases of pancreatic cancer, even when the scans and eyes of the surgeon indicate there is no evidence of the cancer outside of the area resected.  

In this last podcast from his talk, Dr. Katz summarizes the standard approach of surgery followed by chemo or chemo/radiation, or the alternative they tend to favor at MD Anderson of the systemic therapy being delivered prior to planned surgery afterward.   Here are the video and audio versions of the podcast along with the transcript and figures.

Katz Pt 5 Need for Systemic Therapy Even for Localized Pancreatic Cancer Audio Podcast

Katz Pt 5 Need for Systemic Therapy Even for Localized Pancreatic Cancer Transcript

Katz Pt 5 Need for Systemic Therapy Even for Localized Pancreatic Cancer Figs

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Why am I not getting FOLFIRINOX after my pancreatectomy?

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Over the past two decades, it has been increasingly recognized that patients who undergo pancreatectomy for pancreatic cancer do better when they are administered chemotherapy after their operation.

Prior to the 1990s, there was only one drug administered to patients with pancreatic cancer at all—5FU. In 1997, however, a study showed that patients with inoperable pancreatic cancer lived longer and had fewer symptoms when treated with a new drug called gemcitabine than when they were treated with 5FU. Based on the results of this study, gemcitabine quickly became standard treatment for patients with inoperable pancreatic cancer. But its value when given after surgery was unknown. So over 50% of patients who got an operation in the 80s and 90s never received any treatment after surgery—even at major surgical hospitals. 

In 2007, a large study of over three hundred patients was performed in Germany and Austria. The study randomized patients who had undergone curative surgery to receive either nothing (“observation”) or gemcitabine. The duration of time that elapsed between surgery and cancer relapse of patients who received gemcitabine was significantly longer than that of those who did not. Although another large European study showed that gemcitabine was no better than 5-FU when given after surgery, gemcitabine became standard postoperative therapy worldwide largely based on the results of this trial.

Last year, another European study showed that patients with inoperable pancreatic cancer who received a combination of drugs—called FOLFIRINOX—lived even longer than patients who received gemcitabine. In fact, the survival of patients who received FOLFIRINOX was almost twice as long as that of patients who received gemcitabine! Given the failure of multiple other otherwise promising regimens when compared to gemcitabine, this was remarkable. This was a truly revolutionary study that generated an understandable amount of excitement among doctors and patients worldwide.

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