CASE OF ADVANCED PDAC: PROGRESSION BEYOND FIRST LINE AND - - PowerPoint PPT Presentation

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Nov 29, 2023 39 likes •180 views

CASE OF ADVANCED PDAC: PROGRESSION BEYOND FIRST LINE AND CARCINOMATOSIS MEENA SADAPS, MD FELLOW, HEMATOLOGY/ONCOLOGY DAVENDRA SOHAL, MD, MPH ASSOCIATE PROFESSOR, HEMATOLOGY/ONCOLOGY DIRECTOR, CLINICAL GENOMICS PROGRAM CLINICAL CASE 57 year

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CASE OF ADVANCED PDAC: PROGRESSION BEYOND FIRST LINE AND CARCINOMATOSIS

MEENA SADAPS, MD

FELLOW, HEMATOLOGY/ONCOLOGY

DAVENDRA SOHAL, MD, MPH

ASSOCIATE PROFESSOR, HEMATOLOGY/ONCOLOGY DIRECTOR, CLINICAL GENOMICS PROGRAM

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CLINICAL CASE

¡ 57 year old male ¡ Initial presentation of 60 lb weight loss + new onset, uncontrolled DM2 ¡ Imaging: pancreatic mass, liver lesions ¡ Liver biopsy: Adenocarcinoma, consistent with pancreatic primary (CK7+, CK20-) ¡ ECOG PS 0

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WHAT WOULD YOU DO?

A. Best supportive care
B. FOLFOX
C. FOLFIRINOX
D. Gemcitabine alone
E. Gemcitabine/nab-paclitaxel

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TREATMENT HISTORY

¡ Jun 2017: Started FOLFIRINOX

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ASCO GUIDELINES – FOLFIRINOX – 1ST LINE TREATMENT

¡ Recommendation 2.1: FOLFIRINOX is recommended for patients who meet all of the following criteria: ¡ ECOG PS of 0 to 1 ¡ Favorable co-morbidity profile ¡ Patient preference ¡ Support system for aggressive medical therapy ¡ Access to chemotherapy port and infusion pump management services

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TREATMENT HISTORY - PROGRESSION

¡

Oct 2017: Imaging with progression of disease

¡

ECOG PS 1

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GENERATION

SEQUENCING

¡ Foundation One ¡ No actionable

alterations

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WHAT WOULD YOU DO NEXT?

A. Best supportive care
B. KRAS-targeting drug (e.g. MEK inhibitor)
C. Non-genomics-driven clinical trial
D. Gemcitabine alone
E. Gemcitabine/nab-paclitaxel
F. Nanoliposomal irinotecan

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ASCO GUIDELINES – 2ND LINE TREATMENT

¡ Recommendation 3.3: Gemcitabine plus nab-paclitaxel can be offered as second-line therapy to

patients who meet all of the following criteria:

¡ 1st line treatment with FOLFIRINOX ¡ ECOG PS of 0 to 1 ¡ Relatively favorable co-morbidity profile ¡ Patient preference ¡ Support system for aggressive medical therapy

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TREATMENT HISTORY

¡ Patient preferred chemotherapy ¡ Oct 2017: Started gemcitabine/nab-paclitaxel

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TREATMENT HISTORY - PROGRESSION

¡ Dec 2017: Imaging with progression

f disease

¡ Now with rapid clinical

deterioration

¡ Cachexia, anasarca, ECOG PS

barely 3 – transitioned to hospice

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QUESTIONS?

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