Dr. Ramanathan Discusses the Treatment of Pancreatic Cancer

Ramesh K. Ramanathan, MD, director, Gastrointestinal Medical Oncology Program, Mayo Clinic, discusses the treatment of patients with pancreatic cancer.

In the first-line, the 2 regimens used to treat patients with pancreatic cancer are gemcitabine plus nab-paclitaxel (Abraxane), and FOLFIRINOX. In practice, the regimen is chosen based on the individual patient, Ramanathan says. Generally, patients will be on 1 regimen for 4 to 6 months, develop side effects, and then switch to a second regimen.

In the second-line, there is MM-398 (irinotecan liposome injection; Onivyde) in combination with 5-fluorouracil (5-FU), which is used after gemcitabine plus nab-paclitaxel or single-agent gemcitabine.

There are a number of new agents in clinical trials, and Ramanathan says that molecular profiling is becoming more common in pancreatic cancer. It is important to know if a patient has a genetic alteration such as microsatellite instability, as pembrolizumab (Keytruda) can be given, Ramanathan explains. There is also a lot of interest in identifying patients with a BRCA2 mutation, as these patients often respond better to platinum-based regimens or PARP inhibitors and may have a better survival.