 |
| Kennith H. Yu, MD Memorial Sloan Kettering Cancer Center New York Reproduced from Oncology Frontier(肿瘤瞭望) |
Oncology Frontier(肿瘤瞭望): Which factors do you consider when selecting the first-line systemic chemotherapy regimen for pancreatic cancer patients?
Dr Kenneth H. Yu: The approach to treating pancreatic cancer has changed a lot over the last five years.
There are now two very effective chemotherapy combinations that we use. One is FOLFIRINOX, a combination of 5-FU, leucovorin, irinotecan and oxaliplatin. Another effective combination is gemcitabine plus nab-paclitaxel (Abraxane).
For the most part, both regimens seem to be active but most patients seem to have more side effects on the FOLFIRINOX regimen, so we usually reserve that regimen for very fit patients and patients who are younger (<76).
Patients receiving gemcitabine and Abraxane tend to also be quite fit but we allow for patients to be a little more debilitated from their cancer and we are also willing to treat patients who are a bit older with that particular regimen.
 |
ASCO 2015
McCormick Place, Chicago
Photo: Oncology Frontier
|
Beyond classical cytotoxic agents administered in different formulations and combinations, could you outline other kinds of novel therapeutic approaches that offer substantial promise for improving the outlook of patients with advanced pancreatic cancer?
Dr Kenneth H. Yu: An important study that was presented at this year's meeting was a study looking at combining standard chemotherapy (gemcitabine plus nab-paclitaxel) with an investigational agent called PEGPH20.
This agent dissolves an important component of the tumor microenvironment. Preliminary studies suggest that for patients whose tumors have very high levels of the target of this drug seem to have significantly prolonged survival. That's a very interesting targeted agent that is being pursued in clinical research.
Another targeted agent is MM-398, a novel formulation of an old drug called irinotecan. There is evidence that this drug combined with 5-FU chemotherapy can be effective in patients as second-line treatment for pancreatic cancer.
There is another targeted agent in late stage development called Ruxolitinib. It is approved for myelofibrosis but it appears that patients with high C-reactive protein, a marker of inflammation, can also benefit in the second-line from this targeted agent, when combined with Capecitabine.
 |
| ASCO 2015 Photo:Oncology Frontier |
The identification of predictive biomarkers remains a major challenge in pancreatic cancer. By which methods can we look for predictive or prognostic biomarkers for pancreatic cancer and which factors do you think have more predictive value?
Dr Kenneth H. Yu: I don't think there is going to be one single biomarker that is going to be effective at predicting treatment response and prognosis.
There are likely to be a number of them.
The ones that seem to be most promising right now are biomarkers such as genomic profiles consisting of BRCA mutations. Even if the patient doesn't have a BRCA mutation, it seems up to a quarter of patients have a genomic profile consistent with that. That can be predictive for treatment with drugs such as platinum agents as well as PARP inhibitors.
A second important biomarker from the Ruxolitinib study is high C-reactive protein.
And then from a study that was presented here today looking at tumor hyaluronic acid levels, there are tumors that are targets for the drug PEGPH20.
There is a lot of active research looking at other biomarkers but they still remain exploratory. These include things like circulating tumor cells, exosomes and circulating DNA.
 |
| ASCO 2015 May 29-June 2, 2015 Photo:Oncology Frontier |
Considering the prognosis of metastasis pancreatic cancer is poor, what do you think are the challenges in pancreatic cancer treatment and clinical trial design?
Dr Kenneth H. Yu: The challenges in treating pancreatic cancer are many and include factors such as very complex genetic mutations making it difficult to target any one mutation, on top of the fact the tumor has developed the ability to evade the immune system much better than other cancers.
Trial designs that look promising are combining different immunotherapy agents to try and overcome these problems with pancreas cancer as well as strategies looking at multiple targeted agents acting on important pathways in the progression of pancreatic cancer.
Reference:
[ASCO2015] 胰腺癌研究的当前状况和未来前景?--Dr Kenneth H. Yu 访谈
2015/6/1 2 肿瘤瞭望 Video 微信公众号
No comments:
Post a Comment