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Meet The Professors: Pancreatic Cancer Edition, 2016 (Video Program)
Released March 2017

A case-based roundtable discussion on the management of pancreatic cancer. Featuring faculty members Drs Tanios Bekaii-Saab and Margaret A Tempero and community oncologists Drs Philip L Brooks, Philip T Glynn and Michael Schwartz. (Video Program)

CE Disclosures and Faculty Information

    This activity is intended for medical oncologists and other healthcare providers involved in the treatment of pancreatic cancer.

    An estimated 53,070 people will be diagnosed with pancreatic cancer in the United States in 2016, and approximately 41,780 will die of the disease. For the better part of the past 2 decades, gemcitabine chemotherapy had been the main systemic therapy used to treat locally advanced and metastatic pancreatic adenocarcinoma. However, its actual clinical benefit was a modest 1-month extension in overall survival when compared to 5-FU alone. Despite the recent breakthroughs with FOLFIRINOX and nab paclitaxel, systemic options for patients with advanced pancreatic adenocarcinoma remain limited. However, ongoing research into other therapeutic strategies continues. One chemotherapeutic agent in particular, nanoliposomal irinotecan (nal-IRI), has recently garnered the attention of gastrointestinal oncologists and patients alike. As more and better treatment options become available and patients are living longer, a variety of supportive care issues, including pain management and palliative care, become more relevant considerations. In fact, the institution of early palliative care, including adequate pain control, can now be considered a life-extending intervention in and of itself.

    Although pessimism has reigned for some time in the management of pancreatic adenocarcinoma, the past few years have witnessed the emergence of a variety of therapeutic and investigational strategies such as FOLFIRINOX, nab paclitaxel and nal-IRI that have already changed clinical practice. The use of PARP inhibitors and immune-directed therapies also holds promise to do so in the future. To offer optimal patient care, clinicians need educational interventions designed to increase their knowledge of recent advancements and appropriately counsel them regarding how those new strategies can be safely and effectively integrated into current protocol and off-protocol treatment algorithms for patients with pancreatic cancer.


    • Apply the results of emerging clinical research to the best-practice management of pancreatic adenocarcinoma.
    • Develop an evidence-based strategy for the initial diagnosis and treatment of resectable pancreatic cancer, exploring the role of neoadjuvant and adjuvant chemotherapy and/or radiation therapy.
    • Consider age, performance status and other clinical and logistical factors in the selection of systemic therapy for patients with locally advanced or metastatic pancreatic cancer.
    • Appreciate the recent FDA approval of nal-IRI in the management of treatment-refractory metastatic pancreatic cancer, and optimally incorporate this agent into patient care algorithms.
    • Recall new data with other investigational agents demonstrating promising activity in pancreatic cancer.
    • Review the potential impact of early palliative care, pain management and end-of-life planning on clinical outcomes for patients with advanced pancreatic cancer, and integrate this information, where applicable, into routine practice.

    Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    CME credit is no longer available for this issue


    CME credit is no longer available for this issue


    CME credit is no longer available for this issue

    This CME activity consists of a video component.

    CME credit is no longer available for this issue

    Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess conflicts of interest with faculty, planners and managers of CME activities. Conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

    FACULTY — The following faculty (and their spouses/partners) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Tanios Bekaii-Saab, MD
    Co-Leader, GI Cancer Program
    Mayo Clinic Cancer Center
    Senior Associate Consultant
    Mayo Clinic Arizona
    Scottsdale, Arizona

    Consulting Agreements: Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Celgene Corporation, Genentech BioOncology, Merck, Taiho Oncology Inc; Data and Safety Monitoring Board: Exelixis Inc, Silagen.

    Margaret A Tempero, MD
    Director, UCSF Pancreas Center
    The Rombauer Family Distinguished Professorship in
    Pancreas Cancer Clinical and Translational Science
    Leader, Pancreas Cancer Program
    Professor of Medicine, Division of Hematology and Oncology
    San Francisco, California

    Advisory Committee: EMD Serono Inc, Gilead Sciences Inc, Threshold Pharmaceuticals; Consulting Agreements: Champions Oncology, Cornerstone Pharmaceuticals Inc, Lilly, Novocure, Opsona Therapeutics; Contracted Research: Celgene Corporation, Halozyme Therapeutics.

    COMMUNITY ONCOLOGISTS — The following community oncologists (and their spouses/partners) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Philip L Brooks, MD
    Hematologist-Medical Oncologist
    CancerCare of Maine/Eastern Maine Medical Center
    Brewer, Maine

    No relevant conflicts of interest to disclose.

    Philip T Glynn, MD
    Director, Medical Oncology, Mercy Medical Center
    Director of Oncology, Noble Hospital
    Director of Noble VNA and Hospice Services
    Springfield, Massachusetts

    No relevant conflicts of interest to disclose.

    Michael Schwartz, MD
    Attending, Division of Hematology and Oncology
    Mount Sinai Medical Center
    Miami Beach, Florida

    No relevant conflicts of interest to disclose.

    MODERATOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Acerta Pharma, Agendia Inc, Amgen Inc, Ariad Pharmaceuticals Inc, Array BioPharma Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Baxalta Inc, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, CTI BioPharma Corp, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Halozyme Therapeutics, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Lilly, Medivation Inc, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, Teva Oncology, Tokai Pharmaceuticals Inc and VisionGate Inc.

    RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no relevant conflicts of interest to disclose.

    This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

    This activity is supported by educational grants from Celgene Corporation and Merrimack Pharmaceuticals Inc.

    Hardware/Software Requirements:
    A high-speed Internet connection
    A monitor set to 1280 x 1024 pixels or more
    Internet Explorer 7 or later, Firefox 3.0 or later, Chrome, Safari 3.0 or later
    Adobe Flash Player 10.2 plug-in or later
    Adobe Acrobat Reader
    (Optional) Sound card and speakers for audio

    Last review date: March 2017
    Expiration date: March 2018

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(WIFI is recommended for best performance):

Treatment strategies in the management of advanced pancreatic cancer

  • 70-year-old man with metastatic pancreatic adenocarcinoma (mPAC) has a cardiopulmonary arrest after the third cycle of FOLFIRINOX
  • Efficacy and toxicity of FOLFIRINOX versus gemcitabine/nab paclitaxel as first-line therapy for patients with mPAC
  • Clinical decision-making in the first-line metastatic setting
  • Second-line treatment of mPAC after first-line nab paclitaxel/gemcitabine

Basis for the use of nanoliposomal irinotecan (nal-IRI, MM-398)

  • Efficacy, pharmacokinetics and toxicity of nal-IRI
  • Rationale for the use of nal-IRI

Results from the NAPOLI-1 Phase III trial of nal-IRI for metastatic pancreatic cancer

  • NAPOLI-1 trial of nal-IRI with fluorouracil and folinic acid in mPAC
  • Phase III NAPOLI-1 trial of nal-IRI, with or without 5-fluorouracil and leucovorin, versus 5-fluorouracil and leucovorin in metastatic pancreatic cancer after previous gemcitabine-based therapy

Mechanism of action of nal-IRI versus nab paclitaxel and toxicity profile of nal-IRI

  • Mechanism of action of nab paclitaxel and efficacy in combination with gemcitabine
  • Mechanism of action and side-effect profile of nal-IRI
  • Neutropenia and diarrhea associated with nal-IRI

Optimal treatment sequencing and comparison of available treatment options

  • Ongoing investigation of nal-IRI-containing regimens for patients with untreated mPAC
  • Efficacy of modified FOLFIRI versus nal-IRI and 5-FU for refractory, advanced pancreatic cancer
  • 94-year-old man with cancer in the tail of the pancreas

Rewarding experience of being an oncologist

  • Perspectives on the rewarding experience of being an oncologist

Treatment strategies for elderly patients and those with preexisting diabetes

  • Rationale for the use of fixed dose-rate gemcitabine
  • 65-year-old man with a history of Type 2 diabetes discontinues treatment with FOLFIRINOX for mPAC because of poor tolerance

Biomarkers of treatment efficacy and toxicity

  • Serum CA19.9 as a screening marker for patients with pancreatic cancer
  • Association between UGT1A1 genotype and irinotecan toxicity

Neoadjuvant therapy for resectable and borderline-resectable pancreatic cancer

  • Outcomes with neoadjuvant therapy for patients with resectable pancreatic cancer
  • Clinical pros and cons of neoadjuvant therapy for patients with resectable pancreatic cancer
  • A021101: Preoperative modified FOLFIRINOX followed by capecitabine-based chemoradiation therapy for borderline-resectable pancreatic cancer
  • 69-year-old-man with borderline-resectable pancreatic adenocarcinoma is enrolled on a clinical trial with neoadjuvant PEGPH20, gemcitabine and nab paclitaxel
  • Novel approaches under investigation for pancreatic cancer in the neoadjuvant setting
  • Role of vascular reconstruction for patients with locally advanced pancreatic cancer who have vascular encasement
  • Perspective on extending the duration of neoadjuvant chemotherapy to achieve resectability
  • Stent use for patients with locally advanced pancreatic cancer undergoing neoadjuvant therapy
  • Imaging tests to determine surgical resectability of pancreatic cancer

Efficacy and safety of gemcitabine-based therapies in the adjuvant setting

  • 66-year-old man who was initially diagnosed with Stage I pancreatic cancer experiences disease recurrence in the liver and lungs 6 months later
  • Phase III MPACT study of weekly nab paclitaxel and gemcitabine versus gemcitabine alone: Use in patients with poor performance status
  • Adjuvant treatment with gemcitabine and capecitabine
  • A 67-year-old man with a long history of abdominal discomfort is diagnosed with adenocarcinoma of the tail of the pancreas
  • Gemcitabine/capecitabine as adjuvant therapy
  • 85-year-old man who was diagnosed with localized pancreatic cancer develops hemolytic uremic syndrome after receiving adjuvant chemoradiation therapy including gemcitabine
  • Synergistic effect of gemcitabine in combination with other regimens

Benefits of genetic testing and treatment holidays

  • 34-year-old woman with an extensive family history of cancer is diagnosed with BRCA-mutated mPAC
  • Treatment holidays for patients with metastatic pancreatic cancer
  • Perspective on the optimal time to reinitiate therapy for patients on treatment holidays

Future directions and ongoing investigations in pancreatic cancer

  • Cachexia associated with pancreatic cancer
  • Role of checkpoint inhibitors for patients with pancreatic cancer