Dana B. Cardin, MD, MSCI, associate professor of medicine, hematology and oncology, Vanderbilt-Ingram Cancer Center, discusses the importance of identifying comorbidities and high-risk features when determining the optimal treatment approach for patients with pancreatic cancer.

Identifying comorbid conditions in patients with pancreatic cancer is vital for navigating treatment options in this space, as the presence of a given condition may discourage the use of certain therapies, Cardin begins. For example, some patients may already experience challenges with eating and drinking. These patients should not be recommended to receive chemotherapy, which are commonly associated with nausea or vomiting, Cardin says. Other agents may cause nerve-related adverse effects (AEs) that could exacerbate pre-existing neuropathy or nerve damage from conditions like diabetes, Cardin adds.

ECOG performance status can also be used to predict patient responses to treatment, and determine the optimal treatment approach, Cardin continues. This describes a patient's ability to perform activities of daily living such as personal care, walking, cooking meals, going to work, or running errands, she expands. If patients have a limited functional status, certain treatment-related AEs may more significantly impact their quality of life and outcomes, , Cardin explains.

For patients being considered for surgery as a part of their treatment approach, it is especially important to assess their frailty, Cardin emphasizes. A patient’s frailty and number of medical comorbidities directly correlates with their likelihood of experiencing complications after pancreaticoduodenectomy, she says.

Lastly, a patient's nutritional status should be noted. Malnutrition is commonly observed in patients with pancreatic cancer and may affect both performance status and a patient’s responses to treatment, Cardin concludes.

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Dana B Cardin, MD, MSCI, discusses the importance of identifying comorbidities and high-risk features when determining the optimal treatment approach for patients with pancreatic cancer.


Dr Cardin on the Influence of Comorbidities on Treatment Selection in Pancreatic Cancer

Dana B Cardin, MD, MSCI, associate professor of medicine, Hematology and Oncology, Vanderbilt-Ingram Cancer Center, discusses the rationale for exploring KRAS as a therapeutic target in pancreatic cancer.

In an era where an increased understanding has been gained regarding the molecular profile of cancers and the genetic alterations that drive these malignancies, it has become possible to identify the gene alterations that most commonly occur in patients with a specific type of cancer, Cardin says. Within pancreatic cancer, 

 mutations have been established as alterations responsible for driving the disease in a high proportion of patients, Cardin details.

 alterations occur high in the signaling pathway, they can affect other downstream signals, Cardin expands. Studies investigating agents designed to target signals downstream of KRAS have not produced efficacious results, leading investigators to hypothesize that hitting the 

 alteration directly is required for effective treatment, Cardin adds. However, developing KRAS-targeted agents has been a challenge in pancreatic cancer, she says.

Different types of agents, such as small molecule inhibitors, have been designed to target specific 

mutations, Cardin continues, noting that there has been some activity noted with this research. KRAS G12C inhibitors have displayed antitumor activity in other malignancies; however, 

 G12C mutations occur in approximately 1% to 3% of patients with pancreatic cancer, making this a small subset of this patient population, Cardin concludes.

Dana B Cardin, MD, MSCI, discusses the rationale for exploring KRAS as a therapeutic target in pancreatic cancer.


Dana B Cardin, MD, MSCI

Articles

Dr Cardin on the Influence of Comorbidities on Treatment Selection in Pancreatic Cancer

Dr Cardin on Targeting KRAS in Pancreatic Cancer