Dr. Becerra on Sequencing Therapies in Pancreatic Cancer

Carlos Becerra, MD, medical oncologist, Texas Oncology, discusses sequencing therapies in the treatment of patients with pancreatic cancer.

Currently, physicians do not have a head-to-head comparison between the different therapeutic agents. Therefore, in younger patients with a robust performance status there is a trend to treat patients with FOLFIRINOX, which is a 3-drug combination regimen, explains Becerra.

In older patients who are not as robust, there is a tendency to treat them with gemcitabine and nab-paclitaxel (Abraxane) first. Upon disease progression, physicians can switch to an alternative regimen. If a physician starts with gemcitabine and nab-paclitaxel and the patient's tumor gets worse, they can consider adding or changing to either FOLFIRINOX if the patient still has a very good performance status, or a variation such as FOLFOX, says Becerra. Another regimen that can be utilized is liposomal irinotecan in combination with 5-fluorouracil, which is approved as second-line chemotherapy in this particular setting, states Becerra.