Dr. Chung on Sequencing Chemotherapy Regimens in Metastatic Pancreatic Cancer

Vincent Chung, MD, associate clinical professor, Department of Medical Oncology and Therapeutics Research, Director Phase I Program, City of Hope, discusses sequencing chemotherapy regimens in patients with metastatic pancreatic cancer.

When it comes to choosing a chemotherapy regimen for patients, much of the decision comes down to toxicity, says Chung. For that reason, Chung recommends starting these patients on gemcitabine and nab-paclitaxel (Abraxane). Although nab-paclitaxel causes a lot of neuropathy, it tends to resolve over time, he adds. If a patient progresses on that regimen, they can start on second-line nanoliposomal irinotecan and 5-fluorouracil, which offers good disease control.

As opposed to nab-paclitaxel, the neuropathy seen with the use of oxaliplatin is more permanent. Therefore, oxaliplatin is typically reserved for later lines of therapy, explains Chung. For a patient with a very good performance status who is given modified FOLFIRINOX, Chung advises dropping the oxaliplatin as neuropathy becomes more evident.