Dr. Sahai on Sequencing Strategies in Metastatic Pancreatic Cancer

Vaibhav Sahai, MBBS, assistant professor of medicine at the University of Michigan, discusses sequencing strategies in metastatic pancreatic cancer.

Approximately half of patients with newly diagnosed metastatic pancreatic cancer receive the combination of gemcitabine plus nab-paclitaxel (Abraxane), and the other half receive FOLFIRINOX. After patients progress on their initial therapy, they are often switched to the alternative regimen. As such, it remains unclear whether sequencing matters if patients are going to be exposed to both regimens regardless, says Sahai.

Presently, there are no known immunotherapies in this space. However, researchers are hopeful that targeted therapy with olaparib (Lynparza) may be a maintenance strategy worth pursuing. Data from the phase III POLO trial presented at the 2019 ASCO Annual Meeting demonstrated that patients with germline BRCA1/2-mutated metastatic disease experienced a significantly improved progression-free survival with maintenance olaparib versus placebo. Maintenance therapy was given after at least 4 months of FOLFIRINOX or platinum-based chemotherapy, says Sahai.