Leveraging Endoscopic Ultrasound in Pancreatic Cancer: From Diagnosis to Personalized Treatment

In this first episode of OncChats: Leveraging Endoscopic Ultrasound in Pancreatic Cancer, Toufic A. Kachaamy, MD, of City of Hope, Madappa Kundranda, MD, PhD, of Banner MD Anderson Cancer Center, and Tamas A. Gonda, MD, of NYU Langone, discuss how endoscopic ultrasound (EUS) has changed the diagnosis of pancreatic cancer and how it may also be utilized to guide personalized treatment in nonmetastatic adenocarcinomas.

Kachaamy: Hi, I am Toufic Kachaamy. I am the chief of medicine and the director of gastroenterology at City of Hope in Phoenix, Arizona. Today, we will be talking about pancreatic cancer and ablation. Pancreatic cancer is the fourth leading cause of cancer mortality despite its relatively low incidence of 3%. It is postulated that [this disease] will become the second leading cause of cancer mortality if we don’t do anything [drastically] different in [terms of] management soon. Also, pancreatic neuroendocrine tumors are increasing; they have increased around five-fold in incidence in the past decade.

Surgery, the mainstay of cure for these patients, is very morbid. [Also], many [patients] are identified at a [later] stage in which [they have] either comorbidities that preclude surgery, or in over 80% of the cases, [they are diagnosed] at an advanced stage where surgery is no longer an option. There has been a strong effort to impact outcomes [for patients] for [all these] reasons. Because of the anatomic location of the pancreas, EUS is playing a central role—not just in diagnosis and obtaining tissue, but also in new and developing areas of therapeutics.

Today, I am joined by Tamas A. Gonda, MD, and Madappa Kundranda, MD, PhD. Dr Gonda is an associate professor of medicine at NYU Grossman School of Medicine in New York, and he is the chief of endoscopy at Tisch Hospital. He’s also the director of the Pancreas Disease Program at NYU [Langone]. Dr Kundranda is the division chief of cancer medicine at Banner MD Anderson Cancer Center in Phoenix, Arizona.

Today, we will [first] focus on [EUS in] pancreatic adenocarcinoma and [we’ll] leave the [pancreatic] neuroendocrine tumors for later. Dr Gonda, the first question I want to ask you is, can you tell us about the role of EUS in the personalized treatment of nonmetastatic adenocarcinomas?

Gonda: Thanks so much, Dr Kachaamy. I’m very glad to be here. This is obviously an incredibly important area. As you mentioned, pancreatic cancer is unfortunately taking a leading place among some of the deadliest cancers, with a slightly increasing incidence. I think EUS has really evolved from [being] a purely diagnostic tool; over the past 10 to 20 years, [this] has really become the dominant way that we diagnose any kind of pancreatic tumor.

Increasingly, [EUS] has taken a role in taking the diagnosis one step further, from just a histologic diagnosis to the specimens increasingly being used to direct personalized therapy. We now know that EUS-guided biopsies, in most cases of any kind of pancreatic tumor, can provide us with sufficient information from immunohistochemical staining and from molecular analysis, from sequencing methods from the tissue, that may impact the treatment of 10% to 20% of patients.

Check back on Tuesday for the next episode in this series.