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Age Specific Incidence Rates of Pancreas Cancer, in California, by Race, 1988-2008

Saint Agnes Medical Center Oncology Symposium October 15, 2011 Neoadjuvant, Adjuvant and Palliative Management Marshall Flam, MD Hematology, Oncology Medical Group. Age Specific Incidence Rates of Pancreas Cancer, in California, by Race, 1988-2008. Courtesy of Paul Mills, PhD, MPH.

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Age Specific Incidence Rates of Pancreas Cancer, in California, by Race, 1988-2008

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  1. Saint Agnes Medical CenterOncology SymposiumOctober 15, 2011Neoadjuvant, Adjuvant and Palliative ManagementMarshall Flam, MDHematology, Oncology Medical Group

  2. Age Specific Incidence Rates of Pancreas Cancer, in California, by Race, 1988-2008 Courtesy of Paul Mills, PhD, MPH

  3. Stage at Diagnoses of PAC

  4. SINGLE AGENT CHEMOTHERAPY

  5. Overall Survival: Gemcitabine vs 5-FU

  6. Fixed Dose Rate vs. Standard Rate

  7. Toxicity Summary

  8. Assessment of Clinical Benefit Analgesic Consumption Pain Intensity Responder > 7% Increase in body weight Responder Stable or decreased weight

  9. COMBINATION CHEMOTHERAPY

  10. Phase III Trials of Chemotherapyin Advanced Pancreatic Cancer

  11. EGOC Trail: Survival – Gemcitabine vs GEMOX

  12. French Trial: Survival Gemcitabine vs GEMOX

  13. Objective Responses in the Intention-to-Treat Population

  14. Progression-free Survival

  15. Overall Survival

  16. TARGETED THERAPIES

  17. Summary of the CAN-NCIC PA.3 Phase III TrialGemcitabine +Erlotinib vs Gemcitabine Alone in Advanced Pancreatic Cancer

  18. Phase III Trial of Bevacizumba + Gemcitabine in Patients with Advanced Pancreatic Cancer: Median Overall and Progression-Free Survival

  19. SECOND LINE THERAPIES

  20. Clinical Trials Investigating second-line combination chemotherapy in gemcitabine-pretreated patients with advanced pancreatic cancer

  21. CONKO 003

  22. Phase II trial of capecitabine + erlotinib in gemcitabine-refractory advanced pancreatic cancer

  23. ADJUVANT THERAPY FOLLOWING RESECTION OF PAC

  24. Key Trials of Adjuvant Therapy in Resectable Pancreatic Cancer

  25. NEO-ADJUVANT (PRE-OPERATIVE) THERAPY

  26. Advantages Pre-operative Chemo radiation over Post-operative Chemo radiation • More effective chemotherapy delivery with an intact blood supply • Avoidance of hypoxia related chemo radiation resistance • Avoidance of late radiation toxicity by surgical removal of irradiated duodenum and use of unirradiated jejunum use in reconstruction • Immediate use of systemic therapy for a disease that is systemic at diagnosis in the majority of patients • Improved patient selection for pancreatic surgery • Pancreatic surgery is safer following chemo radiation due to reduced risk of pancreatic anastomotic leak due to pancreatic fibrosis • Timely access to therapy. No delays due to post-operative recovery complications • Increases R0 (complete) resection rates in patients with borderline resectable tumors

  27. Operability Classification of Localized PAC based on high-quality cross-sectional imaging • Resectable • Borderline Resectable • Locally Advanced • Metastatic

  28. Selected Trials of Neoadjuvant Chemoradiation for Patients with Potentially Resectable Pancreatic Cancer

  29. Kaplan-Meier curves compare overall survival in patients according to timing of systemic therapy. MS indicate medial survival.

  30. Kaplan Meier curves compare overall survival in patients with extra pancreatic disease (ie, T3 or T4 Disease) according to timing of sytematic therapy. MS indicates median survival.

  31. Add Title

  32. Need Title Survival adjusted for age, sex, and comorbidity for patients receiving treatment versus untreated patients.

  33. Need Title Kaplan-Meier overall survival curves in patients with good Karnofsky performance score (90 to 100). Gem, gemcitabine; GemCap, Gemcitabine plus capecitabine.

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