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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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Saint Agnes Medical CenterOncology SymposiumOctober 15, 2011Neoadjuvant, Adjuvant and Palliative ManagementMarshall Flam, MDHematology, Oncology Medical Group
Age Specific Incidence Rates of Pancreas Cancer, in California, by Race, 1988-2008 Courtesy of Paul Mills, PhD, MPH
Assessment of Clinical Benefit Analgesic Consumption Pain Intensity Responder > 7% Increase in body weight Responder Stable or decreased weight
Phase III Trials of Chemotherapyin Advanced Pancreatic Cancer
French Trial: Survival Gemcitabine vs GEMOX
Summary of the CAN-NCIC PA.3 Phase III TrialGemcitabine +Erlotinib vs Gemcitabine Alone in Advanced Pancreatic Cancer
Phase III Trial of Bevacizumba + Gemcitabine in Patients with Advanced Pancreatic Cancer: Median Overall and Progression-Free Survival
Clinical Trials Investigating second-line combination chemotherapy in gemcitabine-pretreated patients with advanced pancreatic cancer
Phase II trial of capecitabine + erlotinib in gemcitabine-refractory advanced pancreatic cancer
ADJUVANT THERAPY FOLLOWING RESECTION OF PAC
Key Trials of Adjuvant Therapy in Resectable Pancreatic Cancer
NEO-ADJUVANT (PRE-OPERATIVE) THERAPY
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
Operability Classification of Localized PAC based on high-quality cross-sectional imaging • Resectable • Borderline Resectable • Locally Advanced • Metastatic
Selected Trials of Neoadjuvant Chemoradiation for Patients with Potentially Resectable Pancreatic Cancer
Kaplan-Meier curves compare overall survival in patients according to timing of systemic therapy. MS indicate medial survival.
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.
Need Title Survival adjusted for age, sex, and comorbidity for patients receiving treatment versus untreated patients.
Need Title Kaplan-Meier overall survival curves in patients with good Karnofsky performance score (90 to 100). Gem, gemcitabine; GemCap, Gemcitabine plus capecitabine.