GI CONNECT’s Post

Name: GI CONNECT on LinkedIn: #medicaleducation
Uploaded: 2024-12-28T13:45:01.066Z
Duration: 4 min 54 s
Channel: GI CONNECT

GI CONNECT

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Systemic chemotherapy is the standard treatment for metastatic PDAC. Find out more about treatment regimens, sequencing, and managing toxicities in this 2-part accredited micro learning from medical oncologists Prof. Efrat Dotan and Prof. Shubham Pant. ⬇️ https://lnkd.in/e7MMCTcY Watch the video from Module 2 below📺 #MedicalEducation This educational programme is supported by an Independent Educational Grant from Ipsen USA.

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Chemotherapy strategies for metastatic pancreatic ductal adenocarcinoma. Pancreatic ductal adenocarcinoma, otherwise known as PDAC, is usually diagnosed at an advanced stage, leading to an extremely poor prognosis due to nonspecific symptoms. Scienter Toxic chemotherapy is the cornerstone of treatment for advanced or metastatic cases. Chemotherapy agents with different mechanisms of action are used to treat metastatic PDAC. Molecularly targeted therapies and immunotherapies may also benefit select patients. For years, gemcitabine was the standard first line treatment. Recent advancements in combination chemotherapy have enhanced survival across all disease stages. Current first line therapies include FOLFIRINOX, gemcitabine plus nanoparticle albumin bound paclitaxel or Nab paclitaxel and Valerie Fox. Validated by the Prudish 4 IMPACT and Napoli 3 trials. The Pradesh 4 trial in untreated metastatic PDAC patients compared FOLFIRINOX with gemcitabine. FOLFIRINOX demonstrated improved overall survival, establishing it as a standard for fit patients. Despite higher toxicity levels. Side effects included hematological toxicities, diarrhea, and fatigue. Management strategies such as dose adjustments and supportive care can mitigate these effects. The impact trial assessed to the combination of gemcitabine and NAB paclitaxel against gemcitabine alone, resulting in improved overall survival. This led to the approval of gemcitabine plus NAP paclitaxel as a first line option. While this combination resulted in notable neutropenia and thrombocytopenia, a modified biweekly regimen reduced side effects while maintaining efficacy. The Napoli 3 trial in previously untreated patients evaluated Maleri Fox, which pairs liposomal irinotecan with five fluorouracil or five FU leucovorin and oxaliplatin versus gemcitabine plus NAP paclitaxel. Liposomal encapsulation of irinotecan allows for slower clearance and enhanced tumor accumulation, reducing traditional irinotecan side effects. Nellie fox showed significant improvements in overall survival compared to gemcitabine plus nan paclitaxel. Although more gastrointestinal side effects were observed with an Alera fox, these can be managed with dose modifications without adversely affecting efficacy. Patients who respond or have stable disease after four to six months of first line chemotherapy may be eligible for maintenance therapy with capecitabine or gemcitabine based treatments. Those with germline BRACA One or Braca 2 mutations may receive PARP inhibitors like olaparib. Second line treatment choices depend on prior therapies. After fluoropyrimidine treatment, options include gemcitabine based therapies. For those who previously received gemcitabine, options include liposomal irinotecan +5 FU and leucovorin or other fluoropyrimidine based regimens such as FOLFOX and FOLFIRINOX. Targeted therapies are considered when molecular alterations are identified. The pivotal Napoli One trial showed that liposomal irinotecan with five FU and leucovorin improved survival in patients progressing on gemcitabine based therapies, leading to its approval as a second line treatment. Common side effects included diarrhea, vomiting and neutropenia, but these were managed with dose adjustments while maintaining efficacy. Additionally, trials like Conco 003 and Pancreas Box investigated oxaliplatin combinations. Yielding conflicting survival outcomes. Choosing a treatment depends on various factors, including patient performance status and comorbidities. For those unsuitable for systemic therapy, palliative care focuses on pain management and nutritional support. Although newer treatment regimens have improved survival rates, ongoing efforts in risk assessment and early detection remain essential.

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