How do you determine which patient is a candidate for a modified regimen of gemcitabine/nab-paclitaxel?

FAQ Library published on August 22, 2018
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Tanios Bekaii-Saab, MD, FACP
Professor
Mayo Clinic College of Medicine and Science
Program Co-Leader, Gastrointestinal Cancer
Mayo Clinic Cancer Center
Medical Director, Cancer Clinical Research Office
Section Chief and Vice-Chair
Division of Hematology/Oncology
Mayo Clinic
Phoenix, Arizona
How do you determine which patient is a candidate for a modified regimen of gemcitabine/nab-paclitaxel?

Welcome to Partners in Pancreatic Cancer. I am Dr. Tanios Bekaii-Saab.

Today, I would like to discuss which patient may be a candidate for a modified regimen of gemcitabine/nab-paclitaxel and the difference seen in terms of the side effects and the overall survival. When we think about our patients coming through the clinic, patients with pancreas cancer tend to be, for the most, under performance compared to a lot of patients with other cancers. Typically, they have cachexia, weight loss, muscle loss, appetite loss. There are patients who are in some bad shape when they get to the clinic and the regimens we’ve used so far had been relatively aggressive and a lot of patients are unable to tolerate it, in fact, about half of the patients are unable to tolerate the dosages that are applied per the package insert or per the studies. In fact, we do have data that suggest that modifying FOLFIRINOX, modifying gemcitabine and nab-paclitaxel, may end up yielding in terms of very similar outcomes while cutting down significantly on the levels of toxicities that typically are observed with the weekly regimens in the case of gemcitabine and nab-paclitaxel. Modifications of the regimen with gemcitabine and nab-paclitaxel are either day 1 and day 8 of every three weeks. The preferable one in my viewpoint is the every-other-week, day 1 and day 15 based on our publication that suggested that survival stage relatively well preserved while the toxicities gets significant improvement. Overall, in my clinic at least, almost every patient that is eligible for gemcitabine and nab-paclitaxel outside the clinical trial will get an every-other-week regimen of gemcitabine and nab-paclitaxel day 1 and day 15. In other practices perhaps the patients that would be most eligible are those with performance status of 1 or those that are older that are less likely to be able to go through the weekly regimen. Of course at the end of the day, it is important to look at these questions prospectively through a randomized trial. Thank you for viewing this activity.

Last modified: August 13, 2018
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