My name is Dr. Vince Picozzi. I am an oncologist at the Virginia Mason Clinic in Seattle, Washington, who has a big interest in pancreatic cancer.

I think maintenance therapy has been really underappreciated and understudied, and is extremely important in pancreatic cancer. If we think of patients with advanced metastatic disease, the goal for treatment currently is to really try to take their disease and turn it into a chronic one where they can live a very significant period of time with good quality. Now if one thinks about achieving that, currently the only therapies we readily have involve chemotherapy which can be difficult from the standpoint of tolerance, both from the standpoint of side effects as well as emotional and logistical tolerance. If we want to make pancreatic cancer a chronic disease, we have to at least be able to have interludes from chemotherapy as we know it where a patient can be maintained and the disease stabilized without side effects. Maintenance therapy of some fashion really provides the key to this to be able to extend the meaningful time period of treatment that patients can have, so it is going to be critically important to the future of pancreatic cancer.

There are studies that are actually just beginning, and they look at using drugs such as lower-dose chemotherapy, immunotherapy agents, perhaps agents that affect the stroma, the cellular surround of the cancer either individually or in combination. The hallmark of all of these is that they have to be easy to take on a convenient schedule without significant side effects; but those studies, in fact, are beginning now.