Ep. 42 Neoadjuvant Therapy in Resectable Pancreatic Cancer with Dr. Rebecca Snyder

For the small subset of pancreatic cancer patients whose cancer is detected early and remains localized, there are now opportunities to offer treatment and improve outcomes. In this episode of the BackTable Tumor Board Podcast, Ochsner medical oncologist Dr. Jonathan Mizrahi and MD Anderson surgical oncologist Dr. Rebecca Snyder discuss the contemporary management of localized pancreatic cancer. --- SYNPOSIS Dr. Snyder and Dr. Mizrahi break down the categories of resectable, borderline resectable, and locally advanced pancreatic cancer; and explain the current treatment strategies that are tailored to each stage. The discussion highlights the role of neoadjuvant therapy, the potential benefits of radiation for certain subpopulations, and the importance of a multidisciplinary team approach for optimal patient care. The doctors also cover pivotal clinical trials, ongoing research, and future directions in the field, including targeted therapies and biomarker development, to inform best practices in treating patients with localized pancreatic cancer. --- TIMESTAMPS 00:00 - Introduction02:24 - Defining Resectable, Borderline, and Locally Advanced Pancreatic Cancer11:10 - Neoadjuvant Therapy for Resectable Pancreatic Cancer17:16 - Ongoing Clinical Trials: FOLFIRINOX and Gemcitabine Nab-Paclitaxel23:04 - The Role of Radiation in Pancreatic Cancer Treatment26:52 - Treating Locally Advanced Pancreatic Cancer34:49 - Future Directions and Targeted Therapies --- RESOURCES APOLLO Randomized Phase II Studyhttps://clinicaltrials.gov/study/NCT04858334 PRODIGE 29-UCGI 26 (NEOPAN) Phase III Trialhttps://ascopubs.org/doi/10.1200/JCO-24-02210 ALLIANCE A021806 Phase III Trialhttps://doi.org/10.1245/s10434-024-15817-5 NORPACT-1 Phase II Trialhttps://pubmed.ncbi.nlm.nih.gov/38237621/ Dutch Randomized Phase III PREOPANC Trialhttps://pubmed.ncbi.nlm.nih.gov/32105518/ SWOG S1505 Randomized Clinical Trialhttps://pubmed.ncbi.nlm.nih.gov/32740235/ ALLIANCE A021501 Phase II Randomized Clinical Trialhttps://pubmed.ncbi.nlm.nih.gov/35834226/ LAP07 Randomized Clinical Trialhttps://pubmed.ncbi.nlm.nih.gov/27139057/ LAP100 Phase III Trialhttps://clinicaltrials.gov/study/NCT06958328 Meta-analysis on Arterial Resections in Pancreatic Cancerhttps://pmc.ncbi.nlm.nih.gov/articles/PMC12070998/ PANOVA-3 Phase III Studyhttps://ascopubs.org/doi/10.1200/JCO-25-00746 NRG-GI011 Clinical Trial: Openinghttps://www.nrgoncology.org/patients/patient-study-webpages/nrg-gi011-testing-higher-dose-rt-for-locally-advanced-pancreatic-cancer