Ep. 62 Advancements in Managing Locally Advanced Pancreatic Cancer with Dr. Rebekah White and Dr. Michael Sherer

Can a tumor deemed permanently unresectable actually be downstaged to surgery? In this episode of BackTable Tumor Board, host Dr. Zach Berman (interventional radiologist, UC San Diego) is joined by Dr. Rebekah White (surgical oncologist) and Dr. Michael Sherer (radiation oncologist) to discuss the complexities of managing locally advanced, unresectable pancreatic cancer and evaluate how individualized patient factors, treatment response, and multidisciplinary expertise can turn inoperable tumors into surgical candidates. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Meet the Tumor Board06:17 - Induction Chemo Pathway11:54 - Imaging Workup and PET16:45 - Chemoradiation Basics21:01 - SBRT Dose Escalation28:00 - IRE NanoKnife Explained31:14 - Emerging Options RAS and Fields36:27 - Wrap Up and Credits --- More about this episode The doctors define locally advanced versus borderline resectable disease using NCCN vascular criteria, while emphasizing institutional nuance, tumor biology, patient fitness, and response to induction systemic therapy (modified FOLFIRINOX vs. gemcitabine/Abraxane). They discuss how biomarkers like CA 19-9 and CEA inform decisions in the absence of significant radiographic shrinkage, and review the use of pancreas-protocol CT, MRI, PET, and staging laparoscopy for optimal assessment. The doctors explore post-chemotherapy strategies, including when to switch regimens, the choice between chemoradiation and SBRT, surgical aggressiveness, and the application of local therapies like IRE (NanoKnife). The conversation also touches on innovative techniques, histotripsy, intra-arterial options, tumor treating fields and looks ahead to the promise of KRAS inhibitors and ctDNA-driven personalized treatment. --- Resources NCCN Guidelines for Pancreatic Cancerhttps://www.nccn.org/patients/guidelines/content/PDF/pancreatic-patient.pdf ACSO 2025 Presentation on Tumor Treating Fieldshttps://www.asco.org/abstracts-presentations/241499 May 2026 Metastatic RAS Inhibitor Clinical Trialhttps://www.dana-farber.org/newsroom/news-releases/2026/rason-inhibitor-daraxonrasib-shows-promising-results-in-advanced-pancreatic-cancer-phase-12-study --- BackTable Tumor Board is the go-to multidisciplinary podcast for medical oncologists, surgical oncologists, and other healthcare professionals that play an active role in cancer care. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app