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Second-Line Treatment of Pancreatic Cancer

Second-line treatment of pancreatic cancer includes only one FDA-approved regimen, which includes IV 5-FU in addition to nanoliposomal irinotecan (Onivyde). Side effects of this combination of chemotherapy drugs are similar to the widely recognized FOLFIRI drug cocktail, but hasn’t yet become an FDA-approved Level One regimen for second-line treatment. Patients without improvement from second-line treatment are typically referred to the clinical trial setting. More videos: https://ruesch.georgetown.edu/rueschr... Transcript: I'm often asked what I use for second-line therapy for metastatic pancreatic cancer. There's really only one FDA-approved regimen with Level One evidence, which is the cocktail that includes IV 5-FU in addition to nanoliposomal irinotecan, which is also called Onivyde. This nal-IRI cocktail, which is what we call it, was proven to be better than just 5-FU alone in a large randomized trial, and again led to the FDA approval of this regimen. It's a cocktail that's not too dissimilar in terms of its side effect profile to the more widely recognized FOLFIRI cocktail. We consider nal-IRI essentially as an encapsulated version of the standard irinotecan, and that's why the side effects are somewhat similar, but again, it's the only proven cocktail for patients who have progression on gemcitabine-based first-line therapy. For patients who've received FOLFIRINOX or a 5-FU-based regimen in the front-line setting, there really is no FDA-approved Level One approved regimen for second-line setting. Given the data that exists for front-line setting for patients with metastatic pancreatic cancer with gemcitabine and nab-paclitaxel, that is often the go-to regimen and it is certainly what I would recommend for patients outside of a clinical trial. Gemcitabine and nab-paclitaxel seems to be fairly well tolerated even for patients after FOLFIRINOX, and again I will routinely drop the day eight dosing, so giving it every other week seems to make it much more tolerable. For patients whose disease progressed on second-line therapy, unfortunately there really is no standard therapy in the third-line setting, and virtually all of those patients should be referred to clinical trials.