CHEMOTHERAPY IN ELDERLY PATIENTS WITH PANCREATIC CANCER Akshjot - - PowerPoint PPT Presentation

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Mar 12, 2023 187 likes •294 views

CHEMOTHERAPY IN ELDERLY PATIENTS WITH PANCREATIC CANCER Akshjot Puri, MD Post Graduate Year 5 MENTOR: Madappa N. Kundranda, MD. PhD. CASE A 77 yo female, good PS, presents with non-specific epigastric pain and pruritus for 2 months No other

SLIDE 1

CHEMOTHERAPY IN ELDERLY PATIENTS WITH PANCREATIC CANCER Akshjot Puri, MD

Post Graduate Year 5

MENTOR: Madappa N. Kundranda, MD. PhD.

SLIDE 2

CASE

A 77 yo female, good PS, presents with non-specific epigastric pain and pruritus for 2 months No other significant medical problems, non smoker, family history of breast and ovarian cancers Examination shows severe jaundice Total bilirubin: 18, CA 19-9: 1930

SLIDE 3

Biopsy of pancreatic head mass shows pancreatic adenocarcinoma EUS staging T2N1 Biliary stent placement, normalization of bilirubin, CA 19-9: 1100 BRCA 1 and 2 mutations are negative

SLIDE 4

QUESTION 1

Choice of neoadjuvant regimen for this borderline-resectable pancreatic head adenocarcinoma?

A. mFOLFIRINOX
B. mFOLFIRINOX and CFRT (Conventionally fractionated

radiation therapy)

C. Gemcitabine and Abraxane
D. Gemcitabine alone
E. mFOLFIRINOX and SBRT (Stereotactic body radiation

therapy)

SLIDE 5

At 8 months from diagnosis

FOLFIRINOX X 8 Cycles with dose interruptions followed by SBRT x 5 fractions

CA 19-9: 193065 Whipple surgery pathology showed partial response (Evans grade II)

2.3 cm moderate to poorly differentiated adenocarcinoma, 6 out of 27 lymph nodes involved, duodenal wall involvement

SLIDE 6

At 11 months from diagnosis Surveillance scan at 3 months from surgery CA 19-9: 193065  471 71 PS 1

SLIDE 7

QUESTION 2 Ch Choice o

f next l

lin ine in in t therapy?

A. Re-challenge with mFOLFIRINOX
B. 5FU plus Onivide
C. Gemcitabine and Abraxane
D. Gemcitabine alone
E. Hospice

SLIDE 8

CASE

Patient was started on Gem/ABX
Tolerated this expected TRT’s
After 2 months:

– worsening abdominal pain and distension – new backpain – 10lb weight loss

Restaging scans: New omental metastasis with L3

pedicle lesion

PS 2

SLIDE 9

QUESTION 3 Ch Choice o

f next l

lin ine in in t therapy?

A. Clinical trial
B. 5FU plus Onivide
C. FOLFOX
D. Gemcitabine alone
E. Palliative Radiation, paracentesis and hospice

SLIDE 10

Case

Patient elected to proceed with palliative care and

CHEMOTHERAPY IN ELDERLY PATIENTS WITH PANCREATIC CANCER Akshjot Puri, MD

Post Graduate Year 5

MENTOR: Madappa N. Kundranda, MD. PhD.

CASE

A 77 yo female, good PS, presents with non-specific epigastric pain and pruritus for 2 months No other significant medical problems, non smoker, family history of breast and ovarian cancers Examination shows severe jaundice Total bilirubin: 18, CA 19-9: 1930

Biopsy of pancreatic head mass shows pancreatic adenocarcinoma EUS staging T2N1 Biliary stent placement, normalization of bilirubin, CA 19-9: 1100 BRCA 1 and 2 mutations are negative

QUESTION 1

Choice of neoadjuvant regimen for this borderline-resectable pancreatic head adenocarcinoma?

radiation therapy)

therapy)

At 8 months from diagnosis

FOLFIRINOX X 8 Cycles with dose interruptions followed by SBRT x 5 fractions

CA 19-9: 193065 Whipple surgery pathology showed partial response (Evans grade II)

2.3 cm moderate to poorly differentiated adenocarcinoma, 6 out of 27 lymph nodes involved, duodenal wall involvement

At 11 months from diagnosis Surveillance scan at 3 months from surgery CA 19-9: 193065  471 71 PS 1

QUESTION 2 Ch Choice o

lin ine in in t therapy?

CASE

– worsening abdominal pain and distension – new backpain – 10lb weight loss

pedicle lesion

QUESTION 3 Ch Choice o

lin ine in in t therapy?

Case

hospice