abraxane combination therapy in Pancreatic Cancer- astounding progress in deadly disease! | CELG Message Board Posts

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Msg  173549 of 206118  at  11/28/2012 4:44:06 PM  by


Strong Buy

abraxane combination therapy in Pancreatic Cancer- astounding progress in deadly disease!

The following is from Medscape.
Note the comment by an oncologist in comment #7: He has been using abraxane
in pancreatic cancer based on phase II.

Getting the details on phase III
pancreatic data is the most exciting data point on the list!


Gem/Abraxane Shows Survival Benefit in Pancreatic Cancer
Alok Khorana, MD, Oncology, Medical, 10:00AM Nov 10, 2012

In a brief press release, Celgene has indicated that the phase III study evaluating the benefit of adding Abraxane to gemcitabine in treatment of advanced pancreatic cancer shows a statistically significant benefit for the combination when compared to gemcitabine alone. No details have been provided and we'll have to wait on those until the abstract is released for ASCO GI in January. This is a study that has long been rumored to be positive, so it will be good to have actual data. The control arm being gemcitabine alone, however, will invite controversy particularly given the positive results for FOLFIRINOX. Given the significant toxicity of FOLFIRINOX, however, most clinicians are waiting for a more tolerable and clinically beneficial combination. I personally will not be changing my practice for now, however, until I see the actual results.

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#1, Added By: paulroda, MD, Oncology, Hematology/Oncology, 02:10PM Nov 10, 2012
Making toxic chemicals work

Alok --

I've given folfirinox twice, both times to healthy patients. Both times were disasters. I will not give that regimen again and currently use gem/erlotinib as my "standard" for met disease. Of course, that regimen only had a two week median survival benefit. But I've seen a lot of prolonged survivors with it.

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#2, Added By: Alok Khorana, MD, Oncology, Medical, 03:25PM Nov 10, 2012

So my current practice is FOLFIRINOX only for healthy, younger good PS patients who want to be aggressive. I empirically dose reduce the irinotecan and use growth factor support and book appts for IVF during weeks off. Still pretty toxic and I'd love to find a different regimen. I also like gem/erlotinib- it did meet its endpoint, unlike all the other gem plus regimens; its relatively non-toxic; I've seen a handful of pathologic CRs with it; 1 yr survival is about 24% up from 18% with gem alone and can be as high as 40% in those with bad skin rash. Hopefully the results for gem/abraxane live up to be clinically significant and not just statistically so.

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#3, Added By: doc911, MD, Oncology, Hematology/Oncology, 06:27PM Nov 10, 2012

I have given Folfirinox to several patients successfully with very minimal toxicity. The key is to start at a dose reduction and build your way up.

I agree that IVF is absolutely essential with this regimen.

I was initially very skeptical about it, but have been pleasantly surprised at how well it can be tolerated if given with some of these strategies. The duration of response has been much higher than anything I have seen in this disease.

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#4, Added By: catalinagonzpons, MD, Oncology, Medical, 06:45PM Nov 20, 2012

I also have given Folfirinox to several patients successfully with very minimal toxicity. It could be interesting to compare FOLFIRINOX Vs Gemzar/Abraxane.

The combination of Gemzar/ Erlotinib is very well tolerate. I'll be pending about the Gemzar/Abraxane, results information.

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#5, Added By: cantanapoli, MD, Oncology, Hematology/Oncology, 04:43PM Nov 25, 2012

I have given FOLFIRINOX to one patient with success starting at the regular dose and then dose reducing as needed. It is not clear if FOLFOX would be good enough. I do not use erlotinib because a 2 weeks improvement in survival is too low.

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#6, Added By: jdilucca, MD, Oncology, Medical, 04:56PM Nov 27, 2012

What is not really convincing about FOLFIRINOX is the unusual patient population of the trial, which is not representative to the real-world population of advanced pancreatic cancer patients. I'm not sure that gemcitabine/nab-paclitaxel is much less toxic and I question whether a randomized trial comparing these two regimens is worthwhile.

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#7, Added By: feltyn, MD, Oncology, Hematology/Oncology, 05:41PM Nov 27, 2012

I have been giving Gem/Abraxane for the last 2 years based on the dramatic phase II data. I have found it very well tolerated, with quite good response rates. MUCH easier than FOLFIRINOX. Glad to see the phase III data at last!

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#8, Added By: tohfe71, MD, Oncology, Hematology/Oncology, 07:32PM Nov 27, 2012
Replying to:
Reply to: #1 by paulroda
Alok -- I've given folfirinox twice, both times to healthy patients. Both times were disasters. I will not give...

I would suggest to give GCSF after each cycle, to start imodium early with diarrhea and check CBC weekly for the first 2 cycles.

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Thoughts on cancer therapeutics, cancer biology and cancer complications with occasional forays into the art of medicine. The bar is set at: Interesting.

Poll: Do electronic medical records make life easier? Yes, for writing chemo orders but no for writing notes|No, its more stuff that takes away from patient care|Yes, a big improvement over finding and writing in paper charts|It doesn't matter- we all have to get them now|

Alok Khorana

Alok A. Khorana, M.D., is Associate Professor and Vice-Chief, Division of Hematology/Oncology, at the James P. Wilmot Cancer Center, University of Rochester, Rochester, New York. His clinical and research programs focus on cancer-associated thrombosis and gastrointestinal cancers and are funded by the NIH and the V Foundation.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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