Pancreatic Cancer

Question 1

Which patients with pancreatic cancer should get germline genetic testing?

Answer 1

Everyone

Question 2

Who are borderline resectable patients?

Answer 2

Stage II/III
Abutment of an artery <180 degrees

Question 3

What is considered locally advanced pancreatic cancer?

Answer 3

T4Nx

Question 4

What is considered resectable pancreatic cancer?

Answer 4

T1-3, N0-1

Question 5

Standard of care treatment paradigm for resectable pancreatic cancer?

Answer 5

Up front surgery then adjuvant chemotherapy for 6 months (Gem, Gem-Cape, mFOLFIRINOX, or Gem-Nab paclitaxel)

Question 6

Adjuvant therapy for resectable pancreatic cancer in an elderly patient? (2)

Answer 6

Gemcitabine or Gem+cape

Question 7

Adjuvant therapy for resectable pancreatic cancer in a fit patient with ECOG 0 without comorbidities?

Answer 7

FOLFIRINOX (Gem + 5-FU, Gem+Cape also)

Question 8

Who should get adjuvant chemoradiation in resectable pancreatic cancer?

Answer 8

R1 resection, but should get 4-6 months of chemotherapy first

Question 9

1st line metastatic pancreatic cancer (2)

Answer 9

Gem-Nab
FOLFIRINOX (KPS >70%)

Question 10

FOLFIRINOX should be reserved for which PC patients in the first line metastatic setting?

Answer 10

KPS >70%

Question 11

Indication for olaparib in pancreatic cancer?

Answer 11

Maintenance for patients with BRCA1 or 2 mutation with platinum sensitive disease in metastatic setting.

Question 12

Most common KRAS mutation in PC?

Answer 12

G12D

Question 13

Pembro indication in PC

Answer 13

MSI-H, generally in 2nd line
(Or TMB >10)

Question 14

Met PC treatment option with NTRK fusion? (2)

Answer 14

Entrectinib
Larotrectinib

Question 15

Treatment option for mPC with NRG fusion

Answer 15

Afatinib

Question 16

Treatment paradigm for borderline resectable PC?

Answer 16

Neoadjuvant chemotherapy +/- chemoradiation, and surgery if it becomes resectable

Question 17

Best 2L option for patients with mPC that progress on Gem-Nab?

Answer 17

5-FU + Liposomal Irinotecan

Question 18

Which patients with resectable pancreatic cancer should receive neoadjuvant chemotherapy+/- chemoRT instead of up front surgery?

Answer 18

High risk features:
-Markedly elevated Ca 19-9
-Large tumors
-Large regional LNs
-Excessive weight loss
-Extreme pain

Question 19

How does NALIRIFOX compare to Gem-Nab in 1L mPC?

Answer 19

NALIRIFOX has improved OS and PFS. Don’t know how it compared to mFOLFIRINOX though