Brian M. Wolpin, MD, MPH

Invited discussant Brian M. Wolpin, MD, MPH, of Dana-Farber Cancer Institute in Boston, said the results of the LAPACT trial will be useful as an aid to patient counseling as well as in designing and interpreting future studies. However, he added, they are not “practice-changing,” as nanoparticle albumin-bound (nab)-paclitaxel (Abraxane)/gemcitabine has already become a standard induction regimen.

“These results are unlikely to change current clinical practice,” Dr. Wolpin stated. “Many patients with locally advanced pancreatic cancer already receive multiagent induction chemotherapy. However, this study provides structured,multi-institutional data for this approach, and this is also useful.”

More Data Needed

Asked by a listener whether nab-paclitaxel and FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin) have “equipoise” as induction regimens, Dr. Wolpin responded: “We really don’t have enough data to say one is better than another. The decision is made on an individual basis with the patient in front of you and what you think the patient can tolerate. We have certainly seen, from data today and from other studies, both gemcitabine plus nab-paclitaxel and FOLFIRINOX can produce good responses in patients with locally advanced disease.”

The optimal treatment approach for locally advanced pancreatic cancer remains unclear, he added, as do some other issues, including how advances in radiation and surgery should be incorporated and how therapy could be intensified for patients who continue to have localized disease after induction therapy. “These questions are important, and their answers would add considerably to our understanding of how best to treat patients with locally advanced pancreatic cancer,” noted Dr. Wolpin. ■

DISCLOSURE: Dr. Wolpin reported no conflicts of interest.