Episode # 3 • 17 Jan 2025
Metastatic Pancreatic Cancer: A New Era of Treatment?
A drug that nearly doubles overall survival in metastatic pancreatic cancer is something Dr. Arsen Osipov says the field has never seen before, and it is why he calls the pan-RAS inhibitor daraxonrasib a paradigm shift on the scale of the first immunotherapy approvals. On this episode of the BackTable GI Oncology Creator Weekend™, host Dr. Andrew Hendifar leads a tumor board on metastatic pancreatic cancer with fellow GI oncologists Dr. Arsen Osipov and Dr. Daniel Ahn. They start with the workup. A CT of the chest, abdomen, and pelvis is usually enough, and a PET rarely changes management. They also cover what to do when a patient does not make CA 19-9, the debate over routine DPYD testing before 5-FU, and why every patient gets molecular profiling.
Timestamps
00:00 - Introduction
01:53 - Workup and Staging in Metastatic Pancreatic Cancer
04:33 - Blood Work, CA 19-9, and DPYD Testing
08:46 - Molecular Profiling: Blood Versus Tissue
11:29 - Choosing First-Line Chemotherapy for Fit and Frail Patients
14:19 - Pain, Anorexia, and Cachexia
17:47 - RASolute 302 and Daraxonrasib
20:50 - A Future Without Chemotherapy?
22:17 - Variant-Specific Versus Pan-RAS Inhibitors and Resistance
26:43 - KRAS Trials to Watch and Treatment After Progression
29:57 - Beyond RAS: Immunotherapy and MEK Inhibition
31:04 - Case: BRAF V600E and ctDNA Surveillance
36:22 - Closing Remarks
Resources
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More about this episode
Next, they compare first-line options (modified FOLFIRINOX, NALIRIFOX, and gemcitabine with nab-paclitaxel), talk through how to counsel a frail patient in their eighties, and share how they manage pain, appetite loss, and cachexia. The second half turns to KRAS: the RASolute 302 results, how pan-RAS and variant-specific inhibitors differ, early signs of resistance, and whether chemotherapy still has a future in this disease. They close with a BRAF V600E case in which a rising circulating tumor DNA signal, five years after surgery, prompted closer surveillance.
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