Episode 168: Pancreatic Cancer Series, Pt. 3 – Borderline Resectable and Locally Advanced Disease

Episode 168: Pancreatic Cancer Series, Pt. 3 – Borderline Resectable and Locally Advanced Disease

This week we continue our Pancreatic Cancer series with the two middle categories of non-metastatic disease: borderline resectable and locally advanced. Using the case of a 61-year-old woman with a pancreatic body mass abutting the superior mesenteric artery, we walk through the vascular definitions that separate resectable, borderline resectable, and locally advanced disease, then trace how multi-agent chemotherapy borrowed from the metastatic setting became the neoadjuvant backbone. We dig into the newest challenger to mFOLFIRINOX, PAXG in the CASSANDRA trial, and the still-contested role of radiation, from Alliance A021501 to PREOPANC-2. Along the way, we cover why restaging CT can understate response, how LAP07 reframed consolidative chemoradiation in locally advanced disease, and what to offer patients who are not candidates for intensive therapy. As always, if you haven't heard the earlier episodes in this series, start there first.