Keypoints:
• The utility of 5-FU bolus and leucovorin in treatment regimens
• Managing common side effects like diarrhea, mucositis, and neuropathy
• The importance of preemptive strategies in side effect management
• Insights on liposomal irinotecan and its tolerability
• The impact of gemcitabine and nab-paclitaxel on quality of life
In this episode of the Oncology Brothers podcast, we dive into the complexities of managing side effects associated with various treatments for pancreatic cancer. Joined by esteemed guests Dr. Rachna Shroff from the University of Arizona and Dr. Midhun Malla from the University of Alabama, we explored the nuances of several key drugs used in clinical practice, including 5-FU, oxaliplatin, irinotecan, liposomal irinotecan, and the combination of gemcitabine and nab-paclitaxel.
We started with 5-FU, discussed the utility of bolus versus continuous infusion and the importance of managing side effects like mucositis and diarrhea. Both Rachna and Midhun shared their practices, leaning towards eliminating bolus 5-FU to reduce toxicities. We also touched on the significance of testing for DPD deficiency and the management of side effects associated with capecitabine.
As we transitioned to oxaliplatin, we highlighted the challenges of neuropathy and the strategies for mitigating this side effect, including preemptive measures and alternative therapies like acupuncture. The conversation continued with irinotecan, where we emphasized the importance of proactive management of diarrhea and marrow suppression.
Liposomal irinotecan was discussed next, with insights into its tolerability compared to traditional irinotecan, while still acknowledging the potential for significant diarrhea. We stressed the importance of patient education regarding antidiarrheals.
Finally, we delved into gemcitabine and nab-paclitaxel, addressing the balance between efficacy and managing side effects such as myelosuppression and pneumonitis. Rachna and Midhun advocated for a performance status-based approach rather than strictly age-based treatment decisions.
Throughout the episode, we emphasized the critical nature of quality of life in palliative care and the need for ongoing communication with patients about their treatment experiences.
We hope this discussion provides valuable insights for oncologists managing pancreatic cancer therapies. Thank you for tuning in, and we look forward to sharing more in our future episodes!
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