Ongoing Dialogue: A Team-Based Approach to Pancreatic Cancer Management

The Evolving Landscape of Pancreatic Cancer Management

In this episode of Partners in Practice, cohosts Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, met with Timothy Brown, MD, MSCE, and Heather Kline, MS, APRN, FNP-C, both of UT Southwestern Medical Center, to discuss the critical role of teamwork in the treatment of metastatic pancreatic cancer. The panelists explored the evolving therapeutic landscape, focusing on the current recommendations, the most common side effects, and the growing importance of communication across the care team.

“We need to choose the right therapy for the patient,” said Dr. Brown. “Doing so requires solid knowledge of the latest data, along with an appreciation of  different perspectives and conversations that happen while we care for patients.”

FOLFIRINOX, NALIRIFOX, and Gemcitabine

Despite the myriad studies that have been conducted in recent years, frontline treatment for metastatic pancreatic cancer hasn’t changed, primarily consisting of FOLFIRINOX (leucovorin [folinic acid], fluorouracil, irinotecan, and oxaliplatin), NALIRIFOX (liposomal irinotecan, 5-fluorouracil, leucovorin, and oxaliplatin), or the doublet of gemcitabine plus nab-paclitaxel, according to Dr. Brown. “Usually, it’s tailored to the patient’s performance status, organ damage, and their ability to tolerate an intensive chemotherapy regimen,” he said. Patients who have  BRCA mutations, he added, may also qualify for gemcitabine plus cisplatin.

FOLFIRINOX has been proven effective. A 2011 study published in The New England Journal of Medicine found that patients who received the combination chemotherapy regimen achieved higher survival rates than those who received gemcitabine. However, patients in the  FOLFIRINOX arm were also more likely to experience side effects, including fatigue, decreased appetite, nausea, diarrhea, and possible pancreatic insufficiency. “We’ve also seen cold sensitivity from oxaliplatin and neuropathy after some cycles,” said Kline. Gemcitabine plus nab-paclitaxel tends to be better tolerated.

These findings demonstrate the importance of ensuring patients are well-informed about the side effects that they may experience, said Kline.

Extensive and Ongoing Chemotherapy Teaching

As such, it’s critical that patients are prescribed the appropriate prophylactic medications and know which symptoms necessitate a call to the office, Kline said, adding that chemotherapy teaching is both extensive and ongoing. “It’s not a one-time event. I find myself having to do a lot of reteaching prior to Cycle 2, because we don’t know how they’re going to feel until they actually start the therapies,” she said.

Another important aspect in determining the right course of treatment is the patient’s condition prior to diagnosis, according to Dr. Brown, who advised paying close attention to patient history. “If they were completely functional two or three weeks ago, chances are they’re probably going to be candidates for the more intensive regimen,” he said. However, a different approach may be required for patients who are more dependent with their daily needs.

“Sometimes you’re taking a chance,” Dr. Brown said. “If you’re on the fence, you need to be willing to do a rapid reassessment and pivot in the event of toxicity. It’s a constant challenge.”

Toxicity Checks and Communication

For that reason, it’s imperative that care providers collaborate closely, from diagnosis and workup to toxicity checks—which, according to Dr. Brown, are increasingly being performed by APPs, particularly if a patient appears robust and not to deteriorate with chemotherapy. However, if issues such as cholangitis or biliary obstruction appear, he recommended getting the physician involved. In many cases, physicians will alternate with APPs as patients progress in their treatment. The collaboration n can benefit both patients and care providers, according to Kline.

“If we’re being entrusted with more regular Tox checks, we need to be able to communicate effectively with one another,” she said. “If I’m concerned about a patient, Dr. Brown will be concerned as well. And so, we need to make sure we’re reporting our findings.” Mutual respect is the other key piece in building a successful cancer care team, said Kline, “it’s important that we respect one another and we respect our patients.”

Dr. Rohit Gosain agreed, noting that ongoing communication plays a critical role in “keeping our patients educated on their treatment options and managing their hopes and expectations.”

Waiting on Daraxonrasib

That component is becoming increasingly significant given the buzz around daraxonrasib, which yielded “groundbreaking improvements in survival for patients with metastatic pancreatic cancer in the second-line setting,” according to the RASolute 302 study presented at the 2026 American Society of Clinical Oncology Annual Meeting. Although the findings are exciting, the drug has not yet been fully FDA approved.

“We’re in this no man’s land right now where we have this wonderful data, but we don’t have access to the drug as freely as we would like,” Dr. Brown said. ”When it does become available, the onus is on providers to have that conversation about daraxonrasib and its side effects and determine whether it’s going to be appropriate for the patient.”

Similarly, Kline—who sees the vast majority of UT Southwestern’s pancreatic cancer patients—believes it’s important to be realistic when discussing daraxonrasib. “In my practice, we’ve had a lot of conversations about the KRAS inhibitor and what could potentially be helpful to them—if not now, then in the future,” she said. “But there’s still a lot that patients need to understand.”