Research Update Corner
By Mila McCurrach
A back-up plan for pancreatic cancer?
Early detection has become a mantra fro the pancreatic cancer community. A significant amount of research is currently focused on finding the ways to warn patients that a cancer has begun to grow, and for good reason. Survival rates increase dramatically if pancreatic cancer is surgically removed before it metastasizes (spreads). Most patients are diagnosed once the cancer has spread and chemotherapy is only mildly effective.
Why is pancreatic cancer so hard to treat?
There are several theories about why pancreatic cancer is so hard to treat. It has been argued that the combination of genes altered in this cancer male it grow and spread faster. it may develop a protective envelope around itself that makes it harder for drugs to reach it. Or, it may be that the environment where the cancer is born (remember that the pancreas is responsible for making digestive enzymes to help digest (break down) the food we eat) is so toxic that the disease is immune to the cancer drugs we throw at it. Whatever the ultimate reason or reasons, it has been very difficult to find therapies to kill pancreatic cancers.
Recently, however, there has been some progress as several new clinical trials have shown significant achievements in the treatment of pancreatic cancer; nearly doubling patients' survival rates. In May of 2011 the New England Journal of Medicine reported the results of a bold European clinical trial. In a Phase III trial, which included 342 metastatic pancreatic cancer patients in Europe, patients were treated with a combination of four chemotherapeutic agents: fluorouracil, leucovorin, irinotecan, and oxaliplatin (know as FOLFIRINOX). The result was an increase in the average survival rate to almost one year (11.1 months average).
In addition, almost one third of patients given FOLFIRINOX had some tumor shrinkage, compared to only nine percent of patients on gemcitabine
" these new developments open the
door to treatment plans that will
likely improve patients' outcomes"
This new FOLFIRINOX regimen is showing success because it is quite aggressive and attacks pancreatic cancer cells in different ways. The downside is that it is not tolerated by all patients and the side effects can be severe. Although there is still an a lot of research to be done, especially focusing on those patients who cannot tolerate FOLFIRINOX, this breakthrough in treatment will undeniably change the care given to many pancreatic cancer patients and, in fact, has already been adopted by numerous oncologists as part of their daily treatment plan.
More Promising News
More promising news was announced in early 2013 from another Phase III clinical trial that tested the use of a drug combination, gemcitabine and nab-paclitaxel (ABRAXANE) in metastatic pancreas cancer patients. ABRAXANE is relatively new compound that is already approved for treating both metastatic breast and non-small cell lung cancers. When given to pancreatic cancer patients, this new therapy doubled the rate of survival at two years and showed an increase in overall survival by nearly two months. While on the surface the overall survival rate of Abraxane plus gemcitabine does not seem as significant as that of the FOLFIRINOX regimen, this therapy gave very few side effects. This is critical for two reasons. First, this new combination can be given to many more patients without the risk of life threatening toxicities giving another option to patients who cannot tolerate very aggressive therapy. In addition, this combination can be used in with other types of therapies to improve patients' responses even further.
While clearly more clinical research must be carried out to further improve therapies for pancreatic cancer, these developments open a door to treatment plans that will likely improve patients' outcome. Catching and removing pancreatic cancer before it has a chance to spread is still the ultimate goal but clinical research is starting to develop a back-up plan.