Pancreatic Cancer

Pancreatic Cancer

Pancreatic cancer has proven to be one of the most challenging cancers to detect and treat. Without effective screening tests, patients are usually diagnosed at an advanced stage when therapies have limited effect. The biological complexity of pancreatic tumors is an added challenge, enabling these tumors to adapt and grow despite intense therapy.

Still, even with this hard-to-treat cancer, important gains have occurred in the last 40 years, thanks in large part to the thousands of patients who have participated in clinical trials. The trials have shown that some drug therapies can control the cancer and improve survival, even for patients with advanced stages of disease.

Today, researchers are using knowledge from the recent mapping of the pancreatic cancer genome to develop therapies that target not one but many genetic abnormalities in pancreatic cancer cells. 
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2018

Modified Adjuvant FOLFIRINOX Produces Better Survival for Resected Pancreatic Ductal Adenocarcinomas

Modified Adjuvant FOLFIRINOX Produces Better Survival for Resected Pancreatic Ductal Adenocarcinomas

The chemotherapy regimen of folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) has been shown to be more effective than gemcitabine for the treatment of pancreatic cancer. A modified — and less toxic — adjuvant FOLFIRINOX regimen is more effective than standard- gemcitabine in patients with resected pancreatic cancer. Treatment with modified FOLFIRINOX results in longer disease-free and overall survival compared with gemcitabine. While grade 3 and 4 adverse events are more common with modified FOLFIRINOX, they are considered manageable. Based on these results, the study changes treatment for patients with resected pancreatic cancer.

More Information: 

N Engl J Med 2018;379:2395-2406

2017

New chemotherapy regimen improves pancreatic cancer survival

New chemotherapy regimen improves pancreatic cancer survival

A new standard of care for pancreatic cancer treatment is set after data from a clinical trial show that adding a second chemotherapy drug, capecitabine (Xeloda), to gemcitabine (Gemzar) modestly improves survival after surgery. For the first time in 20 years, patients with pancreatic cancer – which is difficult to diagnose and often not found until it’s too late to be removed through surgery – have a new option for treatment after surgery.

More Information: 

Lancet 2017; 389(10073): 1011–1024

2013

New First-Line Therapy Extends Survival for Advanced Pancreatic Cancer

New First-Line Therapy Extends Survival for Advanced Pancreatic Cancer

A large phase III trial shows that treatment with the combination of two chemotherapy drugs—nab-paclitaxel (Abraxane) and gemcitabine (Gemzar)—is more effective than standard single-drug therapy for people with metastatic pancreatic cancer.  The new combination is proven to both improve survival and delay cancer progression in this hard-to treat cancer. 
 
 

More Information: 

New England Journal of Medicine

2010

New combination chemotherapy regimen extends advanced pancreatic cancer survival

New combination chemotherapy regimen extends advanced pancreatic cancer survival

Major trial shows that initial treatment with FOLFIRINOX chemotherapy extends survival by nearly five months in patients with advanced pancreatic cancer, compared with standard gemcitabine (Gemzar) treatment. FOLFIRINOX combines the drugs 5-fluorouracil, leucovorin, irinotecan (Camptosar) and oxaliplatin (Eloxatin). This is the largest observed survival advantage in a major clinical trial among patients with advanced pancreatic cancer.

More Information: 

Cancer.Net; Pancreatic Cancer: Treatment Options
N Engl J Med 2011; 364: 1817-25

2008

Adjuvant gemcitabine further extends survival for patients with early pancreatic cancer

Adjuvant gemcitabine further extends survival for patients with early pancreatic cancer

Badge indicating that research was paid for using federal funds

Two important studies demonstrate that adjuvant (post-surgery) treatment with gemcitabine (Gemzar) is beneficial. In one study, 6 months of gemcitabine doubled the average time it took for the disease to come back and extended patients' lives by nearly 3 months. In the other study, the addition of gemcitabine to adjuvant 5-fluorouracil-based chemotherapy and radiation was also associated with a survival benefit.

More Information: 

Cancer.Net; Pancreatic Cancer: Treatment Options
JAMA 2007; 297(3): 267-77
JAMA 2008; 299(9): 1019-26
Major study maps the pancreatic cancer genome

Major study maps the pancreatic cancer genome

Investigators issue results from a large-scale analysis of the pancreatic cancer genome, reporting the identification of 63 genetic abnormalities along 12 key "pathways" that are present in the vast majority of pancreatic tumors. The findings shed new light on the genetic complexity of pancreatic cancers, but also present many potential targets for new cancer treatments.

More Information: 

Science 2008; 321(5897): 1801-06

2005

First targeted drug approved for pancreatic cancer

First targeted drug approved for pancreatic cancer

A major clinical trial finds that adding the targeted drug erlotinib (Tarceva) to standard gemcitabine (Gemzar) chemotherapy extends the lives of patients with inoperable pancreatic cancer, compared to gemcitabine alone. This is the first trial to identify a survival benefit with a new drug for patients with advanced pancreatic cancer since gemcitabine was introduced nearly a decade earlier. The FDA approves erlotinib for pancreatic cancer later the same year. The new drug targets a protein called the epidermal growth factor receptor (EGFR), which fuels the growth of some types of cancer cells.

More Information: 

Journal of Clinical Oncology 2007; 25(15): 1960-66

2004

Adjuvant chemotherapy shown to benefit patients with early pancreatic cancer

Adjuvant chemotherapy shown to benefit patients with early pancreatic cancer

The European Study Group for Pancreatic Cancer (ESPAC) finds that adjuvant use (after surgery) of the chemotherapy drug 5-fluorouracil more than doubles 5-year survival for patients with early-stage disease, compared to surgery alone. The findings resolve a long-running debate about the value of adjuvant chemotherapy. The study also calls into question the need for adjuvant radiation following surgery, since chemotherapy alone was effective. Researchers continue to address this question.

More Information: 

Cancer.Net; Pancreatic Cancer: Treatment Options
N Engl J Med 2004; 350: 1200-10
Screening program for people at high-risk can detect potentially operable pancreatic tumors

Screening program for people at high-risk can detect potentially operable pancreatic tumors

Badge indicating that research was paid for using federal funds

Researchers begin using a combination of screening technologies – CT scan and endoscopic imaging – to screen for pancreatic tumors in patients with a strong family history or genetic predisposition to pancreatic cancer. The goal is to identify cancers at early stages so they can be removed surgically and are potentially curable. Because this screening program is expensive, involves invasive procedures, and has not yet been shown to be cost-effective, it is not appropriate for the general population.

More Information: 

Cancer.Net; Pancreatic Cancer: Diagnosis
Clinical Gastroenterology and Hepatology 2004; 2(7): 606-21
Clinical Gastroenterology and Hepatology 2006; 4(6): 766-81

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