It seems pretty rare that we get humor associated with pancreatic cancer (ductal adenocarcinoma of the pancreas). Now comes a goofy and fun awareness video piece on Youtube from a sister pancreatic cancer nonprofit organization in the UK (Pancreatic Cancer UK).
Will it go viral? Will it ignite the next new dance fad? We can only hope. Our hat’s off to these fellow workers in the pancreatic cancer vineyard – kudos to them. There’s even a Twitter account devoted to this awareness video.
Dale O’Brien, MD
As mentioned, stromal tissue can account for as much as 90% of the bulk in pancreatic cancer tumors (ductal adenocarcinoma of the pancreas). Thought in the past to have been relatively inert, it is increasingly clear that this dense tissue arising from a desmoplastic process is surprisingly dynamic. Thus, it is heartening to encounter a number of recent serious research efforts aimed in a practical way to begin to try to counteract the effects of the pancreatic cancer stromal tissue in ameliorating the effects of standard treatment modalities. We have commented on two of these previous studies HERE and HERE.
Grose and colleagues from the Centre for Tumour Biology Barts Cancer Institute at Queen Mary University of London E-published the results of their pre-clinical work on February 6, 2014 in the open journal EMBO – Molecular Medicine. They studied the fibroblast system that is active in the desmoplasic process resulting in the creation of pancreatic cancer tumor stromal tissue, with particular attention to the fibroblast growth factor (FGF) signalling cascade which appears to be active in pancreatic cancer cell survival and invasion.
FGFs and their receptors are frequently overexpressed in pancreatic cancer, as well as in a number of other tumor types. The researchers particularly looked at FGF1 and FGF2 and their receptors. The respective receptors are notated as FGFR1 and FGFR2. FGF2 over-expresion appears to be correlated with poor patient outcome in pancreatic cancer.
The authors demonstrate that blocking nuclear aspects of FGFR1 and FGFR2 appears to interrupt fibroblast proliferation, thus disrupting the pancreatic cancer “microenvironment.” The practical effect of this mechanism is that pancreatic cancer cell invasion is thwarted. The authors postulate that inhibiting the fibrogen growth factor cascade by therapeutic agents may target the pancreatic cancer stroma in a manner that interferes with the natural history of pancreatic cancer and thus could enhance patient outcomes.
This is another interesting and promising piece of the puzzle.
Dale O’Brien, MD
The standard chemotherapy agent for adjuvant treatment of pancreatic cancer (ductal adenocarcinoma of the pancreas) has typically been Fluorouracil (5-FU) based. But there have been other adjuvant agents and modalities for pancreatic cancer under study including gemcitabine, combined chemotherapy (multiple drug agents), and chemoradiation.
On behalf of the German Study Group for Pancreatic Cancer (a branch of the German Cancer Society), Riess and colleagues from a widely based consortium of community oncologists and oncology centers in Germany and Austria studied pancreatic cancer patients enrolled from 1998 until 2004 in 88 hospitals. The result of this work was published in the October 9, 2013 issue of the Journal of the American Medical Association.
The authors followed 368 patients who received substantive surgery for pancreatic cancer according to the extent of the disease and the dictates of the local hospitals’ protocols. These patients were randomized 1:1 to the no adjuvant therapy arm of the trial OR to the adjuvant therapy with gemcitabine arm of the trial (six months of chemotherapy with a weekly dosage at 700 mg/m2). There were 186 patients in the gemcitabine arm; 111 of the patients were able to receive all six cycles; 90% of patients in this arm received at least one single dose; 87% received at least one full gemcitabine cycle.
The pancreatic cancer patients in both arms of this Phase III trial were followed until September 2012. The data collection and coordination was undertaken by the Charité–Universitätsmedizin Berlin. The researchers found that the median overall survival of the patients in the gemcitabine arm was 22.8 months, compared with 20.2 months in the observation alone arm. This was found to be significant on a statistical basis.
Additionally, the five-year survival in the gemcitabine arm was 20.7%, compared with 10.4% in the observation alone arm. And the ten-year survival in the gemcitabine arm was 12.2%, compared with 7.7% in the observation alone arm.
The researchers suggest that gemcitabine has acceptable toxicity levels and confers survival advantage as adjuvant chemotherapy post-pancreatic cancer surgery.
Dale O’Brien, MD