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Does Aspirin Prevent Pancreatic Cancer? High dose vs. Low Dose Intake

The possible cancer protective effects (including on pancreatic cancer) of aspirin and related drugs have been actively studied for the past twenty-five years or so. The initial work was noted and especially explored in colon cancer.  There is conflicting research but the chemopreventive outcome of long-term aspirin use on cancer seems reasonably likely in colorectal cancer with probable but a lesser likelihood in other parts of the human GI tract.  Research on long-term aspirin usage and pancreatic cancer (ductal adenocarcinoma of the pancreas) has yielded conflicting results.

The active ingredient in the bark of the willow tree (salicylic acid) was discovered in 1763 by Edward Stone of Oxford University UK. More than one hundred years later, this ingredient was first synthesized by the Bayer company in Germany, the “biotech” high flyer of its day.  In modern times, aspirin is categorized in a class called nonsteroidal anti-inflammatory drugs (NSAIDs) that are each separated by slightly different mechanisms of action.  The mechanisms of action of aspirin are myriad, but distinctively include being an irreversible cyclooxygenase (“COX”) enzyme inhibitor – both of the COX-1 and COX 2 pathways.

Qin and colleagues from Zhengzhou and Xinxiang, China conducted a meta-analysis of the chemopreventive possibility of aspirin intake in the medical literature and published the results in the January 2014 issue of the journal Pancreas. The authors identified ten studies that met their criteria for analysis which totaled 7,252 patients carrying a diagnosis of pancreatic cancer.  They found that the odds ratio of taking a high dosage of aspirin was modestly protective against pancreatic cancer at 0.88. For Americans alone the odds ratio was 0.82. Low dosage intake of aspirin showed no apparent preventive advantage.

The distinction between high dose and low dose of aspirin intake may help explain the previous uneven research results in pancreatic cancer.  An interesting result, we will have to watch for follow-up studies to better substantiate these findings.

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Dale O’Brien, MD

Mistletoe for Pancreatic Cancer

Viscum Album is a kind of mistletoe that is native to many European and Asian countries. Members of the mistletoe family have been used as an “alternative” or complementary treatment for any number of maladies including pancreatic cancer (ductal adenocarcinoma of the pancreas). As we have mentioned before, the Pancreatica Blog appreciates alternative therapies for cancer of the pancreas that have been subjected to the scientific method. We like these studies as so many patients who we encounter seem to be interested in alternative or complementary therapy for their pancreatic cancer. It seems like a service to offer up information on ones in which serious study has been undertaken.

Mistletoe has been studied more scientifically for the past two decades for pancreatic cancer.  One of our Pancreatica Science Board members participated in a research study almost twenty years ago that found no substantive survival advantage of mistletoe in pancreatic cancer (yet interestingly, it appeared to demonstrate improved quality of life).  It seems as if it is mostly German researchers who have been exploring this area.

Troger and colleagues from Germany and Serbia published the results of their Phase III study involving 220 patients in the December 2013 issue of the European Journal of Cancer whereby the authors reviewed the effects of a dose escalating subcutaneously given regimen of Viscum album offered to patients with advanced and locally advanced adenocarcinoma of the pancreas VERSUS no antineoplastic therapy given for an evenly randomized control group.

The median overall survival in the mistletoe treated group was 4.8 months, and 2.7 months for the control group (p<0.0001).  There were no adverse side-effects due to the Viscum album noted.

This is intriguing of course. There are potential problems with the study including the Stages mix and selection bias. One cringes a bit that the control group did not receive standard of care chemotherapy. The survival advantage seems fairly small.  But it is a finding – and likely worthy of further inquiry.

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Dale O’Brien, MD

Adding Grade Status to Staging Improves Prognostic Capability in Pancreatic Cancer

The pancreatic cancer surgical (and oncology) team at UCLA developed a new experimental staging method such that the tumor’s grade was added to the standard (TNM) AJCC staging criteria, whereby a high-grade tumor increased the pancreatic cancer stage (ductal adenocarcinoma of the pancreas) to the next higher level than would have been otherwise indicated.

Published in the December issue of the Annals of Surgical Oncology, the study at hand is essentially an attempt at a proof of this concept related to these novel pancreatic cancer stages.  In passing, one might remark that these UCLA researchers must be utilizing Big Data, as many of the team are the same as on another recent intriguing large concept study that the Pancreatica Blog commented on involving prolonged neoadjuvant therapy for pancreatic cancer.

The authors reviewed the records and pathology results of patients who underwent pancreatic cancer resection at UCLA from 1990 until 2006, identifying 256 individuals. These patients’ disease were then re-staged using the new staging schema, and the disease outcomes were examined.

The authors found that low-grade tumors gave about a 13 month median survival advantage as compared to high-grade tumors.  They found that adding grade to the traditional TMN criteria in the staging of pancreatic cancer gave a more precise and discriminatory survival element to the staging system.

The researchers suggest that the addition of tumor grade to the staging of pancreatic cancer be considered.

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Dale O’Brien, MD

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