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Hepatitis as a Risk Factor for Pancreatic Cancer

A number of odd or non-intuitive relationships between apparently unrelated variables and pancreatic cancer (ductal adenocarcinoma of the pancreas) are beginning to emerge – including ABO blood status, and now some forms of hepatitis.

In the World Journal of Gastroenterology from July 14, 2013, Chen and colleagues from the Southern Medical University, in Guangzhou, China report a meta-analysis based on a world review of the medical literature of the relationship between infection with the hepatitis B virus (HBV) and the hepatitis C virus (HCV) AND pancreatic cancer. Using their developed criteria, they found eight studies that were eligible for inclusion in their analysis pool.

The researchers found a small but statistically significant association between chronic HBV and HCV infections and the risk of developing adenocarcinoma of the pancreas. The odds ratio for a patient’s status of the presence of inactive hepatitis surface antigen (HBsAg) and for chronic hepatitis B exposure was 1.2 at a 95% confidence interval – with Chinese patients appearing even somewhat higher (1.3). And the odds ratio for past exposure to the hepatitis C virus was somewhat similar at 1.26. The authors indicate that there is no evidence of publication bias in these associations.

It is not entirely clear what these findings mean. But finding association between pancreatic cancer and possible acute (or chronic?) triggers moves the science a bit further along the cutting edge of understanding.

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Dale O’Brien, MD

Cryotherapy plus Biologic Therapy for Advanced Cancer of the Pancreas

It is the impression of this author that in the past decade or so the quantity and quality of published medical research coming from China has increased rather remarkably. This has included challenges to “standard” established practice – with innovative ideas particularly on the treatment of pancreatic cancer (ductal adenocarcinoma of the pancreas). Now comes a study from China involving cryotherapy, a surgical “ablation” (or removal) procedure that attempts to use a freeze technique to destroy pancreatic cancer malignant tissue.

On July 30th, Vu and colleagues from Jinan University in Guangzhou, China published an article in the journal Pancreas that divided 106 patients with metastatic pancreatic cancer into four groups depending of treatment modality: cryotherapy in combination with immunotherapy, cryotherapy alone, immunotherapy alone, and chemotherapy. They reported the median overall survival duration of the groups with some elaboration, finding that the median survival of the cryotherapy and immunotherapy in combination group was much longer than the others (13 months). Their work also found the median OS was increased if multiple cryoablation was used (rather than a single such treatment).

This is very interesting early work on this combination modality for metastatic pancreatic cancer. This approach appears worthy of further work to see if the results stand up to scrutiny.

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Dale O’Brien, MD

Pancreatic Cancer Pre-clinical study (from an Amazonian tree): Geissospermum vellosii

As mentioned in this blog on several times, we are always on the lookout for interesting scientific studies related to the treatment of pancreatic cancer (ductal adenocarcinoma of the pancreas) with alternative or complementary treatment approaches.

The July 2013 issue of the journal Oncology Reports features research by Chen and colleagues from the University of Kansas Medical Center looking at the effect of the naturally occurring extract of the Pao Pereira tree from the Amazon forests on pancreatic cancer cell lines and in mice. This is a follow-up to earlier work out of Columbia University in New York City suggesting that a couple of plant extracts containing beta-carbolines (including Pao Pereira) appeared to inhibit cancer cell lines.

The current study is somewhat elaborate. The Pao showed inhibition of all five of the pancreatic cancer cell lines that were studied. Also, the combination of Pao Pereira plus gemcitabine showed synergy in the inhibition of these cancer cell lines. Finally, Pao and gemcitabine alone and in combination were presented to live mice with pancreatic cancer tumors (PACN-1) which were then serially scanned. The Pao Pereira showed significant action in inhibiting tumor growth. And the combination of Pao Pereira coupled with gemcitabine showed even more apparent activity (inhibition).

This is the kind of serious science that we love to see with alternative therapies. It appears at this early stage that Pao Pereira is worthy of further study – possibly eventually making its way to clinical trials. There are many stages to this of course, but this research is a refreshing clean look at an interesting potentially effective new treatment agent for the treatment of pancreatic cancer.

Time (and future research) will tell …

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Dale O’Brien, MD

Pao-+-Rau-Slide

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