Interesting research over recent years into risk factors for ductal adenocarcinoma of the pancreas have yielded the usual suspects – and a number of somewhat surprising candidates for pancreatic cancer. These include the smoking of tobacco products, onset of diabetes, large intake of alcohol, pancreatitis, (possibly) obesity, ABO blood typing status, and even infections such as those that cause hepatitis and dental disease.
Also, increasingly there is work showing relationships between infectious agents and several other gastrointestinal cancers – agents including the hepatitis B and C viruses, human papilloma virus (HPV), Epstein-Barr virus, and Helicobacter pylori (a primary cause of peptic ulcers).
In a study released July 10, 2013 in the journal Carcinogenesis, Michaud of Brown University has published an intriguing article discussing infectious agents in the role of the origins of pancreatic cancer that particularly fingers the above noted Helicobacter pylori and Porphyrmomonas gingivalis – the bacterial agent particularly associated with periodontal disease.
Michaud further discusses the possible complex interplay of risk factors, the human immune system, and the possible effect of an “outside” infective agent in the triggering of the onset of pancreatic cancer.
This work presents an altogether exciting and creative thesis. Again, early days – but hopefully this thoughtful synthesis will serve as an impetus to better tease out the role that infectious agents may play in the onset of pancreatic cancer.
Dale O’Brien, MD
There are few hard and fast rules for the medical treatment of patients with metastatic pancreatic neuroendocrine tumors. Two agents which have shown promise include everolimus (Afinitor ~ Novartis) and temozolomide (Temodar ~ Merck).
An article by Kulke and colleagues at Harvard Medical School and the associated Dana-Farber Cancer Institute in Boston as published in the September 2013 issue of the journal Cancer offers the results of a phase I/II clinical trial for a regimen consisting of a combination of the drug agents everolimus and temozolomide for the treatment of advanced neuroendocrine tumors.
In this study, 43 patients with diagnosed metastatic neuroendocrine tumors were given this regimen in two cohorts, and with an escalation of temozolomide dosage after safeties were observed. The progression-free survival median for patients was found to be 15.4 months. The overall median survival point was not reached. The temozolomide treatment was limited to a total duration of six months.
The authors suggest that the toxicity profile appeared to be reasonable. And thus, with apparent activity and tolerable side-effects, the everolimus and temozolomide combination may be appropriate for the treatment of advanced neuroendocrine tumors, and certainly merits further investigation including trying to discover whether the regimen improves survival over the use of each agent alone.
Dale O’Brien, MD
One of the great pleasures of doing worldwide reviews of the medical literature on pancreatic cancer is encountering the obscure, deep background, early and even unusual research on the topic. I think that the following study must fit into one or more of these categories !
Nishino and colleagues of the College of Pharmacy and Pharmaceutical Sciences at Howard University in Washington, DC published recent research in The Journal of Complementary and Integrative Medicine that looked at the administration and effects of the extract of red beets (Beta vulgaris L. – one of the main kinds that we prepare and eat) coupled with the chemotherapy drug doxorubicin on various human cancer cell lines including that of pancreatic cancer (ductal adenocarcinoma of the pancreas).
They found that this combination (beet plus doxorubicin) provided synergy in efficacy against the pancreatic cancer cells.
This is interesting early work that is perhaps deserving of further exploration.
Dale O’Brien, MD