Lack of Pancreatic Cancer Radiologic Improvement May NOT be an Accurate Measure of Neoadjuvant Success – an important and intriguing finding.
Researchers from the University of Texas / MD Anderson Cancer Center published an interesting recent study in the journal Cancer on the treatment and assessment of so-called neoadjuvant therapy in borderline resectable pancreatic cancer.
“Neoadjuvant” is a word that denotes typically the medical and/or radiological treatment of pancreatic cancer BEFORE surgery. The term “adjuvant” refers typically to the medical and/or radiological treatment of pancreatic cancer AFTER surgery.
As those patients who are eligible and receive the surgery option for pancreatic cancer tend to do better than those who are not so eligible, it has seemed logical to see if there are ways to increase the number of patients who are eligible for surgery.
The physicians at MD Anderson Cancer Center (and other noted institutions) have been at the forefront of giving this neoadjuvant therapy – to see if there will be a radiologic response such that some percentage of those previously not eligible for surgery – would now be. And further, if they now are finally eligible for surgery – do these patients do as well as those who were eligible from the beginning? (It appears, with caveats – that they tend to do as well).
The UNEXPECTED finding reported out in this study is different, however ! The researchers looked at 129 patients who met criteria from 2005 until 2010 at their institution. They found that although 69% of those patients with borderline surgical criteria who had received neoadjuvant therapy underwent surgery, only 1% had had their disease downstaged to resectable by radiological standards.
They then looked at outcomes and found that those who had received the surgery tended to live longer.
The rather astounding conclusion is that borderline resectable patients treated with neoadjuvant therapy without subsequent radiological evidence of downstaging should probably receive surgery anyway, in the absence of metastases.
This important conclusion will need to be substantiated by further studies.
Dale O’Brien, MD
Canzian and estimable European colleagues including Dr. John Neoptolemos of Liverpool University (and again our Professor Markus Buchler of the University of Heidelberg / Pancreatica Science Board) in a February 2013 article in the Cancer Epidemiology, Biomarkers, and Prevention – a publication of the American Association for Cancer Research through their newly formed collaborative called the PANcreatic Disease ReseArch consortium or PANDoRA, looked at seven identified SNPs (DNA single-nucleotide polymorphisms) in primarily Caucasian Europeans with and without advanced pancreatic cancer.
These seven SNPs have been found in past studies to be associated with increased pancreatic cancer risk in two Asian populations. With one exception that may be explained by chance due to relatively small population in the Polish sub-group, this study did not appear to demonstrate an association between these possible SNP markers and an increased risk of pancreatic cancer for those of European ancestry.
This published research serves to demonstrate the complexity and difficulty encountered with developing molecular and genetic screening markers across racial and ethnicity backgrounds.
Dale O’Brien, MD
Spanish research Fulgar and colleagues published a recent article in the journal Anticancer Research detailing the results of their multi-center Phase 2 clinical trial evaluating oral erlotinib (Tarceva – 150 mg per day) coupled with the also orally administered capecitabine (Xeloda). Capecitabine is a pro-drug of 5-FU that becomes 5-fluorouracil in the course of its metabolism.
They treated 32 patients with a 12-month survival rate of twenty-two percent. 34% of those treated developed a notable skin rash (perhaps related to Tarceva).
The authors indicate that the regimen appears to be active and reasonably safe. They suggest that this oral combination could perhaps be considered as a 1st Line treatment for cancer of the pancreas.
This is an early study that requires further inquiry.
Dale O’Brien, MD