The issue of offering combination treatment with radiation and chemotherapy AFTER pancreatic cancer surgery (for ductal adenocarcinoma of the pancreas) to improve survival has been in place based on the classic August, 1985 study by the (U.S.) Gastrointestinal Tumor Study Group under Kalser and Ellenberg published in the Archives of Surgery. These findings appear to have been essentially confirmed by European researchers, but the additional use of the radiation in the regimen has been strongly challenged by the work of the European Study Group for Pancreatic Cancer since the early 1990s.
This debate has raged on – with research appearing to support each side at different times.
A recent article by Landry and colleagues at Emory University in Atlanta may help shed some light on the subject. In the June 15th 2013 issue of the journal Cancer, the authors report reviewing National Cancer Data Bank information from 1998 until 2002 – specifically looking for the outcomes of the treatment of pancreatic cancer in those treated with surgery and subsequent adjuvant radiochemotherapy – as broken out by the dosage used in the radiation portion of the regimen.
The researchers looked at four radiation dosage categories – and found that those who received more than OR less than the perceived “optimal” dosage of radiation for post-surgical chemoradiation for pancreatic cancer, did not fare as well as those who received the optimal dose (between 50 to 55 Gy).
This is an intriguing finding – which could help explain apparent disparate results among serious scientists. The results are preliminary, and deserve further inquiry to help determine the extent and modalities of adjuvant treatment that is generally necessary to produce the best outcomes after the surgery for pancreatic cancer.
Dale O’Brien, MD
A long friend to the mission of our foundation, Al Laporta, DDS of New Your (who lost his beloved mother to pancreatic cancer) reminds us of intriguing work by physician and dentist researchers at UCLA demonstrating proof of concept work published in 2010 in the journal Gastroenterology which identified 12 salivary messenger RNA biomarkers that gave a high specificity (95%) and sensitivity (90%) for the diagnosis of pancreatic cancer (ductal adenocarcinoma of the pancreas).
A diagnostic test based on this work would be noninvasive.
Dale O’Brien, MD
Especially researchers in Japan have been studying the outcomes of the orally administered drug known as S-1 in the treatment of pancreatic cancer (ductal adenocarcinoma of the pancreas). S-1 is a fluorouracil drug agent (similar to 5FU – fluorouracil), which like 5-FU, functions as an inhibitor of thymidylate synthase. S-1 is comprised of three components: tegafur (a prodrug of 5-fluorouracil), 5-chloro-2,4-dihydroxypyridine, and potassium oxonate.
In the May 1st issue of the Journal of Clinical Oncology, the official publication of the American Society of Clinical Oncology, Tanaka and his Japanese colleagues from the National Cancer Center Hospital in Tokyo, reported out the results of a Phase 3 study that compared the combination of gemcitabine and S-1 against the use of S-1 alone, and use of gemcitabine alone in patients with either locally advanced or advanced pancreatic cancer.
They recruited 834 patients with to the study, and found a median survival duration of 8.8 months in the patients receiving gemcitabine, 9.7 months in those receiving S-1, and 10.1 months in those receiving the combination regimen. There was found to be no significant statistical significance between the use of gemcitabine versus S-1 as monotherapy. And the combination gemcitabine plus S-1 arm of the study demonstrated more severe toxicity in patients, primarily hematologic and gastrointestinal side effects.
The researchers conclude that therapy with either gemcitabine or S-1 is comparable in locally advanced and advanced pancreatic cancer. This is an intriguing finding that certainly deserves further study.
Dale O’Brien, MD