The search for a screening or diagnostic marker in pancreatic cancer is paramount. If the disease could be found earlier, it is likely that serious inroads could be made into improved survival advantage for patients.
Wang and associates at Fudan University in Shanghai, China published an intriguing article in April’s edition of the Journal of Cancer Prevention Research which investigated microRNA patterns in the peripheral mononuclear blood cells of healthy patients, those with benign pancreatic disease, and those with pancreatic cancer. They found that miR-27a-3p levels in these cells could differentiate patients with benign pancreatic disease from those with pancreatic cancer.
When the researchers added CA19-9 levels to those of miR-27a-3p, they found that the accuracy of this putative diagnostic test increased to a very satisfactory sensitivity of 85.3% with a specificity of 81.6%.
A very interesting aspect of the study is that this was found in peripheral blood cells – thus giving easy access through a simple blood draw to diagnostic results.
These are early days for the role of MicroRNA in the diagnosis of pancreatic cancer, but the results of this intriguing study should serve to increase additional research and confirmatory study.
Dale O’Brien, MD
Two studies have been published on April 1, 2013 about the efficacy of the combination drug regimen of nab-Paclitaxel (Abraxane) plus gemcitabine. These follow closely the earlier results of the international study of 861 patients with advanced pancreatic cancer who appeared to have gained survival advantage as presented by Dr. Daniel Von Hoff and colleagues at the ASCO GI symposium in San Francisco on January 24-26, 2013 (reported here on the Pancreatica blog on November 30, 2012 – see archives).
The first of these new studies was a phase 2 clinical trial of 19 patients with metastatic pancreatic cancer published in the American Journal of Clinical Oncology by Lima and colleagues from the University of Miami and Johns Hopkins (Singapore International Medical Center) which showed that this combination was tolerated well, and that it appeared to have clinical activity.
The second study in Cancer Chemotherapy and Pharmacy by Xu and colleagues which looked at the effect of the Abraxane and gemcitabine combination in Chinese patients with metastatic pancreatic cancer. Again, these researchers found significant results as far as activity against pancreatic cancer tumors; and with a generally tolerable side-effect profile.
The results of these studies are beginning to offer encouragement.
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. 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