The drug agent gemcitabine has been the mainstay of the medical treatment of pancreatic cancer (ductal adenocarcinoma of the pancreas). This assertion has perhaps been challenged by extensive 5-FU combinations in the past couple of years, but is still mostly held to be true by clinicians.
The wide adoption of the use of gemcitabine since 1997 has also engendered a question, why does it ultimately fail? The thought is that resistance to gemcitabine occurs – which then allows the tumor to overpower the effects of the drug.
Now comes a Phase I study by Kurzrock and colleagues at MD Anderson Cancer Center / University of Texas (Houston) that pairs (together with gemcitabine) the leukemia drug dasatinib, which has shown in pre-clinical studies to help overcome resistance to gemcitabine.
Two of eight of the patients with pancreatic cancer either showed stable disease for more than six months or showed a partial response during the treatment.
It is an early study, but perhaps a useful approach to begin to discover methods to extend the benefit of one of the key drugs used in the treatment of pancreatic cancer.
Chinese researchers have utilized an innovative modality for the treatment of advanced pancreatic cancer (ductal adenocarcinoma of the pancreas): High-Intensity Focused Ultrasound (“HIFU”). This mode of therapy involves a manner of directing acoustic energy in a very directed fashion at the tumor itself. HIFU is considered to be essentially a noninvasive procedure (or at least only minimally invasive).
In the December 2012 issue of the journal Hepatobiliary & Pancreatic Diseases International, Ye and colleagues have recently reported out a study of twenty-five patients with metastatic pancreatic cancer (adenocarcinoma) that were treated with one or more sessions of HIFU. They found that increased activity performance levels, and decreased pain levels – in 23 of the patients. Also, overall CA19-9 marker levels were dramatically improved at one month post-procedure; and in five the CA19-9 levels became essentially undetectable.
Further and importantly, the median survival duration of the patients was ten months, with a rate of survival of 42% at one year (post-diagnosis). These results are somewhat remarkable for advanced pancreatic cancer and suggest the need for further confirmation and evaluation of this interesting technology.
Dale O’Brien, MD