Intraductal papillary mucinous neoplasms (IPMNs) are not fully understood, but are felt by many to be precursor tumors to full blown pancreatic cancer (adenocarcinoma).
Thus, an interesting study was recently published by Italian researchers including Giovannetti and colleagues from the University of Pisa in the Annals of Oncology (the official journal of the European Society for Medical Oncology – ESMO) which examined the possible role of microRNAs as biomarkers for IPMNs.
The researchers examined and compared miR-21, miR-101, and miR-155 levels in 86 biopsy specimens of IPMNs. They additionally looked at relationships between these levels and overall survival and disease-free survival of the patients with these IPMNs.
The one microRNA that appeared to offer prognostic value as a biomarker in terms of IPMN risk was miR-21. The authors suggest that these results (especially involving miR-21) be further examined in future studies.
Further research into the role of miRNAs, these small 22-nucleotide non-coding RNA molecules, as possible biomarkers for pancreatic cancer should be of great interest.
Dale O’Brien, MD
Now comes a fascinating study by researchers from UC San Francisco and UC San Diego that tends to refute the common knowledge that pancreatic adenocarcinoma cells arise from genetic mutations in the PANCREATIC DUCT LINING CELLS.
Published in the November 29th 2012 issue of the journal Cancer Cell, Dr. Maike Sander and colleagues have shown that NON-ductal “acinar” cells in the non-hormone aspect of the pancreas can be transformed into what appear to be precursor cells to “ductal adenocarcinoma” (now a misnomer?) under the influence of mutations of the ductal gene Sox9, as accelerated by an additional mutation in the Kras oncogene.
Additionally, the researchers appear to demonstrate that ductal cells themselves tend to be somewhat resistant to the influence of oncogene mutation. These results may give direction to future research for both the treatment and earlier diagnosis of pancreatic cancer.
Dale O’Brien, MD
We discussed two recent studies on the apparent benefits of possible re-treatment of recurrent pancreatic cancer in our Pancreatica Blog entry of November 17, 2012. Now there are two more interesting medical articles on this subject that have been recently published.
Werner and colleagues from the University of Heidelberg (including Markus Buchler who is on our Science Board) in a March 1, 2013 study published in the Annals of Surgical Oncology offer that approximately 30% of pancreatic cancer recurrences are isolated and not associated with metastases. They identified almost 100 patients from 2001 until 2009 at their institution that presented with recurrence. Of the 57 with isolated local recurrence of cancer of the pancreas, 41 patients were eligible (by their criteria) for re-treatment surgery. They found that those patients who were eligible for and received such re-treatment lived significantly longer than those who were not able to receive this additional therapy.
Also, Combs and colleagues again from the University of Heidelberg (including Drs. Buchler, Werner, and two others from the above noted study) in a January 1, 2013 study published in the journal Radiation Oncology reported findings that indicated good treatment response with acceptable toxicity levels to chemoradiation (CRT) in select patients with recurrent pancreatic cancer. Additionally, in some of these patients with recurrent pancreatic cancer, the CRT allowed for additional surgical resection. These are early results and will need further substantiation by future research.
Dale O’Brien, MD