Overshadowed perhaps by the positive results of Von Hoff and colleagues’ research on Abraxane plus gemcitabine for advanced pancreatic cancer (ductal adenocarcinoma of the pancreas), an interesting study on the treatment of LOCALLY ADVANCED pancreatic cancer was presented at the recent ASCO Gastrointestinal Cancers Symposium in San Francisco late January.
In locally advanced cancer of the pancreas the treatment is generally chemoradiotherapy, meaning radiation therapy plus chemotherapy – the chemo often being the drug-agent gemcitabine.
Mukherjee of Oxford University and British colleagues presented a meeting abstract of the results of their work on a Phase II clinical trial that showed a modest survival advantage by using capecitabine (Xeloda) as compared to gemcitabine as the chemotherapy component of chemoradiation for locally advanced pancreatic cancer. The results were later published in the April, 2013 issue of The Lancet, Oncology journal.
Capecitabine is a pro-drug that is converted into 5-FU by the body. It has the advantage of being given orally. The study results by Mukherjee indicated that the regimen that included capecitabine offered less side-effects as compared to that of the gemcitabine regimen.
It will be interesting to see this work followed-up in other peer-reviewed medical journals – to see if the results will be replicated over time.
Dale O’Brien, MD
BRCA1 and BRCA2 genes are important in the repair and upkeep of DNA. Mutations in these genes confer a strong tendency to not only more widely known breast cancer, but to other kinds of cancers as well – including contributing to some amount of pancreatic cancer (ductal adenocarcinoma of the pancreas).
Now, researchers from the Women’s College Research Institute, Familial Breast Cancer Research in Toronto, Canada have published a study in the British Journal of Cancer which has attempted to quantify this increased risk in pancreatic cancer.
Huzarski and colleagues followed women with either an identified BRCA1 or a BRCA2 mutation, and reviewed pedigrees. They found that the risk of either mutation increased the risk of acquiring pancreatic cancer to about double of that of the risk of the general population.
Dale O’Brien, MD
Pancreatic neuroendocrine tumors can roughly be divided into functioning and non-functioning categories. The functioning tumors produce an abundance of a given hormone such that the clinical effects of this overabundance can be observed or felt by physicians and/or patients. Non-functioning pancreatic neuroendocrine tumors produce no hormone, or produce such hormones in sub-clinical quantity, or produce hormones which are not presently known and in which there is no apparent clinical effect.
Surgical researchers from the Mayo Clinic in the journal Surgery have published their results of a decade long study based on comparing non-surgical “watchful waiting” of almost eighty patients with small non-functioning pancreatic neuroendocrine tumors with the outcomes of 56 patients who were treated with surgery. Subjects were included in the study if their tumor was less than four centimeters in diameter without any apparent metastases or other evidence of spread.
They found that the watchful observation approach was worth advocating when interval radiographic studies show no or small growth or change of a solitary pancreatic neuroendocrine tumor, which they observed was quite frequent.
Dale O’Brien, MD