There has not been very much study on when “adjuvant” chemotherapy should begin after pancreatic cancer surgery (this process of chemo AFTER surgery is called adjuvant therapy). What is known is that adjuvant chemotherapy tends to confer a significant survival boost to pancreatic cancer patients. And perhaps it is fair to say that it has generally been assumed as to the timing of the start of this chemotherapy – that it should begin after the immediate effects of surgery have been weathered by the patient – and when that the patient is well enough to begin to accept the side-effects of the chemo. But, does this timing have more significance than is generally believed?
Sueda and associates from Hiroshima University in Japan recently reviewed the records of 104 patients who received chemotherapy after potentially curable surgery in pancreatic cancer – dividing the patients into two groups: those who began the chemo more than or less than 20 days after the day of the pancreatic cancer surgery. They found that those who had received the chemotherapy earlier in the process had significantly better 5-year survival rates (52% vs. 26%). One factor of note is that the early chemo group tended to have had fewer after-surgery complications. So, might these surgical complications be a tell – that the later group was not as predisposed to survival? In any case, this surprising finding is worth considering – and deserves more study.
Dale O’Brien, MD
Those of a certain age will remember the terrible congenital malformations fifty years on due to the prenatal use of thalidomide. Gradually in certain circumstances thalidomide use has made a cautious comeback in medicine – now including for pancreatic cancer.
Chinese researchers from Shang Dong Tumor Hospital in Jinan, China have published an interesting Phase II clinical study in the November issue of Pancreatology that looked at capecitabine (Xeloda) in combination with thalidomide as a possible second-line treatment for advanced pancreatic cancer in those who were refractory to gemcitabine treatment. Their conclusion was that this combination was reasonably well tolerated, and showed reasonable response in certain pancreatic cancer patients with advanced disease. Of 31 patients, two demonstrated a partial response and eleven patients showed stable disease.
Sometimes you can use an old dog for new tricks.
Dale O’Brien, MD
Cancer is a disease that begins as a result of one or more mutations in the DNA of our cells. In the past, pancreatic cancer researchers typically concentrated on a limited number of mutations on perhaps four to eight known gene culprits. Now, a comprehensive listing of genetic mutations in cancer of the pancreas has been published in the journal Nature on November 15, 2012 by a large consortium of Australian, North American and European researchers (including two of our Pancreatica Science Board members, Drs. Hruban and Tempero).
This study is a milestone in pancreatic cancer research that looked at tumors in 142 pancreatic cancer patients. Intensive analysis of 99 tumors found 16 significantly mutated genes with 2,016 identified mutations and many other genetic variations. This included alterations not previously understood to be involved in pancreatic cancer. This new information and understanding gained directly from human subjects (for the first time) looks to open a doorway to an expanded era in treatment targets in the fight against pancreatic cancer.
Dale O’Brien, MD