In some ways, both early stage and late stage pancreatic cancer (under current thinking paradigms) may be easier stages in which to offer standard care: early receives surgery (without or without neoadjuvant or adjuvant augmentation), and late stage is typically chemotherapy in one combination or another – at least initially involving either gemcitabine or 5-FU. These approaches are of course always changing as challenges move the cutting edge of science and medicine forward. The recent modest breakthrough on nab-paclitaxel (Abraxane) plus gemcitabine presented by Von Hoff et al. in San Francisco in January 2013 is perhaps a case in point.
But at least for now, it is often the middle presenting disease stages – locally advanced pancreatic cancer – that do not present easier logical choices. So it is with some interest that we find in the August issue of HPB, the official journal of the International Hepato Pancreato Biliary Association, that Pederzoli and colleagues from Casa di Cura Pederzoli, Peschiera del Garda of Italy have published an intriguing study reflecting the results of an aggressive treatment protocol for locally advanced adenocarcinoma of the pancreas.
The researchers did a retrospective study of the outcomes of multimodal treatment (“Triple Treatment”) on locally advanced pancreatic cancer with radiofrequency ablation (“RFA”), radiochemotherapy, together with systemic as well as intra-arterial chemotherapy. They reviewed the results of 168 consecutive patients who had been treated with initial OR subsequent RFA (from 2007 until 2011), discovering that the median survival of these groups was roughly the same at about 25 months. This was in comparison to the group which had received the more specific and aggressive Triple Treatment modality regimen which carried a subsequent overall median survival duration of 34 months.
This research carries the inherent limitations of what appears to be a nested retrospective study, but represents an interesting hypothesis – maybe especially in this time of more aggressive combinations (such as FOLFIRINOX) – and as such is highly deserving of further study.
Dale O’Brien, MD