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Pancreatic Cancer Medical Treatment

There are no universally agreed upon firm guidelines for medical treatment for those patients with pancreatic cancer (adenocarcinoma of the pancreas) who are not candidates for surgery or who have a recurrence of the cancer after surgical resection. In part, this is because there is no one great treatment option – there are a number of medical treatment approaches for cancer of the pancreas which may be more or less appropriate, given certain variables. Also, medical treatment offerings in pancreatic cancer are often highly tailored to patient circumstance and wishes, which can be exceptionally individual.

Although, the introduction of the more widespread use of the four-drug FOLFIRINOX regimen for advanced pancreatic cancer and the later discovery of the efficacy of the Abraxane plus gemcitabine chemotherapy option have given oncologists hope for modestly improved outcomes in the treatment and care of pancreatic cancer.

In the discussion to follow…More recently, treatment for pancreatic cancer with four and five drug regimens that include 5-FU have shown themselves to offer comparable and perhaps even slightly superior results in comparison to gemcitabine alone, although side-effects may be limiting. And, we have earlier mentioned (above) the increased survival advantages for many with pancreatic cancer of the FOLFIRINOX as well as the Abraxane plus gemcitabine regimens.

A. Locally Advanced

Generally, in locally advanced unresectable pancreatic cancer, chemotherapy plus radiation is often prescribed as standard medical treatment. As early as 1981, a landmark report by the Gastrointestinal Tumor Study Group demonstrated significant survival advantage to those patients with locally unresectable adenocarcinoma of the pancreas who received both chemotherapy (5-FU) and radiation. This combination chemoradiation gave better medical outcomes for pancreatic cancer than either chemotherapy or radiation treatment alone.

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There have been a wide range of studies involving the delivery mode, method and amount of radiation to the pancreatic cancer tumor area. These have included such approaches as external beam radiotherapy, intraoperative radiotherapy and the seeding of the actual tumor area with radioactive pellets or with radioactive colloidal solution (brachytherapy). 5-FU (sometimes with in combination with drugs which enhance its effect) has been perhaps the standard chemotherapy agent in many chemoradiation regimens, but the drug-agents mitomycin-C and cisplatin (a platinum-containing compound) are among the stable of chemotherapy agents which have also been utilized. Also, a number of studies have begun looking at the drug agent gemcitabine as an effective radiosensitizer for combination with radiation therapy in chemoradiation type medical treatment for locally advanced unresectable pancreatic cancer.

According to some studies, chemoradiation medical treatment may push back the cancer enough to allow some patients (a minority) with apparent locally unresectable pancreatic cancer who otherwise might not be candidates – to then be eligible for surgical resection.

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The median survival duration from diagnosis with chemotherapy medical treatment in unresectable locally advanced cancer of the pancreas has been reported as 6-12 months.

B. Advanced

As the pancreatic cancer becomes widespread, although there may be creative modalities by way of exception, the advantages of radiation (more of a field range) are increasingly diminished. Thus, standard medical treatment for advanced cancer of the pancreas typically involves chemotherapy type agents alone.

The chemotherapy agent 5-FU (fluorouracil) which has been in use as medical treatment against pancreatic cancer for more than 40 years, acts in several ways, but principally as a thymidylate synthase inhibitor, interrupting the action of an enzyme which is a critical factor in the synthesis of pyrimidine – a building block which is important in DNA replication. The underlying principle in many standard treatment agents has to do with interfering with the normal progression of the cell cycle. As cancer is caused by uncontrolled cell growth, one if its central weaknesses due to this rapid almost chaotic growth is inherent genetic instability. If a medical treatment agent hurts the ability of the cell to progress through its normal replication cycle, although this will tend to hurt ALL of the cells in the body, its effect will be selectively severe on unstable and rapidly growing cells – the cancer itself.

Gemcitabine is an approved medical treatment agent which tends to offer increased median survival duration (and increased one year survival rates) for pancreatic cancer as compared to 5-FU alone.  It also appears in individual cases to confer improved quality-of-life measures over medical treatment with 5-FU and even over no medical treatment at all.  Additionally, the targeted therapy Tarceva has been approved in the U.S. for the medical treatment of pancreatic cancer.  More recently, treatment for pancreatic cancer with four and five drug regimens that include 5-FU have shown themselves to offer comparable and perhaps even slightly superior results in comparison to gemcitabine alone, although side-effects may be limiting. Please note our FOLFIRINOX grug regimen information, and search for other entries in the Pancreatica Blog.

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There appear to be interesting and potentially promising combinations of several two or more conventional medical treatment drug agents (including gemcitabine) which are in practice and under study for the treatment of advanced pancreatic cancer.  This includes combinations involving more conventional standard medical treatment drugs paired with some of the newer experimental more targeted agents. Please note our Abraxane information and search for other entries in the Pancreatica Blog.

Additionally, there is a wide range of single-mode medical treatment approaches currently in clinical trials against pancreatic cancer (please note the FAQ on clinical trials). These include some of the newer experimental therapies which are aimed more at molecular targets and at interrupting genetic signaling pathways, newer chemotherapy drug agents, and even vaccines against pancreatic cancer.

In summary, in advanced pancreatic cancer, medical therapy is better than no therapy. Creative, intelligently-crafted and individualized medical treatment regimens as tailored by compassionate and thoughtful oncologists involving single agents or combination therapy for pancreatic cancer may be appropriate. And finally, clinical trials remain an option.

A number of the more recent developments in the area of the medical treatment of pancreatic cancer are presented and discussed in greater detail in our Pancreatica Blog.

ABSTRACTS:

The following are descriptions of titles of abstracts of medical journal articles that may be interesting or useful to those who are interested in further information about this topic. These abstracts can be searched Here.

  • 12-Oct-16 – Promising results of Induction chemoradiation for cancer of the pancreas
  • 10-Oct-16 – Unexpected positive response with FOLFIRINOX induction regimen
  • 1-Oct-16 – The hENT1 marker suggests treatment with Gemzar rather than a 5-FU multi-drug regimen
  • 1-Oct-16 – Considerations in the treatment selection in BRCA2 patients with cancer of the pancreas
  • 1-Sep-16 – Outcomes improved with cancer of the pancreas in patients taking metformin
  • 1-Sep-16 –  Evofosfamide for possible use in adenocarcinoma of the pancreas 
  • 1-Sep-16 – Gemzar plus Tarceva plya a statin for metastatic cancer of the pancreas
  • 1-Aug-16  – 2016 ASCO Guidelines for Locally Advanced adenocarcinoma of the pancreas
  • 28-Jul-16 – Liposomal encapsulated irinotecan regimen in gemcitabine refractory cancer of the pancreas
  • 26-Jul-16 – Abraxane, Gemzar, Xeloda, and cisplatin combination for borderline or advanced pancreatic cancer 
  • 21-Jul-16 – Cabometyx plus Gemzar for metastatic adenocarcinoma of the pancreas: Phase I study
  • 10-Jul-16 – EUS RFA for pancreatic cancer 
  • 1-Jul-16 – FOLFIRINOX in locally advanced adenocarcinoma of the pancreas
  • 15-Jun-16 – PEGPH20 plus Gemzar in metastatic cancer of the pancreas 
  • 1-Jun-16 – chemoradiation with gemcitabine vs 5-FU in advanced cancer of the pancreas
  • 1-Mar-16 – Tarceva plus Xeloda as salvage treatment in pancreatic cancer
  • 1-Feb-16 – Increased duration of neoadjuvant therapy in locally advanced cancer of the pancreas
  • 1-Jan-16 – 2nd line treatment with Taxotere and oxaliplatin in metastatic pancreatic cancer
  • 1-Jan-16 – Gem + cisplatin for cancer of the pancreas
  • 29-Oct-15 – FOLFIRINOX (less irinotecan) plus Abraxane for unresectable cancer of the pancreas
  • 7-Oct-15 – Gemzar plus Abraxane regimen after 1st Line FOLFIRINOX in advanced cancer of the pancreas
  • 1-Oct-15 – Neoadjuvant FOLFIRINOX for stage III cancer of the pancreas
  • 1-May-15 -Evofosfamide plus Gemzar for cancer of the pancreas: a phase 2 study
  • 1-Apr-15 – Gemzar, Xeloda and oxaliplatin vs. Gemzar alone in advanced cancer of the pancreas
  • 10-Jan-14 – FOLFIRINOX as 2nd Line in Gemzar Refrectory Cancer of the Pancreas
  • 10-Jan-14 – Optimal Rest Duration between Whipple and Adjuvant Treatment?
  • 10-Jan-14 – Clinical Series of Doublet Gemzar Plus Tarceva for Pancreatic Cancer
  • 27-Dec-13 – Brachytherapy for Advanced Pancreatic Cancer
  • 1-Dec-13 – Phase II: Tigatuzumab Plus Gemzar for Advanced Cancer of the Pancreas
  • 1-Dec-13 – Abraxane as Salavage Therapy for Pancreatic Cancer
  • 16-Nov-13 – Vaccination with KIF20A-66 Peptide for Pancreatic cancer
  • 1-Nov-13 – Sutent for Advanced Pancreatic cancer
  • 1-Dec-13 – Cytokine-induced Killer Cells and S-1 for Cancer of the Pancreas
  • 1-Nov-13 – SOX for Cancer of the Pancreas
  • 1-Nov-13 – FOLFIRINOX with Modified 5-FU Bolus for Pancreatic cancer
  • 16-Oct-13 – Abraxane in Combination with Gemzar
  • 1-Oct-13 – Losartan in Pre-Clinical Study of Pancreatic Cancer
  • 1-Oct-13 – Cisplatin Regimen as 2nd Line for Cancer of the Pancreas
  • 1-Sept-13 – More FOLFIRINOX
  • 1-Sept-13 – Platinum and 5FU Combination as Second Line
  • 15-Jul-13 – Tarveva and Gemcitabine as an Adjuvant Combination
  • 1-Aug-13 – RFA plus Chemoradiotherapy, and Intra-arterial plus Systemic Chemotherapy in Adenocarcinoma of the Pancreas
  • 31-Jul-13 – Neoadjuvant Chemoradiation
  • 30-Jul-13 – Cryotherapy plus Biologic Agent in Advanced Adenocarcinoma of the Pancreas
  • 27-Jul-13 – Sutent for Advanced Pancreatic Cancer
  • 3-Jul-13 – Xeloda Versus 5-FU in Chemotherapy plus Radiation for Adenocarcinoma of the Pancreas
  • 26-Jun-13 – Abraxane or Gemzar Versus Abraxane in Adenocarcinoma of the Pancreas
  • 20-Jun-13 – Vaccine Response in Patients with Adenocarcinoma of the Pancreas
  • 1-Jun-13 – Abraxane and Gemzar and Radiation in the Treatment of Earlier Stages of Cancer of the Pancreas
  • 1-Nov-12 – Avastin, Gemcitabine and 5-FU for Advanced Pancreatic Cancer
  • 7-Sep-12 – Multi-drug Flourouracil Regimen for Pancreatic Cancer
  • 1-Sep-12 – Treatment and Side Effects of FOLFIRINOX for Pancreatic Cancer
  • 2-Feb-12 – Clinical Trial of Abraxane for Stage 4 Pancreatic Cancer
  • 1-Feb-12 – Stereotactic Radiation Plus Gemzar and Tarceva for Cancer of the Pancreas
  • 1-Feb-12 – Gemcitabine, Taxotere and Xeloda for Advanced Pancreatic Cancer
  • 1-Dec-11 – Gemzar And Abraxane for Pancreatic Cancer
  • 1-Nov-11 – Gemzar vs. Gemzar Plus Radiation in Locally Advanced Cancer of the Pancreas
  • 1-Sep-11 – Gemzar, Taxotere and Tarceva for Pancreatic Cancer
  • 12-May-11 – 5-FU Combination Superior to Gemzar in Advanced Cancer
  • 1-Mar-10 – Good Effect of Gemzar Plus Biotherapy – A Case Study
  • 1-Jan-08 – GTX for Cancer of the Pancreas
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