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.

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.

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.