Our knowledge of cancer is always expanding. Researchers and healthcare professionals take the knowledge gained from research studies and use it to develop better practices that will help prevent, detect and treat pancreatic cancer, as well as improve the quality of life of people with pancreatic cancer.
The following information is a selection of research showing promise for pancreatic cancer.
Risk reduction
Risk reduction strategies may reduce the chance of developing cancer.
Noteworthy research includes:
- Researchers believe that the foods people eat over their lifetime can affect their risk of developing some types of cancer. However, research into the effects of diet on pancreatic cancer risk has been inconsistent. Further research is needed to understand the role that diet may play in reducing the risk of pancreatic cancer.
- Some studies have found that diets rich in vegetables and fruits may lower a person’s risk of developing pancreatic cancer (Journal of Gastrointestinal Cancer,PMID* 20101477; Cancer Causes & Control,PMID 19194662 and PMID 21915615; Annals of Oncology, PMID 21460379). Other studies have shown no association between intake of vegetables and fruit and pancreatic cancer risk (International Journal of Cancer, PMID 21328344; American Journal of Epidemiology, PMID 22875754; Cancer Epidemiology, Biomarkers & Prevention, PMID 21278328).
- Some studies have found an association between eating red and processed meat and a risk of pancreatic cancer (British Journal of Cancer, PMID 22240790; Molecular Carcinogenesis, PMID 22162237, Cancer Epidemiology, PMID 22018953; American Journal of Epidemiology, PMID 21685410). However, the link between red and processed meat and pancreatic cancer hasn’t been firmly established.
- Folate is a type of B vitamin that protects against cell damage. Researchers have also studied folate to see if it reduces the risk of pancreatic cancer. A large study found that a high intake of folate may be associated with a lower risk of pancreatic cancer in women. A high intake of folate was not associated with a lower risk of pancreatic cancer in men (American Journal of Clinical Nutrition,PMID 20007302). Another study found that folate intake did not affect the risk for pancreatic cancer (Journal of National Cancer Institute, PMID 22034634).
- Some studies have shown a link between physical activity and pancreatic cancer risk. They suggest that physical activity can lower risk of pancreatic cancer (American Journal of Clinical Nutrition, PMID 21955648; Annals of New York Academy of Science, PMID 21793853).
- Diabetes has been identified as a possible risk factor for pancreatic cancer (Cancer Causes and Control, PMID 23112111). However, researchers haven’t confirmed a direct cause-and-effect link between diabetes and pancreatic cancer. Although high blood sugar is often noted at the time of a new diagnosis of pancreatic cancer, it is often an effect rather than the cause of pancreatic cancer. Some people can control their diabetes with diet alone, while others need to take medicines to lower blood sugar. Researchers have found that some people who take metformin (Glucophage) to control their diabetes have a lower risk of developing pancreatic cancer. Metformin may have a protective effect against the development of pancreatic cancer in people with diabetes (American Journal of Gastroenterology, PMID 22290402; BMC Cancer,PMID 21241523; Cancer Prevention Research,PMID 20947488).
- Researchers think that there may be a link between long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) and a lower risk of developing pancreatic cancer (Cancer Prevention Research,PMID 21803981; British Journal of Cancer,PMID 20372155).
- While we don’t yet understand the link between allergies and pancreatic cancer, people who have allergies appear to have a lower risk of developing pancreatic cancer (Molecular Carcinogenesis, PMID 22162233; International Journal of Cancer,PMID 20143395; Cancer Causes & Control,PMID 19194662).
Screening
Researchers are working to improve screening techniques for pancreatic cancer so that it can be found early, before signs and symptoms are noticed. This is important because the majority of people with pancreatic cancer are diagnosed with advanced disease.
Noteworthy research includes:
- The stool DNA test is a promising tool in screening for colorectal cancer. This test finds DNA markers in precancerous and cancerous cells from the colon that are shed into the stool. The advantage of the stool DNA test is that it is non-invasive, the colon doesn’t need to be prepared and no dietary restrictions are needed. Researchers are studying the stool DNA test in other types of cancer, including pancreatic cancer, to see if it is an effective way to detect the disease early (Cancer, PMID 22083596; Annals of Clinical Biochemistry, PMID 22113956; ASCO**, Abstract 187).
- Researchers are studying different screening tests, including magnetic resonance imaging (MRI), endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), to see if they could be used to find pancreatic cancer in families that are at high risk (Journal of Gastrointestinal Surgery, PMID 22127781; Cancer Control, PMID 18813195).
Diagnosis
A key area of research activity involves developing better ways to diagnose and stage pancreatic cancer.
Noteworthy research includes:
- Researchers are studying gene expression profiling and protein microarray technologies as tools to diagnose cancer. These techniques have allowed researchers to find many genes that can be changed (mutated) in people with pancreatic cancer. This information may be helpful in diagnosing pancreatic cancer (Cancer Prevention Research, PMID 21071578; Expert Review of Molecular Diagnostics,PMID 20629509).
- MicroRNA is short, single-stranded RNA (molecules inside cells that help transmit the genetic information that controls cell functions). Doctors believe that it controls the expression of genes. Researchers have identified several types of microRNA that are changed in pancreatic cancer cells. Finding these changed types of microRNA may help diagnose pancreatic cancer (Pancreas, PMID 22001830; ASCO, Abstract 153; Expert Review of Molecular Diagnostics,PMID 20629509; Cancer Prevention Research,PMID 19723895).
- Next generation sequencing allows researchers to study the cancer genetic code in detail. This new technology is helping researchers to discover new cancer genes in pancreatic cancer, which may lead to improved screening, diagnosis and treatment (Nature Reviews: Gastroenterology & Hepatology, PMID 22751458).
Prognostic factors
Prognostic factors that may help determine the outcome of the disease are being studied in pancreatic cancer. They can be used to predict the chances of recovery or of cancer coming back. Doctors may also use prognostic factors to help make treatment recommendations.
Noteworthy research includes:
- Researchers are studying biomarkers to see if they can help determine prognosis and develop more personalized treatment in people with pancreatic cancer.
- Too much (overexpression) of the protein S100A2 may be a marker that indicates a pancreatic tumour is growing or spreading (tumour progression) and a less favourable prognosis. Researchers found that cells from metastatic sites (areas of cancer spread) of pancreatic cancer expressed higher levels of S100A2 than cells from primary sites (Gastroenterology,PMID 19376121). Another study found that the protein S100A4 may also be useful in predicting outcome for people with pancreatic cancer. The researchers found that S100A4 was associated with a less favourable outcome. They also suggested that these proteins may be useful in deciding which people would be most likely to benefit from surgery (ASCO, Abstract 154) or in measuring how effective certain chemotherapy drugs are (Journal of the Pancreas, PMID 22406595).
- Tumours need blood vessels to bring them oxygen and nutrients so that they can grow. Vascular endothelial growth factor (VEGF) stimulates new blood vessels to form. A large study (called a meta-analysis) showed that tumours positive for VEGF are associated with a less favourable prognosis in people with pancreatic cancer (British Journal of Cancer,PMID 21448172 and PMID 22805328). Researchers are looking for biomarkers that can help identify people who would benefit from with VEGF inhibitors, such as bevacizumab (Avastin) (Lancet Oncology, PMID 22608783).
- Human equilibrative nucleoside transporter 1 (hENT-1) is a protein that carries substances, such as chemotherapy drugs, to the inside of a cell. People who have had surgery for pancreatic cancer and have low levels of hENT-1 appear to have a less favourable prognosis (Gastroenterology, PMID 22705007; European Journal of Cancer, PMID 22137164; Cancer,PMID 21264835).
- Pancreatic tumours that express L-type amino acid transporter 1 (LAT1) tend to have a worse prognosis. LAT1 can be used as a potential target for future treatment of pancreatic cancer with drugs that block (inhibit) this protein (British Journal of Cancer, PMID 22805328; Journal of Clinical Pathology, PMID 22813728; Oncology Reports, PMID 22736142).
- Researchers have found that methylation markers, such as secreted protein acidic and rich in cysteine(SPARC), show promise in helping to find pancreatic cancer early. DNA methylation is commonly found in pancreatic cancer, as well as other types of cancer. DNA methylation is a method used to regulate gene expression. SPARC is a tumour suppressor gene that is inactivated through methylation. Researchers studied SPARC as a measure of prognosis. It also offers a potential future target for treating pancreatic cancer (Anticancer Research,PMID 20393008; Journal of Clinical Pathology, PMID 23135349; Cancer Letters, PMID 22939997; Journal of Clinical Oncology, PMID 21969517; Cancer Treatment Reviews, PMID 22226241).
- Lymph node ratio (nodal density) is the ratio of positive lymph nodes (those with cancer) to the total number of lymph nodes removed during surgery. Lymph node ratio is associated with prognosis in several different types of cancer, including pancreatic cancer. Researchers have found that a higher lymph node ratio (a greater number of positive lymph nodes) was associated with a less favourable prognosis or lower survival (International Journal of Radiation Oncology, Biology, Physics, PMID 20934270; Journal of Gastrointestinal Surgery,PMID 19418101; Annals of Surgery,PMID 20142730).
- People with pancreatic cancer who have higher amounts of belly (abdominal) fat may have a worse outcome after surgery. Researchers have suggested that measuring belly fat may be better than measuring body mass index (BMI) when trying to identify people who will have a less favourable prognosis after surgery (Annals of Surgery, PMID 22609844; Journal of Gastrointestinal Surgery,PMID 20725799 and PMID 21567293; HPB, PMID 21609373).
Treatment
Researchers are looking for new ways to improve the treatment of pancreatic cancer. Advances in cancer treatment and new ways to manage the side effects related to treatment have improved the outlook and quality of life for many people with cancer.
Noteworthy research in chemotherapy includes:
- Researchers are studying neoadjuvant therapy using chemotherapy or chemoradiation before surgery to treat pancreatic cancer. Surgery is the standard treatment for pancreatic tumours that doctors believe can be completely removed (are resectable). However, pancreatic cancer is often advanced at diagnosis and the outcome after surgery can be poor. Neoadjuvant therapy is beneficial because most people can have chemotherapy. Using neoadjuvant therapy before surgery may shrink the tumour, which may allow better removal of the cancer at time of surgery. Several studies are currently investigating neoadjuvant therapy to see if it may benefit people with pancreatic cancer.
- Gemcitabine (Gemzar) is a standard chemotherapy drug used to treat pancreatic cancer. Researchers are looking into combining gemcitabine with otherchemotherapy drugs to treat pancreatic cancer:
- Researchers are currently studying the chemotherapy drug S-1 in phase II clinical trials for the treatment of pancreatic cancer. Gemcitabine plus S-1 chemotherapy given as adjuvant therapy after surgery for pancreatic cancer may be a safe and promising treatment (Journal of Surgical Oncology, PMID 22331838). Researchers are also studying gemcitabine plus S-1 chemotherapy in phase III clinical trials for the treatment of unresectable advanced pancreatic cancer (Japan Journal of Clinical Oncology, PMID 21715364; Cancer Chemotherapy and Pharmacology, PMID 22249272; British Journal of Cancer, PMID 22555398).
- In a phase III trial, British researchers found that the combination of gemcitabine and capecitabine (Xeloda) resulted in better response and progression-free survival rates than gemcitabine alone for the first-line treatment of advanced pancreatic cancer (Journal of Clinical Oncology,PMID 19858379). Another study showed significantly better survival when gemcitabine was combined with either capecitabine or oxaliplatin (Eloxatin) (Japan Journal of Clinical Oncology, PMID 20147334).
- Researchers are studying other chemotherapy in the treatment of pancreatic cancer, including:
- FOLFIRI is a chemotherapy combination made up of irinotecan (Camptosar, CPT-11), 5-fluorouracil (Adrucil, 5-FU) and folinic acid (Leucovorin). FOLFIRI was tested as a second- or third-line therapy in people with advanced pancreatic cancer that didn’t respond to gemcitabine, platinum-based drugs nor both types of treatments. Researchers found that FOLFIRI was an effective second- and third-line treatment for advanced pancreatic cancer. (Cancer Chemotherapy and Pharmacology, PMID 22576338; ASCO, Abstract 272).
- FOLFIRINOX is a chemotherapy combination of 5-fluorouracil, folinic acid, irinotecan and oxaliplatin. In a phase III trial, researchers compared FOLFIRINOX to gemcitabine as a first-line treatment of metastatic pancreatic cancer. Researchers found that FOLFIRINOX improved survival and response rate compared to gemcitabine alone. However, the FOLFIRINOX regimen caused more side effects (New England Journal of Medicine, PMID 21561347). Another study found that 55% of people with metastatic cancer benefited from treatment with FOLFIRINOX. This study also found that the FOLFIRINOX regimen had a good safety profile and was effective as a second-line treatment of metastatic pancreatic cancer (Oncology, PMID 21778770).
Noteworthy research in biological therapy includes:
- Researchers have studied interferon in combination with chemotherapy and radiation therapy to see if it is an option for treating people with locally advanced pancreatic cancer (cancer that spread to tissues near the pancreas) who cannot have surgery. So far the results are promising, but further research is being done to see if different ways of giving the drug can reduce side effects (Surgery, PMID 22503318; Annals of Surgical Oncology, PMID 21701927; Annals of Oncology, PMID 20670978; ASCO, Abstract e14648).
- Cancer vaccines are an exciting area of research in cancer treatment. Therapeutic cancer vaccines stimulate the body to produce an immune response against cancer cells. Ongoing clinical trials are trying to find out if cancer vaccines could be used to treat people with pancreatic cancer (Expert Review of Vaccines,PMID 21692703; BioDrugs,PMID 21815696).
- Researchers are studying a vaccine that targets KRAS mutations that can occur in pancreatic cancer cells. Vaccination against the mutant KRAS gene could become a future adjuvant therapy given after surgery for people who have pancreatic cancer with this gene mutation (International Journal of Cancer,PMID 20473937; American Journal of Clinical Oncology,PMID 20686403).
- One cancer vaccine uses dendritic cells. Dendritic cells are a type of white blood cell that helps fight infection by producing signals (antigens) to boost the immune system. A dendritic vaccine uses cancer cells mixed with dendritic cells to stimulate the immune system to fight cancer cells. These vaccines are made specifically for each person using their own cancer cells. Researchers are studying dendritic vaccines in people with pancreatic cancer (Seminars in Oncology, PMID 22595054; Pancreas,PMID 21792083). They are also studying dendritic vaccines that use live-attenuated Listeria monocytogenes (Lm) in clinical trials for the treatment of pancreatic cancer (Clinical Cancer Research, PMID 22147941).
- Another study is looking at immunotherapy using cancer vaccines along with chemotherapy to treat pancreatic cancer (Annals of Surgery, PMID 21217520).
- G17DT is another cancer vaccine that researchers are studying in clinical trials to treat pancreatic cancer (Pancreas, PMID 22228104).
- Targeted therapy uses drugs to target specific molecules (for example, proteins) involved in cancer cell growth. These drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Researchers are studying targeted therapies to see if they are effective in treating pancreatic neuroendocrine tumours. The following are some targeted therapies that have shown promise in clinical trials.
- Everolimus (Afinitor) slows or stops cancer cell growth, reproduction and blood vessel growth (angiogenesis). It blocks (inhibits) the mammalian target of rapamycin (mTOR). Researchers have found that everolimus improved survival in people with advanced pancreatic neuroendocrine tumours (New England Journal of Medicine, PMID 21306238).
- Sunitinib (Sutent) is a tyrosine kinase inhibitor that has shown promise in treating pancreatic neuroendocrine tumours (New England Journal of Medicine, PMID 21306237; BioDrugs, PMID 21942915).
- Researchers have shown that poly(ADP-ribose) (PAR) inhibitors have promise in treating ovarian cancer in women who have the BRCA gene mutation (Lancet, PMID 20609468). Studies are examining the role of these agents in pancreatic cancer (Oncologist, PMID 21934105; Anticancer Research, PMID 21508395; Journal of the Pancreas, PMID 21386635).
Noteworthy research in radiation therapy includes:
- Intensity-modulated radiation therapy (IMRT) is a specialized form of conformal radiation therapy that delivers external beam radiation in a targeted way. IMRT can be given at lower doses than conventional and other conformal radiation therapy techniques. This appears to lessen the side effects to the upper and lower parts of the digestive system and the right kidney (Journal of Surgical Oncology,PMID 21520097; International Journal of Radiation Oncology, Biology, Physics,PMID 20399035 and PMID 18954715).
- Stereotactic radiation therapy is a type of external beam radiation therapy that delivers radiation in a targeted way. Stereotactic radiation therapy can deliver a single high dose of radiation to the tumour (called a single fraction) while sparing surrounding tissue.
- Stereotactic radiation therapy appears to be an effective way to treat advanced or unresectable pancreatic cancer while sparing surrounding normal tissue (American Journal of Clinical Oncology,PMID 20308870; Cancer,PMID 19117351). Researchers in one study gave stereotactic radiation therapy followed by gemcitabine (Gemzar). This treatment resulted in acceptable side effects for people with locally advanced pancreatic cancer (International Journal of Radiation Oncology, Biology, Physics,PMID 20171803, PMID 21549517 and PMID 22768988). In another study, stereotactic body radiotherapy (SBRT) was given after induction gemcitabine to successfully treat locally advanced pancreatic cancer (International Journal of Radiation Oncology, Biology, Physics,PMID 21658854).
- Stereotactic radiation therapy may also be used as adjuvant therapy after surgery if only a small amount of healthy tissue was removed around the tumour (close margins) or cancer cells are found in the tissue removed with the tumour (positive margins) (Journal of Gastrointestinal Cancer, PMID 20809393).
- CyberKnife is a machine that uses a linear accelerator to produce radiation and has a robotic arm that can direct radiation to any part of the body from any direction. CyberKnife may be used to deliver stereotactic radiation therapy to people with advanced pancreatic cancer. Researchers found that CyberKnife is a good palliative treatment option and helped to control the spread of the cancer (ASCO, Abstract e14506; Korean Journal of Gastroenterology;PMID 22113043).
- People with pancreatic cancer that has spread to the liver have limited treatment options. Most can’t have surgery because there are too many tumours in the liver, they are in poor health or removing the tumour would cause too much damage to the liver. Radioembolization is a type of internal radiation therapy that infuses radioactive substances directly into the main artery that carries blood to the liver (hepatic artery) to deliver radiation to the liver tumour more effectively. Microspheres (such as TheraSphere) are tiny glass beads that contain a radioactive isotope like yttrium-90. Doctors inject the microspheres into the hepatic artery. They then become stuck in the small blood vessels of the tumour and deliver radiation to the tissue. Researchers are studying radioembolization with microspheres in people with pancreatic cancer that has spread to the liver (Tumori,PMID 21388058; American Journal of Clinical Oncology,PMID 21127414 and 22363944). Most people with metastatic disease have tumours in many organs, so the value of selectively treating liver tumours in this way is uncertain.
Other promising research includes:
- Radiofrequency ablation (RFA) is a procedure that uses a high-frequency electrical current to destroy cancer cells. RFA may be used alone or combined with chemotherapy and radiation therapy. Researchers are studying RFA as a treatment option for people with locally advanced pancreatic cancer (British Journal of Surgery, PMID 22648697; Journal of Vascular and Interventional Radiology, PMID 22525021; ASCO, Abstract e14607; British Journal of Surgery,PMID 20069610).
Supportive care
Living with cancer can be challenging in many different ways. Supportive care can help people cope with cancer, its treatment and possible side effects.
Noteworthy research includes:
- The formation of blood clots (thrombosis) inside of the veins near the pancreas is a complication of pancreatic cancer. Some research has shown that giving blood thinners (anticoagulant therapy) can help improve the quality of life for people with pancreatic cancer. They may even help to prolong survival (ASCO, Abstract e14622; ASCO, Abstract 143; Journal of the Pancreas, PMID 21737895).
*PMID is the National Library of Medicine PubMed abstract identity number.
**ASCO is the American Society of Clinical Oncology.
Find out more about the research process.