Pancreatic cancer

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Research in pancreatic cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help prevent, find and treat pancreatic cancer. They are also looking for ways to improve the quality of life of people with pancreatic cancer.

The following is a selection of research showing promise for pancreatic cancer. We’ve included information from PubMed, which is the research database of the National Library of Medicine. Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract). We have also included links to abstracts of the research presented at meetings of the American Society of Clinical Oncology (ASCO), which are held throughout the year. You can find information about ongoing clinical trials in Canada from CanadianCancerTrials.ca and ClinicalTrials.gov. Clinical trials are given an identifier called a national clinical trial (NCT) number. The NCT number links to information about the clinical trial.

Preventing pancreatic cancer

Researchers look at substances or behaviours that might prevent pancreatic cancer or lower the risk of developing it. They may study people who eat certain foods, take certain drugs or vitamin supplements or do physical activity to see if they develop pancreatic cancer less often than people with different habits.

Find out more about research in cancer prevention.

Finding pancreatic cancer early

Researchers are looking for ways to find pancreatic cancer early, before any signs or symptoms appear. This is important because most people with pancreatic cancer are diagnosed with advanced disease. The following is noteworthy research into finding pancreatic cancer early.

Researchers are trying to find out if blood tests or imaging tests can help find pancreatic cancer early, before it spreads. The research is mainly focusing on people who have a high risk of developing pancreatic cancer such as those with certain genetic conditions or those with a strong family history of the disease.

Liquid biopsy tests blood or other body fluids for cancer cells (called circulating tumour cells or CTCs) or pieces of tumour DNA (called circulating tumour DNA). Some research has found that testing the blood for circulating tumour cells and certain biomarkers, including KRAS gene mutations, may help doctors find pancreatic cancer early (Proceedings of the National Academy of Sciences of the United States of America, PMID 28874546; Annals of Oncology, PMID 28104621).

Find out more about research in screening and finding cancer early.

Diagnosis and prognosis

A key area of research looks at better ways to diagnose and stage pancreatic cancer. Researchers are also trying to find ways to help doctors predict a prognosis (the probability that the cancer can be successfully treated or that it will come back after treatment). The following is noteworthy research into diagnosis and prognosis.

Biomarkers are substances, such as proteins, genes or pieces of genetic material like DNA and RNA, that are found naturally in the body. They can be measured in body fluids like blood and urine or tissue that has been removed from the body. A gene mutation or a change in the normal amount of a biomarker can mean that a person has a certain type of cancer. When biomarkers are used to help find cancer, they are also called tumour markers. Researchers are trying to find new tumour markers to see if they can help doctors diagnose, predict a prognosis for and find out which treatments will benefit a person with pancreatic cancer. Glypican-1 and certain types of microRNA are examples of biomarkers that researchers are studying to help find cancer and predict prognosis (International Journal of Cancer, PMID 28542740; Cancer Medicine, PMID 28440066; Nature, PMID 26106858).

Gene-based tests find differences between normal genes and genes that are changed (mutated) in cancer cells. Microarray analysis is a type of gene-based test that allows researchers to look at many genes together to see which ones are turned on and which ones are turned off. Analyzing many genes at the same time to see which are turned on and which are turned off is called gene expression profiling. Looking at the big picture of genes that are turned on and turned off can sometimes allow researchers to see patterns that can help them better understand a disease, such as finding out which cancers are more likely to spread. Researchers hope that developing more gene-based tests will help doctors diagnose and identify the best treatments for certain cancers, including pancreatic cancer (Journal of Clinical Oncology, PMID 28767289; Nature, PMID 26909576; Journal of the National Cancer Institute, PMID 26857392).

Find out more about research in diagnosis and prognosis.

Treatment

Researchers are looking for new ways to improve treatment for pancreatic cancer. Advances in cancer treatment and new ways to manage the side effects from treatment have improved the outlook and quality of life for many people with cancer. The following is noteworthy research into treatment for pancreatic cancer.

Surgery

Laparoscopic surgery uses long, thin surgical tools to pass a tiny video camera through small incisions (cuts) in the abdomen. Doctors are trying to find out which people with pancreatic cancer who need a Whipple procedure would most likely benefit from having it done laparoscopically. A Whipple procedure is a complex surgery used to remove a cancerous tumour in the pancreas. Most people who have this surgery done through a large cut in the abdomen (called a laparotomy) need to stay in the hospital for many days. So some major hospitals are looking at doing a Whipple procedure laparoscopically. Results show that people tend to recover more quickly from laparoscopic surgery than a laparotomy (British Journal of Surgery, PMID 28895142; Medical Oncology, PMID 28573639; World Journal of Gastroenterology, PMID 27621576).

Find out more about research in cancer surgery.

Alternatives to surgery

Researchers are studying some alternatives to surgery for pancreatic cancer, including the following.

High-intensity focused ultrasound (HIFU) uses focused ultrasound waves to create intense heat, which destroys tissue. Researchers are studying HIFU as a palliative treatment for pancreatic cancer that can’t be removed with surgery. Results so far show that HIFU may help shrink tumours and lessen pain in people with advanced pancreatic cancer (Journal of Therapeutic Ultrasound, PMID 28373906; European Radiology, PMID 26886904; Advances in Experimental Medicine and Biology, PMID 26486333). Some research also shows that people with metastatic pancreatic cancer may live longer and have better pain control when they have chemotherapy with S-1, which is similar to 5-fluorouracil (Adrucil, 5-FU), combined with HIFU (American Journal of Cancer Research, PMID 27073725).

Irreversible electroporation (IRE or NanoKnife) uses an electric current to make tiny holes in the walls of cells, which causes them to die. It is a type of ablation therapy that is used to destroy (ablate) tissue. Researchers are studying IRE to treat cancers that are close to important structures, which may be damaged with types of ablation therapies that use heat, such as radiofrequency ablation. IRE may also make chemotherapy drugs work better by helping them get inside cancer cells (Scandinavian Journal of Gastroenterology, PMID 28687047; Pancreas, PMID 28187107; Medical Oncology, PMID 28161827; Annals of Surgery, PMID 26258317).

Radiation therapy

Researchers are looking at different ways of giving radiation therapy to treat pancreatic cancer.

Brachytherapy is a type of internal radiation therapy. Some research is looking at using radioactive iodine seed brachytherapy for people with advanced pancreatic cancer that can’t have surgery. Using radioactive seeds may allow doctors to give larger doses of radiation to tumours in the pancreas. Results show that people who were given brachytherapy with radioactive seeds had less pain, their cancer was less likely to grow or spread and they survived longer than people who did not have brachytherapy (Journal of Huazhong University of Science and Technology, PMID 27072963; Indian Journal of Cancer, PMID 26728678). A meta-analysis showed that survival may be longer when brachytherapy is given along with other treatments (Medicine, PMID 28151849).

Intensity-modulated radiation therapy (IMRT) is a way of giving radiation in a targeted way. The radiation beams are shaped to the area being treated, and the strength of the beam is changed across the treatment area. This means that higher doses of radiation can be given to the tumour without harming surrounding tissues. Researchers looked as using IMRT to treat advanced pancreatic cancer that can’t be removed by surgery. They compared treatment with high-dose IMRT and chemotherapy to low-dose IMRT and chemotherapy. Results show that higher doses of IMRT improved survival and control of the pancreatic tumour compared to lower doses of IMRT (International Journal of Radiation Oncology, Biology and Physics, PMID 26972648).

Stereotactic radiotherapy delivers precisely targeted high doses of radiation to tumours in difficult or hard-to-reach areas in fewer sessions. Researchers are looking at the role that stereotactic radiotherapy may have in treating pancreatic cancer that can’t be removed with surgery (World Journal of Gastroenterology, PMID 26185389; Expert Review of Anticancer Therapy, PMID 26999329). Research suggests that people may survive longer with stereotactic radiotherapy compared to traditional external beam radiation therapy or IMRT (Cancer, PMID 28708929, PMID 28493288).

Find out more about research in radiation therapy.

Chemotherapy

Researchers are looking for new chemotherapy drugs to treat advanced pancreatic cancer. They usually test new chemotherapy drugs in combination with chemotherapy drugs that are already used to treat pancreatic cancer. There have been some promising results using these drug combinations:

  • nanoliposomal irinotecan (nal-IRI, Onivyde) in combination with 5-fluorouracil and leucovorin (folinic acid) (The Lancet, PMID 26615328)
  • evofosfamide (TH-302) in combination with gemcitabine (Gemzar) (ASCO, Abstract 193)
  • S-1 combined with gemcitabine (British Journal of Cancer, PMID 28472821; Medicine [Baltimore], PMID 26334891)

Find out more about research in chemotherapy.

Targeted therapy

Researchers are trying to find out which targeted therapies may work to treat pancreatic cancer. This involves testing a person’s tumour for certain proteins or mutated genes. If abnormal proteins or gene mutations are found in a tumour, researchers can use targeted therapy drugs that are known to target the specific protein or gene. So far, only a few studies have promising results. Researchers are still trying to find out which drugs will work the best to treat pancreatic cancer.

Find out more about research in targeted therapy.

Drugs that break down stroma

Chemotherapy doesn’t always work well to treat pancreatic cancer. Some researchers think this might be because the connective tissue that surrounds cells (called the stroma) helps form a barrier that protects the cancer cells inside the tumour in the pancreas. So they are trying to find out if drugs that can break down the stroma could make chemotherapy work better. Researchers are testing the drug PEGPH20, which can break down stroma, to see if it can help chemotherapy work better in people with pancreatic cancer (NCT01839487).

Immunotherapy

Cancer vaccines are a type of immunotherapy, which helps strengthen or restore the immune system’s ability to fight cancer. Researchers are trying to find out if immunotherapy will work to treat pancreatic cancer.

Dendritic cell vaccines (also called dendritic cell therapy) are a type of cancer treatment vaccine. They are made from a person’s white blood cells (immune cells that help fight infection and disease). In the lab, the white blood cells are exposed to cancer cells, proteins found on cancer cells or chemicals. After this exposure, the white cells turn into a specialized type of white blood cell called a dendritic cell. The dendritic cells are then injected back into the person to help other immune cells in the body find and attack cancer cells. Researchers are trying to find out if dendritic cell vaccines could be a treatment for pancreatic cancer (ASCO, Abstract TPS4153).

Find out more about research in immunotherapy.

Learn more about cancer research

Researchers continue to try to find out more about pancreatic cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage pancreatic cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for pancreatic cancer were first shown to be effective through clinical trials.

Find out more about cancer research and clinical trials.

biomarker

Any cellular, molecular, chemical or physical change that can be measured and used to study a normal or abnormal process in the body. Biomarkers are used to check the risk for, presence of or progress of a disease or the effects of treatment.

For example, prostate-specific antigen (PSA) can be used as a biomarker for prostate cancer or blood sugar levels can be used to monitor diabetes.

Also called biological marker (a molecular biomarker may be called molecular marker or signature molecule).

gene mutation

A permanent change or alteration in a gene.

Gene mutations can be inherited or can be acquired during a person’s life.

palliative

Giving relief.

For example, palliative therapies relieve symptoms but do not cure disease.

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