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.

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 (NLM). 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.

Reducing the risk for pancreatic cancer

Researchers look at substances or behaviours that might lower the risk of developing pancreatic cancer. They may study people who take certain drugs (Cancer, PMID 25649483) or do physical activity (Cancer Epidemiology Biomarkers and Prevention, PMID 26174790; European Journal of Epidemiology, PMID 25773752) to see if they develop pancreatic cancer less often than people with different habits.

Find out more about research in reducing the risk of cancer.

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. Tumour markers are biomarkers that look just for cancer.

Researchers are looking at the following 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:

A family history of breast, ovarian or pancreatic cancer may be a marker for how well pancreatic cancer responds to platinum chemotherapy drugs, such as cisplatin (Platinol AQ). Researchers found that people with pancreatic cancer who had a family history of at least one of these cancers survived longer when treated with platinum chemotherapy than people who had no family history of any of these cancers (Cancer Chemotherapy and Pharmacology, PMID 26126726).

 

Carbohydrate antigen 19-9 (CA19-9) is a tumour marker that can be used to measure how well advanced pancreatic cancer responds to chemotherapy. A clinical trial measured CA19-9 levels in people with advanced pancreatic cancer after 8 weeks of chemotherapy with gemcitabine (Gemzar) and nab-paclitaxel (Abraxane). Researchers found that people with lowered levels of CA19-9 survived longer than people who did not have lowered levels (Annals of Oncology, PMID 26802160). The study also found that lowered CA19-9 levels could better predict who would survive longer than standard testing using imaging tests.

 

Gene-based tests find differences between normal genes and genes that are changed, or 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. Researchers hope that developing more gene-based tests will help doctors identify the best treatments for certain cancers, including pancreatic cancer (Nature, PMID 26909576; Journal of the National Cancer Institute, PMID 26857392). Gene-based tests will also help doctors tailor more treatments to each person’s cancer based on their unique genetic makeup.

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

The following is noteworthy research into surgery for pancreatic cancer.

Enucleation is surgery that remove just the pancreatic tumour with a margin of tissue around it. This leaves part of the pancreas in the body so it can still make digestive juices. Researchers looked at the combined results of a large number of clinical trials (called a meta-analysis) that compared enucleation to the standard surgery, which removes most of the pancreas. They found that people who had enucleation had shorter surgery times, shorter hospital stays and less blood loss during surgery than people who had the standard surgery. As well, the pancreas worked better after enucleation that when more of the pancreas was removed. The researchers concluded that enucleation can be used as an alternative surgery in some people with pancreatic cancer, especially when the surgeon has experience doing this type of surgery (British Journal of Surgery, PMID 26041666).

Removing lymph nodes in the area of the tumour is part of surgery for pancreatic cancer. Doctors thought that removing more lymph nodes farther away from the pancreas (called an extended removal) might help lower the risk that the cancer will come back. Researchers used a meta-analysis to compare extended lymph node removal with standard lymph node removal. Results show that people who had an extended lymph node removal were more likely to die right after surgery than people who did not have an extended lymph node removal. Researchers also found that extended lymph node removal surgery took longer and people who had this surgery needed more blood transfusions during surgery, and had more diarrhea caused by nerve damage than people who only had the standard lymph node removal (HPB, PMID 25913578; Journal of Gastrointestinal Surgery, PMID 26055135).

Alternatives to surgery

The following are some alternatives to surgery that researchers are studying as treatments for pancreatic cancer.

High-intensity focused ultrasound (HIFU) uses focused ultrasound waves to create intense heat, which destroys tissue. Researchers are studying HIFU to see if can be used as a treatment for pancreatic cancer that can’t be removed with surgery (Advances in Experimental Medicine and Biology, PMID 26486333). Early results show that HIFU can shrink tumours and reduce the amount of pain for a significant length of time (European Radiology, PMID 26886904).

 

A combination of HIFU and the chemotherapy drug S-1 was compared to using S-1 alone as a treatment for people with pancreatic cancer that had spread to other parts of the body and had stopped responding to gemcitabine (Gemzar). Results showed that people who were given both treatments had much better pain control and survived for a longer period of time than people who were only given S-1 (American Journal of Cancer Research, PMID 27073725).

Cryosurgery uses extreme cold to freeze and destroy abnormal cells. It can be used to shrink tumours and reduce pain in people who have advanced pancreatic cancer, but who can’t have surgery to remove the cancer. A recent review of cryosurgery for pancreatic cancer found that it may be more effective when combined with other treatments, such as radioactive seed implants or targeted therapy. More study is needed to understand the best role for cryosurgery in treating pancreatic cancer (World Journal of Gastroenterology, PMID 26811625).

Irreversible electroporation uses an electrical current to open up holes in the cell membranes. This technique may help make chemotherapy more effective by allowing the drugs to get inside the cells and destroy them. A study compared a combination of irreversible electroporation and chemoradiation with chemoradiation alone as a treatment for advanced pancreatic cancer. Results show that people who were given the combination treatment lived longer than people who received chemoradiation alone (Annals of Surgery, PMID 26258317).

Radiation therapy

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

Brachytherapy using radioactive seeds is being studied as a way of giving larger doses of radiation to a pancreatic tumour. Studies have looked at using radioactive iodine seeds as a treatment for advanced pancreatic cancer that can’t be removed with surgery. Results show that people who were given brachytherapy with radioactive seeds had less pain, better control of the cancer and survived longer than people who did not have brachytherapy (Indian Journal of Cancer, PMID 26728678; Journal of Huazhong University of Science and Technology, PMID 27072963). More research is needed to find out what role brachytherapy may have as a treatment option for pancreatic cancer.

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 lower-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 is a type of radiation therapy that uses 3-D imaging to give radiation to a very specific part of the body over a number of treatment sessions. Researchers are looking at the role that stereotactic radiotherapy may have in treating pancreatic cancer that can’t be removed with surgery. Early results show that it has promise as a treatment to control tumours, reduce symptoms such as pain and improve survival (World Journal of Gastroenterology, PMID 26185389; Expert Review of Anticancer Therapy, PMID 26999329).

Chemotherapy

Researchers are looking for new chemotherapy drugs that are effective against pancreatic cancer.

Nanoliposomal irinotecan

Nanoliposomal irinotecan (nal-IRI, Onivyde) uses very tiny spheres of fat (called liposomes) to surround a chemotherapy drug called irinotecan (Camptosar). These tiny spheres can get through the membranes of cancer cells to deliver the irinotecan directly to the cell. Nanoliposomal irinotecan with 5-fluorouracil (Adrucil, 5-FU) and leucovorin (folinic acid), was compared to 5-fluorouracil and leucovorin in an international clinical trial. Researchers gave 1of these 2 treatments to people with pancreatic cancer that had spread to other parts of the body and was no longer responding to treatment with gemcitabine. Results show that the treatment with nanoliposomal irinotecan, 5-flurouracil and leucovorin improved survival by nearly 2 months compared to treatment with just 5-flurouracil and leucovorin (The Lancet, PMID 26615328).

Gemcitabine-based therapies

Gemcitabine is a standard chemotherapy drug used for pancreatic cancer. Researchers are looking at new drug combinations with gemcitabine and new ways to give the drug to improve its effectiveness.

Evofosfamide (TH-302) is a drug that works best in cells that have low oxygen levels (called hypoxia), like cancer cells. A clinical trial compared evofosfamide and gemcitabine to a placebo and gemcitabine. These drugs were used for untreated pancreatic cancer that could not be removed with surgery or that had spread to other parts of the body. Results showed that the evofosfamide and gemcitabine combination did improve survival, but not as much as researchers had predicted it would at the start of the trial. People who were given evofosfamide and gemcitabine also had more side effects than the people who were given the placebo and gemcitabine (ASCO, Abstract 193).

S-1 combined with gemcitabine has been studied as a treatment for advanced pancreatic cancer that could not be removed with surgery. A meta-analysis combined the results of several of these studies to find out how well this combination worked and how safe it was as a treatment for pancreatic cancer. The analysis found that S-1 and gemcitabine significantly improved survival and slowed the growth of the cancer compared to gemcitabine alone. Diarrhea and low white blood cell counts were more common with the S-1 and gemcitabine combination (Medicine Baltimore, PMID 26334891).

Intra-arterial infusion chemotherapy injects a drug through a small tube (called a catheter) into the main artery that supplies blood to the tumour. This delivers the chemotherapy directly to the tumour. A study gave gemcitabine as an intra-arterial infusion to people with advanced pancreatic cancer. The study found this treatment was most effective at improving survival in younger people and in people who had tumours in the head of the pancreas. It also found that levels of CA19-9, a tumour marker, could predict how well intra-arterial infusion chemotherapy would work. People who had lower levels of CA19-9 before treatment had a better survival than people with higher levels (Medicine [Baltimore], PMID 26986149).

Find out more about research in cancer surgery, research in chemotherapy and research in radiation therapy.

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.

chemoradiation

Treatment that combines chemotherapy with radiation therapy. Chemotherapy is given during the same time period as radiation therapy. Some types of chemotherapy make radiation therapy more effective.

Also called chemoradiotherapy.

placebo

A harmless, inactive substance or treatment that looks the same as, and is given in the same way as, an active drug or treatment.

Placebos may be used in controlled clinical trials. One group is given a placebo and the other is given the substance or treatment being studied, then researchers compare the effects of the placebo and the active substance or treatment.

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