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 ways to treat pancreatic cancer. The following is a selection of research showing promise for treating pancreatic cancer.

We’ve included information from the following sources. Each item has an identity number that links to a brief overview (abstract).

  • PubMed, US National Library of Medicine (PMID)
  • American Society of Clinical Oncology (ASCO)
  • Canadian Cancer Trials and ClinicalTrials.gov (NCT)

Surgery

Researchers are looking for the best ways to treat pancreatic cancer using surgery and improve how surgery is done.

 

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 (Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, PMID 29189661; Asian Journal of Surgery, PMID 27688035; British Journal of Surgery, PMID 28895142).

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. So far, results show that HIFU may help shrink tumours and lessen pain in people with advanced pancreatic cancer (Surgical Clinics of North America, PMID 29191269; Cancer Management and Research, PMID 30349376; Ultraschall in der Medizin, PMID 29665583; Journal of Therapeutic Ultrasound, PMID 28373906; European Radiology, PMID 26886904; Advances in Experimental Medicine and Biology, PMID 26486333).

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 that 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 (Biomed Research International, PMID 29854763; Canadian Association of Radiologists Journal, PMID 29458954; Scandinavian Journal of Gastroenterology, PMID 28687047; Medical Oncology, PMID 28161827).

Radiation therapy

Researchers are looking for the best ways to treat pancreatic cancer using radiation therapy.

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. A meta-analysis looked at IMRT along with chemotherapy to treat advanced pancreatic cancer that can’t be removed by surgery. Results show that IMRT combined with chemotherapy improved survival and control of the pancreatic tumour (Radiotherapy and Oncology, PMID 30082144). Researchers looking at IMRT with gemcitabine (Gemzar) found that using higher doses of radiation given by IMRT improved survival (Radiation Oncology, PMID 2990984). Another study in people with locally advanced pancreatic cancer found that giving chemotherapy before starting IMRT (called induction chemotherapy) improved survival slightly (Radiation Oncology Journal, PMID 30309211). Another analysis suggests that chemotherapy and IMRT given after surgery improves survival, over just chemotherapy alone (Cancer Medicine, PMID 29665327).

Stereotactic body radiation therapy (SBRT) delivers precisely targeted high doses of radiation to tumours in difficult or hard-to-reach areas in fewer sessions. Research suggests that people may survive longer with SBRT compared to traditional external beam radiation therapy or IMRT (Cancer, PMID 28708929, PMID 28493288). Researchers are looking at the role that SBRT may have in treating pancreatic cancer that can’t be removed with surgery (Journal of Gastrointestinal Cancer, PMID 28044263) or in combination with induction chemotherapy (ClinicalTrials.gov, NCT 01926197). SBRT may also have a role in treating local recurrences of pancreatic cancer (Annals of Surgical Oncology, PMID 29063299).

Find out more about research in radiation therapy.

Chemotherapy

The following is noteworthy research in chemotherapy for pancreatic cancer.

S-1 (Teysuno) combined with gemcitabine has been studied in Japan for many years as a promising treatment for pancreatic cancer (British Journal of Cancer, PMID 28472821). But it wasn’t known if there would be differences in Caucasian populations. A small study looked at the combination in Caucasian people diagnosed with pancreatic cancer that couldn’t be removed with surgery. Results showed that S-1 and gemcitabine was a safe treatment that showed some improvement in survival (Cancer Chemotherapy and Pharmacology, PMID 29387963).

Maintenance therapy is treatment given after the first-line therapy (the first or standard treatment) to keep cancer under control or to prevent it from coming back (recurring). A small study showed that using S-1 as a maintenance therapy after first-line therapy with S-1 and nab-paclitaxel (Abraxane) improved survival in people with advanced or metastatic pancreatic cancer (ASCO, Abstract 4117).

Neoadjuvant therapy is treatment given before surgery. A study showed that giving chemoradiation before surgery significantly improved survival compared to giving chemotherapy by itself after surgery (ASCO, Abstract 160063).

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 shown promising results. There are many different abnormal proteins or gene mutations in pancreatic cancer, so researchers are still trying to find out which targeted therapy drugs will work the best to treat pancreatic cancer (Targeted Oncology, PMID 30470972).

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 (ClinicalTrials.gov, NCT 01839487). Early trial results are promising, and researchers continue to test PEGPH20 as a potential treatment for pancreatic cancer (Future Oncology, PMID 29235360).

Immunotherapy

Cancer vaccines are a type of immunotherapy, which helps strengthen or restore the immune system’s ability to fight cancer. The following is noteworthy research in immunotherapy for 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.

Other treatments

Research has found some other treatments that may improve survival from pancreatic cancer.

Metformin and statins are medicines that are used for other diseases and conditions. Metformin is used as a treatment for diabetes, and statins are medicines used to lower fats like cholesterol in the blood. Previous studies looking at the risk factors suggested that these drugs might improve survival in people who were on the drugs when they developed pancreatic cancer. A meta-analysis found that both metformin and statin users had improved overall survival, but more studies are needed to confirm the results and clarify the role these drugs may have in pancreatic cancer survival (Current Medicinal Chemistry, PMID 28403788).

Pancreatic enzyme replacement therapy (PERT) replaces the digestive enzymes normally made by the pancreas. These enzymes help with digesting fats and carbohydrates in our food. With pancreatic cancer and other diseases of the pancreas, the pancreas does not make enough enzymes, so food isn’t digested properly. A recent study found that people with pancreatic cancer who were offered PERT by their healthcare teams had a longer survival time than people who did not take PERT. Researchers suggest that more people need to be offered PERT when they are diagnosed with pancreatic cancer to improve both nutrition and survival (Pancreatology, PMID 30385188).

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 treat pancreatic cancer. They also look at ways to prevent, find and manage 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.

palliative

Giving relief.

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

Stories

Dr Shawn Li I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.

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Making progress in the cancer fight

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The 5-year cancer survival rate has increased from 25% in the 1940s to 60% today.

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