BY ELIZABETH WHITTINGTON | DECEMBER 6, 2013
Pancreatic cancer, while hard to treat, is gaining awareness, research dollars and inspirational advocates. Learn more about how we're gaining on this aggressive cancer in the Winter issue of CURE.
BY GUEST BLOGGER | DECEMBER 3, 2013
November was an exciting month for nurses conducting research in the area of cognitive changes related to cancer and cancer treatment.
Many of us were fortunate to attend the Oncology Nursing Society Connections conference in Dallas, where we had the opportunity to share research results and discuss future research projects dedicated to learning more about the cognitive changes that some cancer survivors experience. Additionally, the November issue of the Seminars in Oncology Nursing journal was devoted to "Cognitive Changes Associated with Cancer and Cancer Treatment."
"Chemobrain" and cognitive changes due to cancer and other related treatments pose a challenge to many survivors of cancer. Incidence estimates for cancer-related cognitive changes range from 75 to 90 percent of survivors at some point prior to, during or following treatment.
Around 25 percent of survivors struggle with long-term cognitive effects. Survivors describe the experience of these cognitive changes to include issues such as difficulty with word finding, misplacing things such as keys and cell phones, forgetting why they walked into a room, missing appointments and trouble multitasking. Results from neuro-psychologic tests have shown decreases in processing speed, memory and executive function (the ability to plan out and complete the steps necessary to accomplish a goal). All of these issues cause frustration and can decrease survivors' quality of life.
A great deal of research is being conducted to better understand the causes of these cognitive changes so that preventive strategies and interventions can be developed. Many different theories are being explored such as injury to neural progenitor cells (stem cells that give rise to mature brain cells), changes to DNA-repair genes, accelerated aging of the brain, and genetic pre-disposal to central nervous system injury. Results of studies that include the use of functional magnetic resonance imaging (MRI) and memory testing are demonstrating changes in brain volume and activation.
Additionally, exciting research is being conducted to explore interventions to reduce cognitive injury and/or improve cognitive function. Some interesting results are being seen in the areas of cognitive behavioral training and exercise.
Cognitive Behavioral Training includes exercises to assist with memory and processing speed as well as recommendations for strategies to accommodate for changes in cognitive function. Exercise studies to date have included yoga, Tai Chi, Qigong, aerobic exercise and resistance training. More research needs to be conducted to support the widespread use of these interventions, but these early results are encouraging. Additional results will be presented at the upcoming 2014 International Cancer and Cognition Task Force (ICCTF) Cancer and Cognition Conference to be held in Seattle next February. The Task Force is comprised of oncologists, radiologists, nurses, basic scientists and other disciplines all dedicated to finding solutions to the problem of cancer-related cognitive changes.
One study is currently being conducted to learn more about factors that may predict many of the symptoms associated with breast cancer prior to, during and following chemotherapy (including cognitive changes). Women with breast cancer are being asked to complete a confidential online questionnaire. If you or someone you know are newly diagnosed and have not yet received chemotherapy, or if chemotherapy was completed two or more years ago, please consider helping us learn more about predictive factors by completing the study questionnaire.
Jamie Myers, PhD, RN, AOCNS, is adjunct assistant professor at the University of Kansas School of Nursing and nurse researcher consultant for Carondelet Health in Kansas City. She also is the coordinator-elect for the Oncology Nursing Society Survivorship, Quality of Life, and Rehabilitation Special Interest Group.
To participate in the clinical study mentioned above, go to https://survey.kumc.edu/se.ashx?s=5A1E27D26B60E80F. Participants will be offered the opportunity to receive the study results. If you have questions about the study or would prefer to receive a hard copy questionnaire you can contact Jamie at email@example.com or 913-449-5996.RELATED POSTS
BY SUZANNE LINDLEY | NOVEMBER 7, 2013
I have been writing each day this month, as many others have, to count my blessings and show gratitude for this borrowed time I so enjoy. It isn't just in November that I am thankful. I realize each and every day how fortunate I am to be living in spite of cancer. It has taken more support, knowledge, dedication, passion, research and ability than I can imagine to keep me here and I am grateful for every bit of it!
When I learned that today is International Day of Radiology, I felt that it fit right into my gratitude calendar. I wouldn't be here without the miracles that radiology provide or without and those who study and practice it. I'm thankful for the little magic beads (SIR-Spheres), Radiofrequency ablation, CyberKnife and external beam radiation that have given me more time and better quality of life. I'm grateful for the scans that determine next steps and the ability to have "the right scan at the right time."
"Last year saw more than 80 societies from around the world celebrate the first ever International Day of Radiology and this year more than 110 societies have joined the initiative, bringing even more momentum to this already fast-growing movement."
To learn more, just follow the link! internationaldayofradiology.com
It's a great day to recognize and celebrate!RELATED POSTS
BY GUEST BLOGGER | OCTOBER 23, 2013
At age 59, I was fit, healthy and happily retired. My husband Clint and I had just returned from a great trip to Churchill Manitoba, the land of polar bears and beluga whales.
I was pretty thin at the time, but I noticed that my stomach had been bloated. It was hard, not flabby, which I had heard could be a sign of ovarian cancer. I made myself a gynecologist appointment right away, but even an internal sonogram turned up nothing.
The next day I was relaxing at our swim club with my 3-year-old grandson, whom we had been raising since he was 3 weeks old. I started having horrific abdominal pains. They were persistent and scary. My husband immediately took me to the emergency room.
That night my world changed forever. An X-ray and a CT scan showed a large mass in my abdomen and lots of spots in my lungs. It took a biopsy the next day to confirm the diagnosis of primary cancer of the liver, hepatocellular carcinoma. My husband and I were devastated. Life as we knew it was over--so we thought. Thank God we were wrong.
The only bright spot during that time was that the lung lesions turned out to not be malignant. There was no metastasis. It was determined to be a form of granuloma, frequently seen in this part of the country.
I told my sons of my diagnosis that week, and then sent an email to relatives and friends. I told them the news and all its implications. I let them know I still wanted to have people around me and please not to change the way we interacted, not to feel sorry for me, or walk on eggshells around me. I told them if they didn't feel uncomfortable talking about it, neither did I.
So, that's what we did. We talked, we cried, we prayed, we fought. What a wonderful support system I had, especially my husband and my oldest son, Keith.
While the physicians never gave me a stage for my cancer, they couldn't remove all of the cancer after my liver resection. I then went to M.D. Anderson, where the physicians said I had many more tumors. They said my prognosis was about seven months "on a bell curve," and I might live a little longer because I was otherwise healthy. They said I could never have a liver transplant. They were wrong.
It has been seven years since that awful day when I was diagnosed with terminal liver cancer. A lot of prayers, healing, medical treatment, undergoing radiation called Theraspheres, traveling to cancer centers around the nation, a status of NED (no evidence of disease), and yes, even a liver transplant have come in between.
At age 66, I have come full circle, back to fit, healthy and happily retired.
These days I'm trying to pay it forward by mentoring other newly diagnosed liver cancer patients through organizations like beatlivertumors.org, Imerman's Angels and University of Cincinnati liver transplant support group. I want my example to replace fear and desperation with hope and perseverance.
I have truly been blessed.
You can read Nancy Hamm's full account of living with liver cancer and 26 other survivor stories in "From Incurable to Incredible" by Tami Boehmer.RELATED POSTS
BY LINDSAY RAY | SEPTEMBER 30, 2013
Ahead of schedule, the Food and Drug Administration (FDA) approved Perjeta (pertuzumab) to treat patients with early-stage breast cancer prior to surgery (neoadjuvant) on Sept. 30. This comes on the heels of a unanimous vote from the Oncology Drugs Advisory Committee to recommend the drug for approval. Perjeta was approved just last year to treat patients with metastatic HER-2 positive breast cancer.
Perjeta is the first drug approved for the neodjuvant treatment of cancer and provides another treatment option for patients at high risk of a breast cancer recurrence, metastasis or of dying from the disease. Perjeta is still intended for HER-2 positive patients, but has now been extended to include those with inflammatory, locally advanced or early-stage breast cancer who are at high risk. Perjeta is to be used in combination with Herceptin (trastuzumab) and chemotherapy, and depending on the combination used, chemotherapy can be used after surgery as well. Herceptin, however, should be continued after surgery to complete a year of treatment.
Perjeta was approved under the FDA's accelerated approval program, which provides patients access to drugs for serious conditions while further ongoing trials are conducted. The drug was approved based on a phase 2 trial in which 417 participants were randomly assigned to receive one of four treatment combinations prior to surgery (given every three weeks for four cycles of treatment): Herceptin and docetaxel; Perjeta, Herceptin and docetaxel; Perjeta and Herceptin; or Perjeta and docetaxel. Thirty-nine percent of those receiving the Perjeta, Herceptin and docetaxel combination achieved a complete pathologic response, which means there was no detectable invasive cancer in the breast or lymph nodes. Only about 21 percent of those who received Herceptin plus docetaxel achieved a complete pathologic response. Perjeta is also the first drug approved based on a pathologic complete response instead of traditional endpoints, such as survival data and progression-free survival.
A large, phase 3 trial, called APHINITY, is ongoing to confirm these results and also examine the long-term effects of Perjeta. Approximately 4,800 participants with HER-2 positive breast cancer who have received prior breast cancer surgery and are at high risk for cancer recurrence are enrolled. Results from this trial are expected in 2016. Perjeta is still being further explored for treating breast cancer as well as other HER-2 positive cancers, colorectal and gastric cancers.
When asked for a comment, Lisa Carey, medical director of the UNC Breast Center in Chapel Hill, N.C., said that it is important that the FDA is recognizing the need for more flexible and nimble approaches. "This is a good one since the neoadjuvant trial was well designed and completed," she says. "The adjuvant trials, which will define this in terms of more clinically meaningful results, are finished collecting patients and just need to mature. So this is a good proof-of-principle for using the neoadjuvant approach as an intermediate."
However, some questions still need to be answered. Carey explains: "The questions center on the use of such a short duration of Perjeta since the augmentation of pathologic complete response with Herceptin was associated with improved outcome but with a year of therapy, not weeks. Also how can the heterogeneity of HER2+ disease impact response to single or dual HER2-targeting, and how can we get smarter since this is now an extremely expensive approach that needs a better selection strategy."
As Carey noted,the Perjeta-Herceptin combination will also carry a hefty price tag--it is expected to cost between $27,000-$49,000 for 9-18 weeks of therapy. However, there are patient assistance programs in place that might be able to help off-set the price.
Common side effects for participants receiving the Perjeta-Herceptin-docetaxel combination included hair loss, a decrease in white blood cells (neutropenia) and nausea. Other side effects included allergic reactions, hypersensitivity and decreased cardiac function.
For more information, visit Perjeta.com or call 855-737-5382.
For more information on HER-2 positive breast cancer visit: "Research Unravels New Ways to Treat HER2-Positive Breast Cancer".
Editor's Note: This blog was updated on Oct. 1.RELATED POSTS
BY GUEST BLOGGER | SEPTEMBER 11, 2013
About six months ago, I received a call at my house from a family friend who was in distress. As a community oncologist, it is not uncommon for me to receive cancer crisis calls from family, friends or someone I may not even know. This call concerned the grandfather, whom I will call John, of a friend of one of my boys; the caller was the boy's mother, whom I will call Donna, daughter of the patient.
I had actually known about the situation for some time. Donna and I had briefly talked about it at little league games or at places where parents run into each other. John had been battling liver cancer for over four years. He was being treated at a large, well-known cancer hospital and the doctors there had done an excellent job of keeping the cancer at bay. Over the years, parts of his liver had been surgically removed, others boiled with hot probes and many blood vessels had been choked off to deprive the cancer of oxygen. When these local measures no longer worked, he took chemotherapy and like a good soldier, even enrolled in clinical trials testing experimental ways to treat the cancer.
But John felt that the oncologist taking care of him now was mainly interested in enrolling him in study after study and that none of the chemotherapy or research treatments had done any good. The doctor did not answer his questions, talk to him about prognosis, or treat his ever-increasing pain. By the time his daughter reached out to me, the cancer was growing widespread in his liver and lungs, and John was told to enroll in a hospice program close to home. The center could not do anything more for him. They made him an appointment to return in three months, if he was still alive. Needless to say, the patient and his family were distraught.
Although I did not relish caring for a friend's dying parent, I agreed to see John in my office. I was thinking that I could at least make him feel cared for and supervise his end-of-life care. As John walked into my office and forced a smile, he appeared to be a man in the middle of the ocean holding onto a sinking boat. His wife and children filed in somberly. We started out by getting acquainted, talking about his life a bit and what he wanted most for the remainder of it; we even laughed some. John said he accepted that he was dying, that he could barely get out of bed and had no appetite, but that he just wanted to feel better if possible. He wanted to be hungry again, eat his favorite pasta meal, and be able to move without severe pain.
I first addressed his pain by prescribing a steady, more potent pain regimen. I had to assure him that taking narcotics would not make him an addict, something he feared and which greatly frustrated his family. Next, I was concerned about his shortness of breath, so I ordered a lung scan which revealed blood clots in his lungs (pulmonary emboli) in addition to the tumor deposits; I prescribed an injectable blood thinner, called enoxaparin (Lovenox). He seemed to immediately improved with these changes but he soon developed severe pain in his hip and I diagnosed new bone metastases. I convinced him to undergo a course of radiation therapy (he did not think it was worth the trouble), which fortunately did greatly diminished his pain.
I was relieved that John's pain and breathing improved though his appetite still remained poor. I was not sure how much time he had left. Without us noticing, the days led to weeks which somehow led to months as John's condition gradually improved. He was getting out of bed easily now, going shopping with his wife, even mowing the lawn again. And he was finally eating more; his gaunt appearance began to fill out toward normal. His mood was much less depressed. It was as if the grip of death had given him a respite and left his body.
It took us all by surprise. The family asked, "So, what's going on with his cancer?" I said frankly that I did not know but that we weren't treating it so I couldn't conceive that it was being controlled. But it is not usually the case that a cancer progresses and a patient's condition improves so I was indeed perplexed. Furthermore, I did drawn a tumor marker of liver cancer, called AFP, measurable from the blood. When I first met John it was over 7,000 (normal less than 5). Now two months later, it had inexplicably dropped to 300. I told John and his family that I needed confirmation and another measurement before I believed that huge drop. Sure enough, two weeks later the AFP was 220. In order to see what was happening with the cancer, and to answer their question more accurately, I sent John for a CAT scan. The result was also inexplicable but wonderful: the tumors in his liver and lungs had stopped growing and were actually a little smaller! I was incredulous.
"How could John's cancer be shrinking?" I asked myself this question over and over again as I tried to provide the family with some answers. Could it be the Lovenox? There have been no reports of cancer improving with this blood thinner, though there has been some talk of this possibility in the medical literature. Could it have been the radiation therapy? There have been rare reports of radiation therapy to a focal cancer deposit leading to regression of metastatic cancer in the rest of the body due to activation of an immune response (called an "abscopal effect"). Could it be John's change in attitude, from depression and hopelessness to a feeling of lightness and the joy of living? There certainly has been alot written about a person's "attitude" toward cancer and how important it is to maintain hope. Could it be my role as a trusted physician? I only thought of this after Donna gave me this passage from the book Anatomy Of An Illness As Perceived By The Patient (1979, W.W. Norton & Company) by Norman Cousins:
A prominent physician recalled of his physician father: "The instant he entered the sick room, the patient felt better. The art of healing seemed to surround his physical body like an aura; it was often not his treatment but his presence that cured." Francis Peabody's famous remark, "The secret of caring for the patient is in caring for the patient," is another way of stating that there is a miraculous moment when the very presence of the doctor is the most effective part of the treatment."
I was certainly flattered by that sentiment but could not claim the credit here. No, John's improvement is strictly in the realm of the unexplainable. Regardless, we all shared a joyous moment when the results came in. In contrast, John experienced a different reception when he returned three months later to his original hospital, to which he had considerable loyalty. John and his family were looking forward to seeing the pleased look on his doctor's face but were rendered speechless when he did not comment at all on John's miraculous improvement. "He told me their CAT scans were much better and that I should go for more chemotherapy there." "
Chemotherapy! Can you believe that?" John released a rare expletive as he relayed the encounter. We were all disappointed and surprised by this response.
It is now six months since I first met John, and he continues to thrive. I do not know how much longer he has or why he is enjoying more time than expected. But when you are dealing with cancer and the unexplainable happens, in a good way, I say go with it.
Richard C. Frank is a medical oncologist at Norwalk Hospital in Norwalk, Conn., and is the author of Fighting Cancer with Knowledge and Hope (Yale University Press 2013, 2nd edition).RELATED POSTS
BY KATHY LATOUR | AUGUST 28, 2013
It can get really depressing when you work in cancer. And then you get an email that has a video with it, and you get re-energized that we are making progress and that there are good people working on what seem like impossible ideas that may work.
That's what happened when I opened the TEDxSeattle talk by Jim Olson (Project Violet), a pediatric oncologist at the Hutch in Seattle who has decided he wants to find a way to cure children's brain cancer before he retires. (To watch it, scroll down to the bottom of the page and click on the YouTube video.)
But it's more than his vision that grabbed me with his talk. It's his passion and optimism that it can be done. Of course, the only thing standing in the way is money.
As most of you know who have been around cancer for any length of time, researchers have to get grants to be able to set up labs, hire help and the myriad other requirements to research cancer. Sometimes they spend more of the year begging for money than they do researching. They are also restricted by the unwritten law that their idea can't be too far out of the box or different.
Susan Love, MD, the well-known breast surgeon, addressed this point last weekend when she spoke at the first National Women Survivor's Conference in Nashville. She explained how complicated it can be to get grant funding, so researchers have learned to research things that are already being researched with maybe a tweak or two. Anyone with a really far out idea (that may have efficacy) won't get funds. To try and get researchers away from using mice and rats, Love created the Army of Women where volunteers wh can sign up to take part in clinical trials. But more on that later.
Some may consider Dr. Olson's ideas far out. I don't know if people scoffed at his idea that the toxins from scorpion poison could be the basis for a kind of tumor paint that would light up cancer cells. Well, maybe. But the point is, he has an idea that mother nature may be a great source of some solutions in cancer. And I am guessing he didn't want to wait around years for a couple hundred thousand dollars when he needed a couple of million to accomplish his goal. So he did something different, he started a nonprofit and has gone on the road telling people about his ideas and asking them to give. They can even name a drug.
His biggest boost has come in the form of the TEDxSeattle video he did earlier this year, the one I saw, where he shows the scorpion technology to identify a brain tumor in a way that it shows up differently than healthy tissue to surgeons. Seems that when surgeons get to the margin of a tumor, it's really hard to tell where the cancer stops and the good grey matter begins. This means pieces of cancer can be left in a child's head to begin growing again.
Olson's creation, which he calls tumor paint, shows the surgeon where the tumor cells are to help get it all while keeping the healthy cells undisturbed. It's in the video and it's fascinating.
Think about the applications to other surgeries. Huge. But the tumor paint is only one of his ideas. With his team of young inspired researchers he is looking at other nature-inspired solutions. And to finance his research and to honor one of his young patients, Olson created projectviolet.org a nonprofit where we can go to donate and support specific drug development. There is a spider project in the works, as well as petunia, potato and horseshoe crab. It's based on the idea of "Citizen Science," which says that all of us can participate in the exciting breakthroughs that drug discovery offers. Science belongs to everyone.
At Project Violet you will also meet the real Violet, the little girl who moved Olson to walk around to collect himself before meeting her and her parents, knowing that her brainstem glioma was incurable.
Anyway, I'll let you decide for yourself if this man is inspirational. If you think so, pass this on. Oh, and if you go to YouTube to watch his talk, the Washington Research Foundation will donate $10 to Project Violet – up to $50,000. And the more views he gets, the more likely the talk will make it to the real Ted Talk platform.RELATED POSTS
BY LINDSAY RAY | FEBRUARY 22, 2013
Today, Kadcyla (ado-trastuzumab emtansine, or T-DM1) received a long-awaited approval from the Food and Drug Administration (FDA) to treat patients with metastatic, HER2-positive breast cancer who have previously been treated with Herceptin (trastuzumab) or taxanes, a class of drugs that includes paclitaxel and docetaxel.
Kadcyla belongs to a new class of drugs called antibody-drug conjugates and works by fusing the powerful chemotherapy drug emtansine to the antibody Herceptin, which targets HER2 receptors on cancer cells.
The approval was based on results from the phase 3 EMILIA trial, which enrolled 991 patients who had previously been treated with Herceptin and a taxane-based chemotherapy. Patients were randomly assigned to either receive Kadcyla, or the current standard--a combination of Xeloda (capecitabine) and lapatinib. Those in the Kadcyla arm had a median overall survival of 30.9 months compared with 25.1 months for those in the combination arm. Patients receiving Kadcyla also had improved median progression-free survival: 9.6 months compared with 6.4. Furthermore, patients on Kadcyla experienced fewer severe side effects (grade 3 or higher) than those on Xeloda and lapatinib (43.1 percent compared with 59.2 percent).
Common side effects included low platelet count, nausea, fatigue and joint or muscle pain. This drug also carries a boxed warning (the highest warning the FDA can give) advising doctors and patients that in some instances, this drug can cause liver toxicity, heart toxicity and death. It can also lead to severe birth defects.
The drug is expected to be available within two weeks, and the estimated cost will be $9,800 a month, or $94,000 for a course of treatment. Genentech, the drug's manufacturer, is planning to begin patient assistance programs to help patients that might not be able to afford Kadcyla.RELATED POSTS
BY LINDSAY RAY | FEBRUARY 11, 2013
The Food and Drug Administration approved Pomalyst (pomalidomide) on Feb. 8 to treat patients with multiple myeloma who have progressed during or within 60 days after receiving at least two therapies, such as Revlimid (lenalidomide) or Velcade (bortezomib).
Pomalyst is a derivative of Thalomid (thalidomide), another drug used to treat multiple myeloma and in the same family of drugs as Revlimid. Called immunomodulating agents, these drugs incite the immune system to attack the myeloma cells.
The approval is based on a phase 2 clinical trial in which patients received either Pomalyst and low-dose dexemethasone, a type of steroid, or Pomalyst alone. In those on Pomalyst alone, 7.4 percent had their cancer completely or partially disappear compared with 29.2 percent for those receiving the combination. This response lasted for more than 7 months in the combination arm.
Pomalyst also performed well in a phase 3 clinical trial in which patients received either Pomalyst and low-dose dexemethasone, a type of steroid, or high-dose dexemethasone alone. Those in the Pomalyst combination arm lived 7.7 weeks longer without their disease progressing than those on the steroid alone. The median for overall survival had not yet been reached for those receiving Pomalyst when the data were presented at the American Society of Hematology annual meeting in December.
Common side effects included low white and red blood cell counts, fever and infections. The drug also includes a boxed warning (the highest warning the FDA can give) that pregnant women should not take the drug as it causes serious side effects, such as blood clots and birth defects. Therefore, prescribing physicians must be certified with the Pomalyst Risk Evaluation and Management Strategy (REMS) program.
For more information, visit pomalyst.com or call 800-931-8691.RELATED POSTS
BY ELIZABETH WHITTINGTON | FEBRUARY 6, 2013
Pancreatic cancer is an aggressive, hard-to-treat disease, especially once it spreads outside the pancreas. Unfortunately, about 80 percent of pancreatic tumors are diagnosed at stage 4. Because of the nature of the disease, even small gains are cause to take notice.
At the 2013 Gastrointestinal Cancers Symposium, results of the MPACT study, a phase 3 international trial that examined Abraxane and gemcitabine extended overall survival by more than 7 weeks when compared with gemcitabine alone.
Abraxane, called nab-paclitaxel, is a form of Taxol which is encased in a protein and is given intravenously. This formulation helps reduce side effects, such as severe allergic reaction, and the protein albumin may make it easier for the active compound paclitaxel to reach cancer cells than the camphor oil used in traditional Taxol.
Daniel Von Hoff, lead investigator of the MPACT study, presented the results at the conference as a late-breaking abstract. The study included 842 patients with newly diagnosed metastatic pancreatic cancer. Researchers found that the combination increased the median overall survival by almost two months (8.5 months compared with 6.7 months), meaning that half of the patients in the Abraxane arm were alive at 8.5 months.
Von Hoff noted that the benefit of the Abraxane combination over gemcitabine alone increased over time. At the one-year mark, 35 percent of patients taking Abraxane were alive compared with 22 percent in the gemcitabine-alone arm. Although only a small percentage of patients were followed to the two-year mark, the survival benefit had then doubled (9 percent versus 4 percent). The effect also stretched across various subgroups, even those with poor prognostic factors, such as extent of metastases. The poorer the prognostic factors, the more favorable the addition of Abraxane, Von Hoff said.
Patients who went on to second-line therapy after progressing in the MPACT trial also did better if they had been treated in the Abraxane arm. Although side effects were seen with the combination, including fatigue and peripheral neuropathy, more patients in the Abraxane arm were able to complete their treatment, hinting that it was more tolerable than gemcitabine alone.
Von Hoff predicted that the combination could become a backbone in new regimens for advanced pancreatic cancer.
Philip A. Philip, an oncologist with Karmanos Cancer Institute in Detroit, led the discussion of the study and also proposed Abraxane should be considered with other combinations, as well as in earlier stages of the disease.
"The rational in developing nab-paclitaxel in pancreatic cancer was based on hypothesis largely related to targeting the stroma," Philip said.
Recent studies have shown that one reason pancreatic cancer may be resistant to standard treatment is the stroma, a matrix of cells and molecules that are tightly knit together around the cancer. If Abraxane can weaken the stroma, gemcitabine may have a better chance in getting to the tumor cells, which could explain the synergistic effect researchers are seeing.
"I strongly encourage the investigators to grab this opportunity and go back to the lab to determine the molecular basis of this clinical benefit and its association with any biomarkers, such as SPARC." Research has shown that pancreatic cancers overexpress a protein called SPARC, which may attract Abraxane molecules and subsequently may increase tumor response to the drug. Philips called it an "invaluable opportunity" in developing future trials for this disease.
Celgene, the company that produces Abraxane, is planning to submit the drug to the FDA for approval for this patient population by mid-year. Abraxane is already approved for advanced lung and breast cancers.RELATED POSTS