Changing Course in Pancreatic Cancer

Small, yet significant, advances are reshaping pancreatic cancer treatment.

ROXANNE NELSON
PUBLISHED: DECEMBER 09, 2013
Talk about this article with other patients, caregivers, and advocates in the Pancreatic Cancer CURE discussion group.
“There has been a tendency to try to lump all cancers together—if we understand the signaling pathways in one type of cancer, then we can understand them in all,” Simeone says. “But many of us working with pancreatic cancer feel that isn’t the case, and we need to understand the unique biology of this disease. There is something about it that is particularly aggressive.”

An emerging strategic approach for treatment involves targeting the tumor-associated stroma—the supportive tissue surrounding pancreatic cancers. New research has shown that the stroma encases the tumor cells, which could explain why pancreatic cancer doesn’t respond well to chemotherapy. The stroma also appears to have a specific protein profile called SPARC, which has been associated with a poor clinical outcome.

There has been a tendency to try to lump all cancers together... But many of us working with pancreatic cancer feel that isn’t the case, and we need to understand the unique biology of this disease.

An emerging strategic approach for treatment involves targeting the tumor-associated stroma—the supportive tissue surrounding pancreatic cancers. New research has shown that the stroma encases the tumor cells, which could explain why pancreatic cancer doesn’t respond well to chemotherapy. The stroma also appears to have a specific protein profile called SPARC, which has been associated with a poor clinical outcome.

Targeting the stroma might explain why the Abraxanegemcitabine combination appears to work in advanced pancreatic cancers. Abraxane is encased in a soluble protein called albumin that could help the combination infiltrate the stroma, target SPARC and get to the tumor better. The drug’s approval for pancreatic cancer in September was based on positive results of a large phase 3 study, in which participants who received a combination of Abraxane and gemcitabine lived about two months longer than those who had gemcitabine alone, but neutropenia (low white blood cell count) and neuropathy (nerve damage) were experienced more frequently by participants in the combination arm.

Under Investigation

With Abraxane’s approval, some experts are suggesting the combination will be a new standard of care. A Japanese study of the novel 5-FU-like agent S-1 showed that it boosted survival when compared with gemcitabine alone. While S-1 might soon be considered the new standard treatment in Japan, the study findings may not be applicable to non-Asian populations.

In addition, the monoclonal antibody nimotuzumab has been evaluated in a phase 2 trial as a combination with gemcitabine in patients who have previously untreated, locally advanced or metastatic disease. The study found the combination significantly improved one-year overall survival. Nimotuzumab targets the extracellular region of epidermal growth factor receptor (EGFR), a key target in the development of cancer therapeutics. It is not yet available in the U.S. (outside of clinical trials), but it has already been approved in several other countries to treat various types of cancer.

Smith is betting on continued breakthroughs. Now in her second round of treatment with Abraxane, she is optimistic that she will achieve a second remission and accomplish one of her short-term goals: celebrating her 50th wedding anniversary next year.

Talk about this article with other patients, caregivers, and advocates in the Pancreatic Cancer CURE discussion group.
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