Changing Course in Pancreatic Cancer

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

Susan Smith is hopeful. For the first time in years, a new drug combination has put her pancreatic cancer back into remission. In May, she began receiving gemcitabine in combination with Abraxane (nab-paclitaxel), a drug already approved by the Food and Drug Administration (FDA) for treating breast and lung cancers. A recent scan showed very encouraging news—the size of the lesion was reduced by nearly half. “Both my doctor and I were extremely pleased with the results,” Smith says.

The 66-year-old resident of Vero Beach, Fla., received her pancreatic cancer diagnosis almost seven years ago and underwent surgery to remove part of her pancreas and spleen. She then received an intense regimen of chemotherapy and radiation and was followed closely by her oncologist for the next five years without further treatment, as she appeared to be in remission.

Five years after receiving her diagnosis, she no longer needed imaging scans. However, in March, Smith began experiencing back pain. Scans and a biopsy revealed that her cancer had metastasized to her liver.

Her initial treatment with Abraxane had to be halted because it made her white blood cell count plummet. She restarted treatment with an altered schedule that included doses of granulocyte colony-stimulating factors (G-CSFs) to boost her white blood cells.

Early on, Smith struggled with other side effects, including rash, thrush, mouth sores and poor appetite. But as the treatment progressed, the side effects lessened. “Now I experience tiredness, lethargy and flu-like symptoms on the third and fourth day after chemo, but other than that I get along well,” she says.

Early Detection is Important

About 45,000 new cases of pancreatic cancer are estimated to be diagnosed this year in the U.S. Patients with the disease face a tough challenge due to its aggressive nature and resistance to available treatments. Moreover, it can be difficult to diagnose in its early stages (less than 20 percent of tumors are confined to the pancreas at the time of diagnosis), so all too often, the disease has already spread to the point where surgical removal of the tumor is not possible. Thus, the one-year survival rate for all stages of the disease combined is about 20 percent. Unfortunately, disease recurrence is common, and the five-year survival rate for pancreatic cancer is 6 percent.

The best predictors of long-term survival following surgery (considered the only potentially curative treatment at this time) are small tumor size, no lymph node involvement and no cancer cells surrounding the tissue where the tumor was removed. There is also increasing evidence that the best outcomes after surgery for the disease are achieved at major medical centers that perform more than 20 pancreatic surgeries annually.

Inroads into effective treatments and better diagnostics have been slower than with many other cancers, but new approaches are emerging, especially as more is learned about the biologic makeup of the disease.

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