Changing Course in Pancreatic Cancer

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

“I was very healthy. I didn’t smoke. I’d been going to the gym regularly since I was 20 years old,” says MacCaskill, who divides her time between Los Angeles and Aspen, Colo. “This came as a complete shock to me,” she adds. “It was terrifying.”

Her initial symptom was back pain, and after her physician ran more tests, she finally received a diagnosis of stage 3 pancreatic cancer. At that point, it had already started growing outside the pancreas.

MacCaskill and her husband began doing research. She received second and third opinions. Eventually, MacCaskill underwent a Whipple procedure and then began receiving chemotherapy. She continued that treatment for three years before it became ineffective.

“Four years ago I was told that I had three months to live,” MacCaskill says. Yet instead of accepting that prognosis, she began investigating other options.

“I was fortunate to find a doctor who thinks outside the box,” she says. Ultimately, she was prescribed another chemotherapy treatment that she received twice a day for one month.

Fast-forward to today, seven years after her diagnosis. MacCaskill is alive and thriving, serving as a volunteer and advocate for the Pancreatic Cancer Action Network.

Small Steps

The quest for targeted therapies has received a great deal of attention in cancer care, and deservedly so, but researchers are also looking at how to make better use of drugs and treatment regimens that already exist. One area is combining drugs or radiation therapy with surgery. Systemic chemotherapy, radiation therapy or a combination of the two are being used after surgery (adjuvant therapy) and before surgery (neoadjuvant therapy) in an effort to improve cure rates.

“We have developed combinations of chemotherapy with radiation that effectively downstages some patients who have locally advanced cancers without evidence of metastasis,” Simeone says. “We can now resect a subset of those patients and provide a significant survival benefit, where previously we weren’t able to do that.”

There have been some advancements in treating metastatic disease, although “not as significant as we would like,” she admits. However, she adds, on a positive note, there is much active research in this area.

There has also been interest in the use of FOLFIRINOX, a treatment combining several drugs that have long been used (5-FU [fluorouracil], leucovorin, irinotecan and oxaliplatin).

While gemcitabine has been a cornerstone of therapy for advanced pancreatic cancer for the past decade, it has only a modest impact on survival. A phase 3 clinical trial that compared FOLFIRINOX with gemcitabine as a first-line therapy in 342 patients with metastatic pancreatic cancer found that the combination extended survival by 4.3 months.

The downside is this approach comes with more serious side effects compared with gemcitabine alone. Ongoing and planned studies will continue to evaluate this regimen and investigate how to adjust doses to reduce toxicity.

Targeting the Stroma

Persistent research has resulted in important new leads for treatment.

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