“Penn is setting the standard in terms of survival and outcomes for pancreatic cancer.”
Ursina Teitelbaum, MD, medical oncologist at Penn Medicine
In opening her talk at the recent 2nd Focus On Pancreatic Cancer Conference, Dr. Teitelbaum acknowledged that for many years, pancreatic cancer treatment has characterized by “well deserved gloom.” Gemcitabine, introduced in 1996, was the first drug to show activity against pancreatic cancer, and has been the standard of therapy, but its effectiveness is limited. The multitude of trials using a variety of drugs and combinations of drugs yielded little progress. The scenario began to change in 2010 with the introduction of FOLFIRINOX, a combination of drugs that has demonstrated higher response rates, better control of the cancer and improved quality of life.
The second step in what Dr. Teitelbaum called “sudden, dramatic progress” has been the introduction of nab-paclitaxel, or Abraxane in 2012. Abraxane is a drug that has been used to treat a number of different types of cancer and is currently being tested against several others, including pancreatic cancer. It works by penetrating the stromal tissue, in effect, allowing the other drugs to be more effective in reaching cancer cells. Abraxane given with gemcitabine demonstrates significantly better overall survival for pancreatic cancer patients with advanced disease.
“These new treatments represent a true paradigm shift. It has been a long journey.” Dr. Teiltelbaum
Proton Therapy for Pancreatic Cancer
“The evidence is clear that treatment outcomes for pancreatic cancer are better in centers that treat a high volume of these tumors. These centers of excellence have cutting edge therapies that make a difference.” Edgar Ben-Josef, MD, radiation oncologist at Penn Medicine
Local Control is ImportantFor many pancreatic cancer patients, local control of their disease is crucial to both improving survival and maintaining quality of life. Many problems caused by pancreatic cancer result from the tumor’s progression around the primary site, not from distant metastases. Radiation therapy can play an important role in helping to achieve this local control. At Penn, sophisticated ways of planning and delivering radiation therapy are improving the outcomes and reducing the side effects for patients with pancreatic cancer. This includes IMRT, which allows doctors to increase the dose to the tumor while reducing the effects on other organs. Another approach teaches patients to hold their breath for 15-20 seconds while the radiation is delivered, overcoming the loss of accuracy that occurs when the simple act of breathing causes the pancreas and other organs to shift their position.
Penn is also involved in research that combines radiation therapy with other treatments, including a study to determine if radiation therapy and Abraxane can improve the prognosis for patients with borderline resectable pancreatic cancers, potentially making these patients candidates for surgery. Another protocol is studying whether high doses of radiation therapy can stimulate the immune system.
Proton Therapy For Pancreatic CancerPenn is one of just 10 centers nationally offering proton therapy, a modality that is increasingly being used to treat pancreatic cancer. Protons are another approach to delivering high doses o radiation to the tumor while sparing neighboring tissue. Penn is treating protons to treat advanced stage pancreatic patients with some promising results in extending life and relieving symptoms.
A Safer Approach to Pancreatic Cancer SurgeryThe original surgical procedure for pancreatic cancer, the Whipple procedure, had a mortality rate of 30 to 35 percent. According to Robert Roses, MD, surgical oncologist, the major breakthrough that has occurred in surgery for this disease is a significant improvement in its overall safety and reduced complications for patients who undergo the modern day version of the Whipple, known as the pancreaticoduodectomy.
“Our pancreatic cancer patients generally stay in the hospital for seven to 10 days,” says Roses, “and we focus on assuring that they have a good, safe recovery. They do sometimes have setbacks, but they are often self limited and can be well managed. The most important thing is that this surgery is often curative.”