On September 18, 2020, pancreatic cancer took the life of iconic US Supreme Court judge Ruth Bader Ginsburg. “Our nation has lost a justice of historic stature,” Chief Justice John Roberts said.
Pancreatic cancer is an aggressive type of cancer with traditionally poor outcomes. It remains a challenging disease to treat because of late detection and pancreatic cancer cells’ ability to evade chemotherapy. The survival data for pancreatic cancer is humbling, as cure remains elusive for many patients. Based on traditional statistics, only about 10% of Pancreatic Cancer patients are alive at five years.
Although the pace of progress in pancreatic cancer has been painfully slow, recent developments in the field offer a glimmer of hope and promise.
Emerging role of Precision Medicine
Precision Medicine in Pancreatic cancer is a promising new approach to tailor treatments to cancer cells’ genetic susceptibilities. Genetic sequencing of cancer cells from patients with metastatic pancreatic cancer can uncover potential targets for standard or experimental treatments. Based on a study published in Lancet Oncology, 26% of patients in the Know Your Tumor (KYT) program had mutations targetable with available drugs. Median overall survival across all stages treated with targeted therapies was 2.58 years vs. 1.51 years among patients who received only non-targeted treatments.
We encourage patients to get tested for inherited genetic mutations that may predispose them to pancreatic cancer and other cancers. Genetic testing can be easily performed on blood or saliva samples and is more affordable than ever before. Any positive genetic information provides insights about cancer biology and helps choose the most effective treatment. Also, data from a patient’s genetic test may help family members detect cancers early. For example, in patients with the BRCA gene mutation, platinum chemotherapy and PARP inhibitors have shown impressive results.
Role of multi modality treatment
Surgical resection is the only curative treatment of Pancreatic cancer. Unfortunately, however, many patients will have their cancer recur despite successful surgery. In the last many years, we have recognized pancreatic cancer as a systemic disease that spread early. This appreciation has led to the incorporation of chemotherapy earlier in the treatment course, often before surgery. One single-center study published in JAMA Oncology showed two-year overall survival rates of 72% by giving chemotherapy and radiation before surgery. Giving chemotherapy first leads to a higher rate of a successful surgery. Though the “chemo-first” approach is conceptually very appealing, additional studies are needed to establish its’ effects on survival. Improving outcomes of early-stage pancreatic cancer remains a significant unmet need.
For the last many years, FOLFIRINOX and Gemcitabine Nab-Paclitaxel have been the front line treatments for metastatic Pancreatic Cancer.
A pilot trial Jameson et al. published in JAMA Oncology evaluated the combination of cisplatin, nab-paclitaxel, and gemcitabine for treatment in this setting. This treatment showed a median overall survival of 16.4 months, which was slightly better than the historical numbers seen in prior trials.
We are entering a new phase in the war against cancer. Novel treatment modalities like immunotherapy, vaccines, and T-cell based therapies are expected to augment traditional treatments like surgery, chemotherapy, and radiation. The key to improving Pancreatic Cancer outcomes will rest with experienced multidisciplinary teams with access to cutting edge treatment protocols, both standard and experimental.
References:
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30074-7/fulltext
https://jamanetwork.com/journals/jamaoncology/fullarticle/2679565
https://jamanetwork.com/journals/jamaoncology/article-abstract/2752374
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