Chemotherapy’s a common treatment for pancreatic cancer.
However, a clinical trial underway at UT Southwestern Medical Center is using an innovative approach to better target the cancer with added benefit for late-stage patients.
In today’s Vital Signs, KERA’s Sam Baker talked about the trial with Dr. Salwan Al-Mutar, an assistant professor of medicine and co-director of UT Southwestern’s pancreatic cancer program.
Dr. Al-Mutar: So, what this trial is trying to investigate is doing the induction chemotherapy first for two months, followed by radiation, followed another cycle of chemotherapy, but then people will be randomized into two groups.
One group will continue the standard of care, which is continuation of chemotherapy. The other group getting the chemotherapy directly to the tumor. That is done usually by a catheter, and that catheter introduces chemotherapy directly to the tumor after obtaining access through one of the main arteries in the body, then feeding that catheters into the arteries that supply the tumor.
What we're trying to see is how much better response we can obtain from delivering that chemotherapy, which is the gemcitabine, directly to the tumor. And also, you know, how much are we preventing or improving quality of life in terms of decreasing toxicity?
Baker: The current use of chemotherapy does not normally introduce it to the tumor?
Dr. Al-Mutar: It does make it to the tumor, but through the whole body circulation.
What we're trying is that how can we deliver more to the tumor and also reduce more of the chemotherapy to be dispersed for all other rapidly dividing cells in the body, because we all have rapidly dividing in our stomach lining, for example, in our colon, in our blood, like our blood cells.
So, when you give chemo directly to the whole body by kind of collateral damage, you can affect these rapidly dividing cells.
Baker: What have been the outcomes so far?
Dr Al-Mutar: Well, the outcomes now with the 30% of analysis of the data had been an improvement in what we call progression-free survival. It added around six months.
Also, we had noticed there is significant decrease in toxicity in a lot of the common side effects, like the GI side effects: Nausea, vomiting, diarrhea. Also, what we call hematologic toxicity, so the effect on the blood cells, like the white blood cells that hemoglobin, the platelets had been noted to be less, but that is obviously is still limited. That's based on 30% of the data.
The trial is approaching its end. We're 17 patients away from finishing enrollment and hopefully working on the full analysis of the data and publishing that of course.
Baker: Overall, pancreatic cancer is very difficult to treat. Why?
Dr. Al-Mutar: Part of it is just the biology of it. It has very complex biology and relies on different pathways to grow and progress.
The other thing, it has some kind of protective neighbor, something we call stroma, so that stroma is quite dense and surrounds the tumor and prevents a lot of treatment to infiltrate into the actual tumor. And that makes it more difficult to treat and also have, you know, high rates of recurrence because you can maybe control it for a period of time, but even in the best case scenario, and it can still have high risk of recurrence.
Nonetheless, there have been several advances, especially in the past couple of years, in targeting a very common pathway called the KRAS mutation pathway that mitigates the risk in around 85, 90 percent of the tumors.
We are all optimistic to see some of the drugs approved that target this mutation maybe sometime next year. There is also other advances in different types of immunotherapy in some treatments that targets that that's trauma or the neighboring cells to the tumor and also other targets in pancreatic cancer.
So, I'm happy to witness maybe some shift in the paradigm that we hopefully going to see in the next few years in treating this difficult than devastating cancer.
RESOURCES:
Chemotherapy for Pancreatic Cancer
Systemic treatment for advanced pancreatic cancer
New pancreatic cancer research may improve detection and treatment
