When pancreatic cancer has returned following initial treatment, it is referred to as recurrent or relapsed cancer. Recurrent pancreatic cancer is very difficult to treat and treatment options are limited.
Historically, patients with recurrent pancreatic cancer have been considered incurable and rarely survived more than one year. However, with newer treatments, some patients are deriving benefit and treatment is also focused on reducing pain and maintaining nutrition and quality of life. Pain relief can be achieved by destroying the nerves that provide sensation in the area around the pancreas. This is usually performed by injection of alcohol or other chemicals either through the skin or during an open abdominal operation.
Systemic Therapy: Precision Cancer Medicines, Chemotherapy, and Immunotherapy
Systemic therapy is treatment directed at destroying cancer cells throughout the body. Systemic therapy may include chemotherapy, precision cancer medicines, immunotherapy or a combination of these therapies.
Cancer chemotherapy may consist of single drugs or combinations of drugs and can be administered through a vein or delivered orally in the form of a pill. Combinations of chemotherapy drugs that have not previously been used to treat the cancer are typically used for treatment of recurrent disease. In addition to chemotherapy, participation in a clinical trial evaluating new chemotherapy drugs or precision cancer medicines should be considered.
Strategies to Improve Treatment
The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Areas of active investigation aimed at improving the treatment of pancreatic cancer include the following:
Development of Precision Cancer Medicines
Research is ongoing to develop new medications that specifically target cancer cells in clinical trials. These trials typically require a sample of the cancer or liquid biopsy to be available in order to evaluate for biomarkers. Patients should learn about options to participate in these trials prior to surgery in order to ensure that cancer tissue is obtained correctly.1,2 Learn more about development of precision cancer medicines for treatment of pancreatic cancer.
Vaccines: A vaccine is a form of immunotherapy that is designed to help the patient’s immune system destroy the cancer by activating the patient’s immune cells against the cancer. Vaccines are made from a variety of substances that often include the actual cancer cells removed from the patient. A difficulty in preparing vaccines is that the patient’s cancer cells must be processed immediately following surgery. Patients and their surgeon must therefore prepare in advance to ensure the removed cancer cells can be handled properly for vaccine preparation. Vaccines are currently being evaluated in clinical studies.
The GVAX vaccine has been designed to stimulate the immune system to fight pancreatic cancer.3 The vaccine is comprised of radiated pancreatic cancer cells that are not able to replicate or grow. The cells have been modified to secrete a substance referred to as granulocyte macrophage colony stimulating factor (GM-CSF), which stimulates the immune system to recognize pancreatic cancer cells and attack them.
Results from the initial trial evaluating the GVAX vaccine are promising and additional clinical trials are ongoing.
At a median follow-up of 32 months:
- Survival at one year was 88%.
- Survival at two years was 76%.
Immunotherapy-Trials in Humans Coming
A new study in mice by researchers at Fred Hutchinson Cancer Research Center has found that a specialized type of immunotherapy — even when used without chemotherapy or radiation — can boost survival from pancreatic cancer, a nearly almost-lethal disease, by more than 75 percent. The findings are so promising that human clinical trials are now ongoing.
The researchers devised a therapy using T cells, disease-fighting immune cells, that they engineered in the lab to recognize and attack pancreatic cancer. T cells — engineered to recognize and kill cells bearing a protein called mesothelin, which is overproduced by virtually all pancreatic tumors get into the mice’s tumors and started attacking them.4
Phase I Clinical Trials
New chemotherapy drugs continue to be developed and evaluated in patients with advanced cancers in Phase I clinical trials. The purpose of Phase I trials is to evaluate new drugs in order to determine the safety and tolerability of a drug and the best way of administering the drug to patients.
3 Laheru D, et al. A Safety and Efficacy Trial of Lethally Irradiated Allogeneic Pancreatic Tumor Cells Transfected with the GM-CSF Gene in Combination with Adjuvant Chemotherapy for the Treatment of Adenocarcinoma of the Pancreas. Proceedings from the International Conference of AACR-NCI-EORTC. November, 2005. Philadelphia, PA. Abstract #C28