Pancreatic Cancer

A 72-year-old man is referred for evaluation of abnormal liver chemistries. He has a history of unresectable pancreatic cancer (adenocarcinoma of the head).

Very small pancreatic cystic tumors are safe to observe, rather than treat, in patients with no symptoms and no radiographic features associated with malignancy, according to a study of patients with neoplasms less than 3 cm in size.

Avalon initiates phase II trial of AVN944 in pancreatic cancer

The appearance of a rash in cancer patients treated with erlotinib (Tarceva) is strongly associated with longer survival, according to researchers from the drug's developer, OSI Pharmaceuticals

BRIDGEWATER, New Jersey—Enzon Pharmaceuticals, Inc.'s PEG-SN38, a novel polyethyleneglycol-SN38 conjugate, resulted in significant tumor growth inhibition in mice resistant to irinotecan (Camptosar) (a 25% decrease in tumor volume) and outperformed irinotecan when given as a second-round therapy to mice initially sensitive to irinotecan, the company said in a news release. The data were presented at the American Association for Cancer Research 2007 meeting (abstract 1494). Additionally, PEG-SN38 demonstrated long-lasting anti-tumor activity in mouse models of human breast and pancreatic cancers, the company said.

Study results published by the Journal of Clinical Oncology show that adding erlotinib (Tarceva) to gemcitabine (Gemzar) chemotherapy significantly improves survival by 22% in patients with advanced pancreatic cancer.

ImClone and Bristol-Myers Squibb announced that a phase III study of cetuximab (Erbitux) plus gemcitabine (Gemzar) in patients with locally advanced unresectable or metastatic pancreatic cancer did not meet its primary endpoint of improving overall survival.

Despite attempted curative resection of localized adenocarcinoma of the pancreas, most patients experience a recurrence and die of their disease. The Gastrointestinal Tumor Study Group, European Organisation for Research and Treatment of Cancer, and European Study Group for Pancreatic Cancer trials have suggested the benefit of adjuvant therapy. However, the relatively few randomized trials available have not established a definite standard of care due to study limitations. Although these trials, and the recently published Charité Onkologie (CONKO)-001 trial, have shown a definite advantage of adjuvant chemotherapy, the most effective chemotherapy and the role of radiation therapy remain unclear. This review will discuss the data available from reported trials of adjuvant and neoadjuvant therapy in pancreatic cancer, address the issues leading to the ongoing controversies, and consider future directions for clinical trials.

Despite attempted curative resection of localized adenocarcinoma of the pancreas, most patients experience a recurrence and die of their disease. The Gastrointestinal Tumor Study Group, European Organisation for Research and Treatment of Cancer, and European Study Group for Pancreatic Cancer trials have suggested the benefit of adjuvant therapy. However, the relatively few randomized trials available have not established a definite standard of care due to study limitations. Although these trials, and the recently published Charité Onkologie (CONKO)-001 trial, have shown a definite advantage of adjuvant chemotherapy, the most effective chemotherapy and the role of radiation therapy remain unclear. This review will discuss the data available from reported trials of adjuvant and neoadjuvant therapy in pancreatic cancer, address the issues leading to the ongoing controversies, and consider future directions for clinical trials.

Despite attempted curative resection of localized adenocarcinoma of the pancreas, most patients experience a recurrence and die of their disease. The Gastrointestinal Tumor Study Group, European Organisation for Research and Treatment of Cancer, and European Study Group for Pancreatic Cancer trials have suggested the benefit of adjuvant therapy. However, the relatively few randomized trials available have not established a definite standard of care due to study limitations. Although these trials, and the recently published Charité Onkologie (CONKO)-001 trial, have shown a definite advantage of adjuvant chemotherapy, the most effective chemotherapy and the role of radiation therapy remain unclear. This review will discuss the data available from reported trials of adjuvant and neoadjuvant therapy in pancreatic cancer, address the issues leading to the ongoing controversies, and consider future directions for clinical trials.

Curcumin, an ingredient in the dietary spice turmeric (see box), may be useful in treating pancreatic cancer, according to two groups of investigators who presented their work at the Society for Integrative Oncology Third International Conference.

An investigational therapeutic vaccine (GVAX immunotherapy) given with chemotherapy and radiation therapy following surgery for pancreatic cancer appears to improve survival for these difficult-to-treat patients

Cell Genesys, Inc, announced follow-up data from a phase II clinical trial of GVAX immunotherapy for pancreatic cancer in 60 patients with operable pancreatic cancer who received the immunotherapy after surgical resection of their tumor and adjuvant radiation and chemotherapy.

Mutation of palladin, a cytoskeletal gene that controls cell shape and motility, and overexpression of palladin protein are implicated in both familial and sporadic forms of pancreatic cancer, respectively, and explain the typical nuclear disarray seen histologically in patients with the disease

A panel of 10 biomarkers found in the blood may prove to be useful in detecting asymptomatic pancreatic cancer, according to researchers at the University of Pittsburgh School of Medicine. "With median survival rates of 6 to 12 months, early detection of pancreatic cancer is crucial to patient survival, but there has been no way to diagnose it early before symptoms occur," Anna E. Lokshin, PhD, associate professor of medicine and pathology, said at the American Association of Cancer Research's Frontiers in Cancer Prevention Research meeting

Results from Oncolytics Biotech's phase I trial of Reolysin, its oncolytic reovirus, show stable disease in 7 of 32 patients with advanced or metastatic solid tumors refractory to standard therapy or for which no curative standard therapy exists. Dr. Timothy Yap of The Institute of Cancer Research, Sutton, UK, presented the study at the 18th EORTC-NCI-AACR Symposium on Molecular Targets and Cancer Therapeutics

An innovative cancer agent called PHA-739358, which inhibits one of the aurora proteins, has shown indications of potential benefit in 7 of 36 patients (19.4%) with advanced or metastatic solid tumors who participated in a phase I dosing and toxicity study, Dutch researchers reported at the EORTC-NCI-AACR Symposium on Molecular Targets and Cancer Therapeutics

The science supporting molecularly targeted therapies for the treatment of patients with solid tumors continues to evolve. Nurses are challenged to understand cell signaling, molecular targeting, and the mechanism of action of targeted agents. Two cell signal transduction pathways regulate the development, proliferation, and metastasis of solid tumors: the human epidermal growth factor (HER) receptor pathway and the vascular endothelial growth factor (VEGF) receptor pathway. Several novel pharmacologic agents with distinct indications and methods of administration target the HER and VEGF molecular pathways.

A study comparing two experimental regimens with standard 30-minute gemcitabine (Gemzar) infusions for advanced pancreatic cancer found temporary improvements in tumor response, but no survival benefit

Nationally, the rate of in-hospital mortality associated with pancreatectomy for pancreatic cancer and other neoplasms has decreased in recent years

Salinosporamide A, a novel proteasome inhibitor, enhances the effectiveness of conventional chemotherapy and molecular therapy combinations in pancreatic cancer, new preclinical data show. Lead author James C. Cusack, Jr., MD, presented findings from a set of experiments with the novel agent at the 2006 Gastrointestinal Cancers Symposium (abstract 93).

Surgery for cancer carries concerns of tumor dissemination related to tumor manipulation, tumor violation, and wound seeding. Minimally invasive surgery is now standard for several benign conditions, such as symptomatic cholelithiasis and surgical therapy of gastroesophageal reflux. With the minimally invasive surgery explosion of the 1990s, virtually every procedure traditionally performed via laparotomy has been performed successfully with laparoscopic methods, including pancreaticoduodenectomy for cancer. Shortly after the first descriptions of laparoscopic-assisted colectomy, reports of port-site tumor recurrences surfaced, raising concerns of using pneumoperitoneum-based surgery for malignancy. This review covers the development of laparoscopic surgery for cancer. Historical perspectives elucidate factors that helped shape the current state of the art. Theoretical concerns are discussed regarding surgery-induced immune suppression and its potential effects on tumor recurrence with both open and laparoscopic approaches. The concerns of laparoscopic port-site wound metastases are addressed, with a critical evaluation of the literature. Finally, a technical discussion of laparoscopic-assisted resections of hepatic and pancreatic tumors details patient selection, operative approach, and existing data for these operations.

Treatment of metastatic breast cancer is "a book with many chapters, ie, with many opportunities for meaningful intervention, as opposed to pancreatic cancer, for example," Andrew Seidman, MD, said in his discussion of metastatic breast cancer at the Second Annual Advances in Oncology meeting, sponsored by the journal ONCOLOGY.

This supplement to Oncology News International includes more than 15 reportson presentations made at the 41st annual meeting of the American Society of Clinical Oncology.Reviews focus on the use of targeted agents in non–small-cell lung cancer and other solid tumors,evaluating the novel therapies bevacizumab, cetuximab, bortezomib, erlotinib, and gefitinib, aloneand/or in combination with other chemotherapy agents. Continuing medical education credit isavailable by completing a post-test and evaluation online at www.cancernetwork.com/cme.

TORONTO, CANADA-Addingerlotinib (Tarceva) to gemcitabine(Gemzar) increased 1-year survivalby 40% for patients with

BASEL, SWITZERLAND-The combination of gemcitabine(Gemzar)/capecitabine (Xeloda)(GemCap) failed to prolong survivalmore than gemcitabine (Gem) alone,

ANAHEIM, California-Heavy consumption of red meat and processed meats may increase the risk of pancreatic cancer, according to a multiethnic study. The results suggest that carcinogenic substances related to meat preparation, rather than the

Combined-modality positronemissiontomography (PET)–computed tomography (CT) isbecoming the imaging method ofchoice for an increasing number ofoncology indications. The goal of thispaper is to review the evidence-basedliterature justifying PET-CT fusion.The best evidence comes from prospectivestudies of integrated PETCTscans compared to other methodsof acquiring images, with histopathologicconfirmation of disease presenceor absence. Unfortunately, veryfew studies provide this kind of data.Retrospective studies with similarcomparisons can be used to provideevidence favoring the use of integratedPET-CT scans in specific clinicalsituations. Also, inferential conclusionscan be drawn from studies whereclinical rather than pathologic dataare used to establish disease presenceor absence.

HOLLYWOOD, Florida-Smoking not only increases the risk of developing pancreatic cancer but also speeds disease progression, according to Randall E. Brand, MD. In a presentation at the 2005 Gastrointestinal Cancers Symposium (abstract 76), Dr. Brand said that current smokers develop pancreatic cancers about 10 years sooner than nonsmokers. "Smoking at any age has an impact on the age of diagnosis of pancreatic cancer," Dr. Brand said. "To our knowledge, this is the first report that provides compelling evidence for the role of cigarette smoking early in neoplastic transformation of the pancreas."

This special “annual highlights” supplement to Oncology News International (ONI)is a compilation of selected news on important advances in the management ofgastrointestinal cancers over the past year, as reported in ONI. Guest Editor, Dr.James L. Abbruzzese, comments on the reports included herein and discussesdevelopments in the clinical management of GI cancers, with a look at the impactof targeted agents with cytotoxic chemotherapy, first-line and adjuvant therapies foradvanced disease, and the role of statins and COX-2 inhibitors in prevention.