New Therapies May Increase Survival in Pancreatic Cancer

ORLANDO—A number of therapies now in clinical trials may make a difference in outcome for patients with pancreatic cancer, and some may indefinitely prolong survival, Alexander S. Rosemurgy II, MD, said at the Joint Cancer Conference of the Florida Universities. The conference is sponsored by the Univerity of South Florida College of Medicine and presented by the H. Lee Moffitt Cancer Center & Research Institute, University of Florida Shands Cancer Center, and University of Miami Sylvester Comprehensive Cancer Center..

Dr. Rosemurgy, director of the Center for Digestive Diseases, Tampa General Hospital, said that pancreatic cancer causes about 30,000 deaths a year, a number that seems to be rising for reasons that are not clear. It is the ninth most common cancer and ranks fifth as a cause of cancer deaths.

“Pancreatic cancer often involves no signs or symptoms, although some patients do get jaundice, and they tend to go see a doctor earlier,” he said, “Today, by and large, the death rate equals the number of diagnoses.”

Often with pancreatic cancer, both the diagnosis and the initiation of treatment drag. “The lack of signs or symptoms leads to patient delays. Most physicians see an average of one or two patients a year with this disease, so it may take a month to make the diagnosis. Then come the system delays. Patients need referrals for a specialist’s care, and that takes time.”

Dr. Rosemurgy described one man he treated whose diagnosis had occurred in September but who only reached him for treatment in February of the next year. He described another patient whose insurance company denied his request for treatment at Dr. Rosemurgy’s institution. The insurance company instead sent the man to a surgeon who had not performed a pancreatic cancer resection in 5 years. Dr. Rosemurgy’s group performs about 100 each year.

“Resection should be aggressively sought even if the tumor cannot be completely removed,” Dr. Rosemurgy said. Medical therapies can then be employed to deal with the remaining cancer. “Cure rates with resection are as high as 20%,” he said, “but very few people ever get to the operating room.”

On the horizon are a number of therapies that may make a difference in outcome. Dr. Rosemurgy distinguished between therapies that add just a few weeks or months to a patient’s life and those that increase survival for longer periods and thus “are commensurate with the inconvenience and cost.”

Promising Cancer Medications

He discussed several categories of drugs that may be useful after surgery. Genetic manipulation compounds comprise one such category. These might change the genetic structure of tumors by introducing segments of DNA to regulate the genes, such as p53, that govern the out-of-control growth.

Another promising category is cytotoxic boosters—compounds that increase the efficacy of cytotoxic therapies. “A host of these compounds, all known by numbers rather than names, are now in placebo-controlled trials,” Dr. Rosemurgy said.

Research is also ongoing as to the value of enzyme inhibitors, including marimastat, which inhibits metalloproteinases, enzymes that break down the bonds within cells. Such inhibition stabilizes the bonds within cells, thus limiting cancerous growth into adjacent organs.

“People need to be registered into these studies,” Dr. Rosemurgy said, “and if physicians were more willing to enroll patients in trials, we would complete these trials faster. Patients need to ask for this participation, too.”