The National Cancer Institute estimates that nearly 46,000 people will die this year from pancreatic cancer, which is the third-leading cause of cancer-related deaths. However, thanks to recent advancements, there is some good news for patients suffering from the disease.
While pancreatic cancer remains one of the most difficult cancers to treat, even with early diagnosis, two studies released last year have brought newfound hope. The evolution of treating pancreatic cancer began with introducing Folfirinox for those with metastatic cancer, which led to longer survival rates.
The second development defined borderline resectable pancreatic cancer — when a tumor surrounds the vascular system and was previously considered high risk — opening the window to surgically remove the tumor if it was non-progressing. We can now operate on more patients who were previously deemed inoperable. It takes a certain amount of courage to operate when the X-ray looks terrible. In reality, we can.
Here are more reasons of hope for pancreatic cancer patients.
Changes to the approach and definition of resectable pancreatic cancer tumors have helped patients live longer. For those with advanced disease, people with non-metastatic pancreatic ductal adenocarcinoma (PDAC) who had surgery followed by chemotherapy with Folfirinox (see No. 2) lived longer and were cancer-free longer than those who received standard chemotherapy.
For patients with advanced disease, Folfirinox treatment before surgery offers a path to hope. This is a major sea change because traditionally clinicians attempted to downstage (shrink the tumor) patients if they were deemed unresectable. They would hope and pray the tumor would shrink. If it didn’t shrink, they didn’t operate. Now we know clinicians need to look for non-progression of the tumor instead of it shrinking. If the tumor doesn’t progress, it can be surgically removed.
Folfirinox is a chemotherapy regimen that combines four drugs — oxaliplatin (Eloxatin), leucovorin (Wellcovorin), irinotecan (Camptosar) and 5-fluorouracil (5-FU; Adrucil). It has proven to extend the lives of those with advanced pancreatic cancer. Some perceive it as a game-changer for pancreatic cancer care.
Here’s why: During a recent study, Folfirnox or the standard gemcitabine was given to 493 participants three to 12 weeks after resection. When Folfirinox was delivered, the median survival was 54 months, nearly 20 months longer than gemcitabine.
Treatment before surgery is increasingly offered for patients with both resectable and borderline resectable pancreatic cancer. We’ve seen exceptional results for those who had Folfirinox after surgery.
A second study published in June 2018 showed chemoradiotherapy was effective in helping patients live longer. Nearly 250 participants were sectioned into two groups: one that received surgery first and a second that received chemoradiotherapy for 10 weeks before surgery. Results showed chemoradiotherapy patients had a median overall survival that was about three months longer than those who did not.
We need to update doctors and surgeons that the rules have changed. Simple X-rays don’t tell the entire picture. It’s a vast culture change that can start now, beginning with spreading the word about these advancements and providing alternatives for people who were previously deemed untreatable and inoperable.
I’ve performed surgery on some patients where the tumor literally melts off of blood vessels. In this case, it can look fine and there is no or very little cancer. The future question is: how do we save more lives?
William Nealon, MD, is codirector of Northwell’s Comprehensive Pancreas Cancer and Disease Center, one of the nation’s most groundbreaking programs in treating pancreatic conditions, including chronic and acute pancreatitis, type 3C diabetes and pancreatic cancer. He is also vice chair and chief of Northwell Health’s gastrointestinal and pancreatic surgery.