Research And Clinical Trials
In addition to being up to date with the current standard of care for pancreatic cancer, our team also strives to develop and deliver cutting-edge treatment options that can lengthen patient survival.
For instance, our research group, led by Dr. Ken Olive, has pioneered a new understanding of how the cells which surround the pancreatic tumor relate to cancer growth. Currently a new drug, called hyaluronidase, is being studied at Columbia to further investigate this concept.
The Pancreas Center at NewYork-Presbyterian/Columbia also offers patients the opportunity to participate in clinical trials examining other new drug combinations, as well as targeted therapies that kill only cancer cells and not normal cells. Other therapies that we are testing in clinical trials include vaccines against pancreatic cancer cells and specialized treatments for patients with specific genetic mutations . We have many active clinical trials for patients with adenocarcinoma and neuroendocrine cancers and recommend that every patient be evaluated for participation in an appropriate study.
Pancreatic Cancer Treatment Is Impacted By Resectability
Surgery is the only treatment that can cure pancreatic cancer, but is an only option for about 20% of cases. This means that its important to define whether a patient may benefit from surgery at the time of pancreatic cancer diagnosis, and reserve surgery only for when it may provide clinical benefit.
Because of this, MD Anderson doctors use a contemporary staging system, called resectability staging, to plan a patients treatment. This type of staging classifies pancreatic cancers into three groups, based on whether or not they can be removed with surgery. A patients potential treatment plan varies depending on the resectability staging of their pancreatic cancer.
Chemotherapy & Targeted Drugs For Pancreatic Cancer
Doctors at NYU Langones Perlmutter Cancer Center may prescribe chemotherapy, a group of drugs that helps destroy cancer cells, to manage pancreatic cancer.
Chemotherapy is sometimes combined with targeted drugs, which are designed to destroy cancer cells while sparing healthy cells. Targeted drugs may cause fewer side effects than chemotherapy because theyre less likely to damage healthy tissues. Sometimes, these targeted drugs are given to people with pancreatic cancer who cannot have surgery.
Because chemotherapy increases the effectiveness of radiation therapy, in which energy beams are used to remove cancer cells, the two are often combined in an approach called chemoradiation.
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Further Improving Pancreatic Cancer Treatment
Together, the two trials immediately raise additional questions, Dr. Rudloff said. They include whether mFOLFIRINOX should replace gemcitabine as neoadjuvant therapy and whether using newer types of radiation therapy, such as stereotactic body radiation therapy, in neoadjuvant treatment regimens could further improve outcomes.
While waiting for further trials, more oncologists will probably start to use mFOLFIRINOX both in the neoadjuvant and adjuvant settings, speculated Dr. Ocean. “The challenge will be to accurately predict which patients will be able to handle this more intensive regimen, especially after a major surgery such as a Whipple or pancreatic cancer resection,” she said.
Moving forward, Dr. Rudloff added, more laboratory studies and clinical trials are needed to develop completely new therapies for pancreatic cancer.
What we need in pancreatic cancer, without any question, are better drugs, he said. And while these studies represent progress, it is incremental. There’s so much room for improvement.
Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.
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Treating Resectable Pancreatic Cancer
People whose pancreatic cancer is considered resectable may undergo one of three surgeries:
Whipple procedure : A surgeon removes the head of the pancreas and sometimes the body of the pancreas, parts of the stomach and small intestine, some lymph nodes, the gallbladder, and the common bile duct. The remaining organs are reconnected in a new way to allow digestion. The Whipple procedure is a difficult and complicated surgery. Surgeons and hospitals that do the most operations have the best results.
About half the time, once a surgeon sees inside the abdomen, pancreatic cancer that was thought to be resectable turns out to have spread, and thus be unresectable. The Whipple procedure is not completed in these cases.
Distal pancreatectomy: The tail and/or portion of the body of the pancreas are removed, but not the head. This surgery is uncommon for pancreatic cancer, because most tumors arising outside the head of the pancreas within the body or tail are unresectable.
Total pancreatectomy: The entire pancreas and the spleen are surgically removed. Although once considered useful, this operation is uncommon today.
Chemotherapy or radiation therapy or both can also be used in conjunction with surgery for resectable and unresectable pancreatic cancer in order to:
- Shrink pancreatic cancer before surgery, improving the chances of resection
- Prevent or delay pancreatic cancer from returning after surgery
How Long Does Chemo Work For Pancreatic Cancer
There are a number of factors that influence whether chemotherapy is a successful treatment option for pancreatic cancer and how long remission lasts. For example, the specific kind of chemotherapy drugs prescribed as well as the dosage and length of treatment are all important factors. Your treatment team will make recommendations based on your individual case. If the chemotherapy stops being a viable treatment option, your treatment team will consider other options.
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Chemotherapy Before And After Surgery
Chemotherapy may be given alone or in combination with radiation therapy, called chemoradiation, before surgery to shrink large tumors located near important blood vessels. This improves the odds that the surgeon can remove the cancer. Chemoradiation may also be given after surgery to help prevent the tumor from returning.
Chemotherapy or chemoradiation may be the only treatment used in people who have advanced pancreatic cancer that has spread to organs such as the liver and lungs and therefore cannot benefit from surgery.
Our doctors may also prescribe chemotherapy or chemoradiation to ease pancreatic cancer symptoms, such as pain or weight loss. Because chemotherapy can shrink tumors, it can help relieve discomfort and improve your ability to eat if the tumor is interfering with nearby digestive organs, such as the stomach or intestines.
How And Where Is Chemotherapy Given
Chemotherapy drugs can be given through a vein into the bloodstream or by mouth . Usually, patients receive chemotherapy as an outpatient treatment at a hospital, clinic or doctors office. The time needed for each treatment session depends on the type of chemotherapy. In some cases, a hospital stay may be necessary if the doctor wants to monitor the patient during the treatment.
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Chemotherapy Regimens For Pancreatic Cancer
The Food and Drug Administration has approved four chemotherapy drugs for the treatment of pancreatic cancer: gemcitabine , nab-paclitaxel , liposomal irinotecan , and 5-FU . NCCN guidelines also include treatment with oxaliplatin in combination with 5-FU based chemotherapy, and the drug combination FOLFIRINOX. Each of these treatments have varying levels of efficacy and toxicity.
If someone has early stage I or stage II disease, where the goal of treatment is potentially curative, we tend to be more aggressive with our chemotherapy choices, Chung says. Heres how it breaks down:
5-FU: Before 1995, fluorouracil was the standard treatment for advanced pancreatic cancer. In trials using CT assessment of tumor response, the reported response rates for single-agent 5-FU ranged from 0% to 19%. Now 5-FU is typically used in combination with other therapies.
Gemcitabine: In 1996, the FDA approved gemcitabine for the treatment of pancreatic cancer that doctors cant remove surgically. A 2007 report showed benefit in preventing recurrence after surgery.
Nab-Paclitaxel: In September 2013, the FDA approved nab-paclitaxel for use, in combination with gemcitabine, as a first-line treatment for metastatic pancreatic adenocarcinoma.
Liposomal Irinotecan: In October 2015, the FDA approved liposomal irinotecan in combination with 5-FU for metastatic pancreatic adenocarcinoma that progressed after treatment with gemcitabine.
Possible Side Effects Of Chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow , the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Common side effects can include:
- Nausea and vomiting
- Increased chance of infections
- Easy bruising or bleeding
Most side effects go away after treatment is finished. Tell your cancer care team about any side effects or changes you notice while getting chemotherapy, so that they can be treated promptly. Often medicines can help prevent or minimize many of the side effects. For example, your doctor can prescribe drugs to help prevent or reduce nausea and vomiting. In some cases, the doses of the chemo drugs might need to be lowered or treatment might need to be delayed or stopped to keep the effects from getting worse.
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Is Chemotherapy Given With Other Treatments
Chemotherapy may be given alone or in combination with surgery, targeted therapy, immunotherapy and/or radiation. When chemotherapy is given in combination with radiation, a low dose of chemotherapy is typically used. Chemotherapy may act as a radiosensitizer that can enhance the effect of the radiation on the tumor.
The chemotherapy drugs most commonly used in conjunction with radiation therapy are fluorouracil and gemcitabine . 5-FU is used most often since there is more experience using this drug in combination with radiation and there are fewer side effects.
Chemotherapy For Pancreatic Cancer
Chemotherapy may be used at any stage of pancreatic cancer to kill cancer cells. Chemotherapy drugs are usually administered in cycles, with alternating periods of treatment and recovery. They may be given alone or in conjunction with radiation therapy or surgery.
According to the American Cancer Society, the following chemotherapy drugs may be used to treat pancreatic cancer:
- Irinotecan liposome
If the patients health is strong enough, two chemotherapy drugs may be used together to fight pancreatic cancer. They may be given intravenously or by mouth. Chemotherapy is very powerful and can lead to a wide range of side effects, including hair loss, nausea and vomiting, changes in appetite and fatigue.
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Treatment For Pancreatic Cancer
Pancreatic cancer can be difficult to treat.
The treatment you have will depend on:
- the size and type of pancreatic cancer you have
It may include surgery, chemotherapy, radiotherapy and supportive care.
The specialist care team looking after you will:
- explain the treatments, benefits and side effects
- work with you to create a treatment plan that is best for you
- help you manage any side effects, including changes to your diet to help you digest your food
You’ll have regular check-ups during and after any treatments. You may also have tests and scans.
If you have any symptoms or side effects that you are worried about, talk to your specialists. You do not need to wait for your next check-up.
Chemotherapy For Pancreatic Neuroendocrine Tumor
Chemotherapy uses anti-cancer drugs injected into a vein or taken by mouth to kill cancer cells. These drugs enter the bloodstream and reach almost all areas of the body, making this treatment useful for some types of cancers that have spread.
Chemo is most often used to treat pancreatic neuroendocrine tumors if they:
- Have not responded to other medicines ,
- Have spread to other organs,
- Are large or growing quickly,
- Are causing severe symptoms, or
The most commonly used drugs for pancreatic NETs include:
Some tumors might be treated with more than one drug. Possible combinations include:
- Doxorubicin plus streptozocin
- 5-FU plus doxorubicin plus streptozocin
- Temozolomide plus capecitabine
- 5-FU plus streptozocin
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Help Getting Through Cancer Treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
Treating Metastatic Pancreatic Cancer
In metastatic pancreatic cancer, surgery is used only for symptom control, such as for pain, jaundice, or gastric outlet obstruction. Radiation may be used for symptom relief, as well.
Chemotherapy can also help improve pancreatic cancer symptoms and survival. Gemcitabine has been the most widely used chemotherapy drug for treating metastatic pancreas cancer. Other drug combinations include gemcitabine with erlotinib , gemcitabine with capecitabine, gemcitabine with cisplatin, and gemcitabine with nab-paclitaxel. If youâre in fairly good health you may receive FOLFIRINOX . Other combinations include gemcitabine alone or with another agent like –paclitaxel or capecitabine. Next line drug combinations to treat pancreatic cancer include oxaliplatin/fluoropyrimidine, or irinotecan liposome in combination with fluorouracil plus leucovorin. The drug olaparib has been approved for metastatic patients with the BRCA gene mutation whose cancer has responded well to chemotherapy.
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How Is Chemotherapy For Pancreatic Cancer Given
Chemotherapy drugs are often administered intravenously , meaning directly into a vein. The procedure may be done at your doctors office, hospital, or a chemotherapy clinic.
The drugs may be administered through your arm or a larger type of IV called a central venous catheter . A tube connected to your central venous catheter is inserted through your chest into a large vein near your heart.
Some types of chemotherapy drugs can also be taken through oral pills.
Adjuvant and neoadjuvant chemotherapy usually last
Before You Start Chemotherapy
You need to have blood tests to make sure its safe to start treatment. You usually have these the day before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your doctors and pharmacists work out your chemotherapy dose based on your blood test results, your weight, height and general health.
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Surgery To Help Control Symptoms Of Pancreatic Cancer
This can include surgery to:
- unblock the bile duct or stop it getting blocked, which helps with jaundice
- unblock the first part of the small intestine or to stop it getting blocked, which helps with feeling or being sick
Many of these procedures are done using endoscopy, where the surgeon uses a long, thin, flexible tube to reach the blockage or organ.
The aim of these operations is to help improve your symptoms, not to cure the cancer.
Treating Pancreatic Cancer Based On Extent Of The Cancer
This information is about treating exocrine pancreatic cancer, the most common type of pancreatic cancer. See Pancreatic Neuroendocrine Tumor for information about how that type is typically treated.
Most of the time, pancreatic cancer is treated based on its stage how far it has spread in the body. But other factors, such as your overall health, can also affect treatment options. Talk to your doctor if you have any questions about the treatment plan they recommend.
It can be hard to stage pancreatic cancer accurately using imaging tests. Doctors do their best to figure out before treatment if there is a good chance the cancer is resectable that is, if it can be removed completely. But sometimes cancers turn out to have spread farther than was first thought.
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Pancreatic Cancer Treatments By Stage
The best treatment for pancreatic cancer depends on how far it has spread, or its stage. The stages of pancreatic cancer are easy to understand. What is difficult is attempting to stage pancreatic cancer without resorting to major surgery. In practice, doctors choose pancreatic cancer treatments based upon imaging studies, surgical findings, and an individualâs general state of well being.
Thinking About Taking Part In A Clinical Trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
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