“There’s a real expectation that, in an incremental way, outcomes are going to be improved meaningfully for people with this disease,” says medical oncologist Eileen O’Reilly. Dr. O’Reilly recently participated in a CancerSmart panel discussion on pancreatic cancer treatment and the future of research, along with William R. Jarnagin, Chief of the Surgical Hepatopancreatobiliary Service, and Mark A. Schattner, a gastroenterologist on the Gastroenterology and Nutrition Service.
Pancreatic cancer strikes 44,000 Americans every year, causing 37,000 deaths. It’s so deadly in part because it’s hard to diagnose at an early, treatable stage. Also, there is no evidence to suggest that screening for pancreatic cancer helps to improve survival.
Most patients, says Dr. Schattner, learn they have pancreatic cancer only after it has spread enough to cause symptoms, such as jaundice without pain, unexplained weight loss, new-onset diabetes, and pain that affects both the abdomen and the back.
The Team Approach
There is no single path for pancreatic cancer treatment, our experts emphasize, which is why a team approach is so important to help determine the best possible treatment. Surgery is only appropriate in about 25 to 30 percent of pancreatic cancer cases; in every case, our multidisciplinary team will collaborate to decide what combination of radiation, chemotherapy, and/or surgery will work for the patient, and in what order.
“Patients with earlier-stage cancers generally do better with surgery and chemotherapy, which is the most effective treatment combination we have for the disease,” says Dr. Jarnagin. “Even someone with an early-stage pancreatic cancer has a very high risk of recurrence,” he adds, “more so than other cancers that we deal with.”
But, as Dr. O’Reilly points out, new treatment options and promising therapies for early detection and treatment are on the horizon. Researchers at Memorial Sloan Kettering are developing noninvasive methods of screening for precancerous and early-stage pancreatic tumors. Our Familial Pancreatic Cancer Registry is collecting data from people with genetic risk factors for pancreatic cancer, such as a mutated BRCA1 or BRCA2 gene. Data from the registry may help us to identify pancreatic cancers earlier, as well as teach us more about the molecular changes that occur in the disease, so that we can develop targeted therapies.
Memorial Sloan Kettering experts are also leading a number of clinical trials for pancreatic cancer treatments. Some of these treatments include innovative new radiation therapies and ways to combine chemotherapy with higher-dose, shorter courses of radiation.
Particularly promising is the use of biomarkers, genetic guidelines in our DNA that will allow doctors to select the most-effective treatment for each patient and develop new targeted therapies for pancreatic cancer. Other clinical trials are investigating ways to reduce surgical complications, deliver therapies endoscopically, and reduce the side effects of radiation.
“The next five years is going to allow some of the fruits of this work to bear,” Dr. O’Reilly observes.