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Preoperative and Postoperative Chemotherapy Trial for Pancreatic Cancer
Pancreatic cancer is the fourth leading cause of cancer death, according to the American Cancer Society. Cancer of the pancreas produces few symptoms, and by the time it’s diagnosed, it’s likely to have spread to other sites in the body, complicating treatment.
Investigating the optimal sequence of treatments for this difficult-to-manage cancer is the goal of a study offered by the American College of Surgeons Oncology Group. Froedtert & The Medical College of Wisconsin are participating in this study, the first multisite trial that will assess administering chemotherapy before and after surgery in patients with localized Stage I and Stage II pancreatic cancer.
Emerging data suggest chemotherapy before surgery may be superior to a “surgery first” strategy. Study results will help find the right pathway for treatment.
Patients who may participate in this study will receive chemotherapy consisting of Gemcitabine plus Erlotinib before and after surgery. Both drugs are FDA approved and commercially available, but their use together in this clinical trial for patients with early stage pancreatic cancer is new.
Determining the most effective sequence of treatments is critical, because pancreatic cancer is so aggressive. “Seventy percent to 80 percent of patients have micrometastatic disease, meaning the cancer has spread to other areas of the body. However, in such minute form, it cannot be detected by imaging technology such as X-rays or CT scans. This is problematic to long-term survival,” said Douglas B. Evans, MD, Medical College of Wisconsin surgeon and chairman of the Department of Surgery. Dr. Evans is one of the original authors of the study.
Performing surgery on the primary tumor in the pancreas first can perpetuate the growth of the micro-metastases. Pancreatic surgery is a major procedure that requires about six weeks of recovery before post-operative chemotherapy can be initiated. But that time period gives the micro-metastases a chance to grow.
“The body’s normal response to surgical trauma is to heal itself, so it secretes growth factors to do that,” Dr. Evans said. “These growth factors also accelerate the growth of the metastases. Administering chemotherapy prior to surgery may keep the metastases from getting a head start. Additionally, it may shrink the tumor and improve the surgical outcome.”
Results fromthe study at Froedtert & The Medical College will be compared with those from other sites to determine the best standard of practice for patients with pancreatic cancer. “Our goal is to enhance the way we treat pancreatic cancer five or 10 years from now,” Dr. Evans said.
Source: Froedtert Today Date: September 2009 |
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