What’s new in pancreatic cancer research?
Research into the causes and treatment of pancreatic cancer is going on in many medical centers around the world.
Genetics and finding cancer early
Scientists are learning more about some of the changes in DNA that cause cells to become cancer. In some families an inherited risk increases the chance that members will have pancreatic cancer.
Researchers have learned that pancreatic cancer does not form suddenly. It develops over many years in a series of steps. In the early steps there are changes in a small number of genes, and the cells of the pancreas look almost normal. In later steps there are changes in more genes and the cells look more abnormal.
This information is being used to develop tests for finding acquired (not inherited) gene changes in pancreatic cancer pre-cancerous conditions
For now, imaging tests like endoscopic ultrasound, ERCP, and genetic tests for changes in certain genes are options for people with a strong family history of pancreatic cancer. But these tests are not helpful for people at normal risk who have no symptoms.
The major focus of much research is on finding better treatments for pancreatic cancer.
Surgery for pancreatic cancer is often a long and complex operation that can be hard both for the surgeon and the patient. A newer approach is to do the operation through a few small incisions in the belly instead of one large one. This is known as laparoscopic or keyhole surgery. People often recover from this type of surgery more quickly. But this is still a difficult operation. Surgeons are looking to see how it compares to standard surgery and which patients might be helped the most by it.
Some studies are looking at different ways to give radiation to treat pancreatic cancer. One example is intraoperative radiation therapy (IORT), in which a single large dose of radiation is given to the pancreas in the operating room at the time of surgery. Another is a special type of radiation called proton beam radiation.
Many clinical trials are testing new ways to combine chemo drugs. Other studies are testing the best ways to combine chemo with radiation or other treatments.
As researchers have learned more about what makes pancreatic cancer cells different from normal cells, they have developed newer drugs that should be able to attack only the cancer cells. These targeted therapies may prove to be useful along with, or instead of, current treatments. For the most part, they seem to have fewer side effects than the usual chemo drugs.
Growth factor inhibitors: Many types of cancer cells have certain molecules on their surface that help them to grow. These molecules are called growth factor receptors. Many drugs that target growth factor receptors are now being studied. One drug, erlotinib (Tarceva), is already approved for use.
Angiogenesis inhibitors: All cancers depend on the growth of new blood vessels (this is called angiogenesis) to nourish the cells. New drugs that can block this growth and thus starve the tumor are being studied in clinical trials.
Drugs that target the tumor stroma (supporting tissue): Chemo often does not work well for pancreatic cancer. This is partly because of the dense supportive tissue (stroma) in the tumor, which seems to help protect the cancer cells from the effects of chemo drugs. Researchers are now looking at drugs that attack the stroma to help break it down.
Immune therapies attempt to boost a person’s immune system to attack cancer cells. Some studies have shown promise for treating pancreatic cancer.
Monoclonal antibodies: These immune system proteins are designed to lock onto specific substances on cancer cells. Toxins or radioactive atoms can be attached to these antibodies, which bring them right to the cancer cells. The hope is that the antibodies will damage the cancer cells while leaving normal cells alone. These treatments are only being used in clinical trials at this time.
Cancer vaccines: Several types of vaccines for boosting the body’s immune response to pancreatic cancer cells are being tested in clinical trials.
Drugs that target immune system checkpoints: The immune system normally keeps itself from attacking other normal cells in the body by using “checkpoints” – molecules on immune cells that need to be switched on (or off) to start an immune response. Cancer cells sometimes find ways to use these checkpoints to avoid being attacked by the immune system. Newer drugs that target these checkpoints have shown a lot of promise in treating some types of cancer, and are now being studied for pancreatic cancer.
Some drugs seem to work better if certain types of gene changes can be found in the patient’s tumor. Finding markers that can predict how well a drug will work before it is given is an important area of research in pancreatic and other types of cancer.
Last Medical Review: 08/01/2014
Last Revised: 01/09/2015