Pancreatic Cancer Treatments: Exploring Different Methods, Understanding Adverse Reactions, and Additional Info
In the fight against pancreatic cancer, the landscape of treatment options has evolved significantly. As the fourth most common cause of cancer death in the United States, researchers and medical professionals have been working tirelessly to develop more effective strategies for both treating and managing this devastating disease.
One of the mainstay treatment methods for pancreatic cancer remains chemotherapy. Multiagent regimens such as the newly FDA-approved first-line combination, Nalirifox, a four-drug chemotherapy combo, have provided novel options. Common combinations like gemcitabine with nab-paclitaxel or the modified FOLFIRINOX regimen offer improved survival, but often come with side effects such as nausea, fatigue, low blood counts, neuropathy, and risk of infection.
Targeted therapies have also expanded the treatment arsenal for pancreatic cancer. Precision therapies, such as those targeting BRCA mutations and rare gene fusions, offer tailored treatments for patients with these genetic alterations. KRAS inhibitors, historically unavailable, are now entering early-phase trials for KRAS-mutated tumors, sometimes combined with chemotherapy or immunotherapy.
Immunotherapy approaches, which aim to bolster the body's immune system to recognize and attack cancer cells, have shown promising results. For example, the addition of a CD73 inhibitor to block adenosine (an immunosuppressive molecule) alongside checkpoint inhibitors and chemotherapy showed significant tumor shrinkage and no disease progression pre-surgery in a small cohort.
Radiation therapy, which involves high-energy radiation beams to kill cancer cells, can be administered externally or internally. Ablative radiation, such as Stereotactic MRI-guided On-table Adaptive Radiation Therapy (SMART), improves local control and overall survival without increasing serious gastrointestinal toxicity. Radiation combined with chemotherapy may also improve survival in some settings and is being actively studied.
Tumor Treating Fields (TTFields), when combined with gemcitabine and nab-paclitaxel, have shown a meaningful increase in median overall survival and significantly delayed pain progression in locally advanced pancreatic cancer patients. This suggests a dual benefit of prolonging life and improving quality of life.
Ablation, a treatment for pancreatic cancer involving the destruction of cancer cells, may be used as a stand-alone treatment for small pancreatic tumors or as an additional treatment alongside surgery or other therapies for larger tumors. However, it's important to note that ablation may not destroy all of the cancer cells, leading to the need for additional treatments.
Surgery, particularly for tumors that have not spread beyond the pancreas, offers the best chance for a cure. The surgery for pancreatic cancer is called a pancreaticoduodenectomy, also known as the Whipple procedure. However, surgery can have risks such as significant bleeding, the need for blood transfusions, increased risk of infection, and a lengthy recovery period. There is also a risk of damage to nearby organs and infection during ablation.
The outlook for pancreatic cancer can vary depending on the stage of the cancer, the patient's overall health, and the type of treatment used. Every person's experience with pancreatic cancer is unique, and some patients may have better outcomes than others. People should work closely with their healthcare team to determine the best treatment plan for their situation and to discuss their prognosis and expectations.
Clinical trials test new treatments or combinations of treatments for pancreatic cancer, and participating in a clinical trial may give people access to the latest treatments before they are widely available. These trials continue to expand options, especially with precision medicine and immunomodulatory combinations showing promising early results.
In summary, advanced pancreatic cancer treatment in the US now involves combining chemotherapy with emerging targeted agents, immunotherapy strategies, advanced radiation methods, and novel modalities like TTFields. These approaches aim to improve survival and quality of life, although treatment-related side effects require careful management. The goal of treatment for pancreatic cancer is typically to cure the cancer if possible or to control it and relieve symptoms, improve quality of life, and extend survival.
- Chemotherapy, such as the newly FDA-approved first-line combination, Nalirifox, remains a mainstay treatment for pancreatic cancer, even though combinations like gemcitabine with nab-paclitaxel or FOLFIRINOX may bring better survival with potential side effects.
- Targeted therapies, like those for BRCA mutations and rare gene fusions, offer tailored treatments for specific genetic alterations in pancreatic cancer, while KRAS inhibitors, now in early-phase trials, aim to combat KRAS-mutated tumors.
- Immunotherapy approaches, such as the use of CD73 inhibitors to block adenosine, have shown promise in killing pancreatic cancer cells and improving survival without increasing serious gastrointestinal toxicity.
- Tumor Treating Fields (TTFields), when combined with chemotherapy like gemcitabine and nab-paclitaxel, have displayed a meaningful increase in median overall survival and delayed pain progression for locally advanced pancreatic cancer patients, potentially improving both life span and quality of life.
