Published in UAB Insight, Spring 2008
Surgery, Clinical Trials, Palliation
Pancreatic cancer is one of the most challenging and deadly human malignancies. Its tumor biology is aggressive and often resistant to available agents, surgical management is complex, and diagnoses are most often made when disease is locally advanced or widely metastatic. “Despite the poor prognosis most patients face, it is a misconception that nothing can be done,” says UAB surgical oncologist Juan P. Arnoletti, MD.
“Surgical resection is an option for 15% to 20% of patients but is underutilized nationally — probably because of ingrained fatalistic attitudes surrounding pancreatic cancer. Even for cases when a cure is not possible, it is crucial to offer patients optimal care, which includes access to clinical trials, palliative care, and education to make informed decisions,” he says. “Being able to consider all options — including the latest therapeutic developments — gives patients and their families some peace of mind.”
UAB is constantly developing protocols to test promising new agents for pancreatic cancers, and a number of clinical trials for patients in different clinical situations are enrolling participants. “All are testing molecularly targeted agents, some in combination with traditional chemotherapy,” Arnoletti says.
Chemotherapy-naïve patients with unresectable or metastatic pancreatic cancer are candidates for a phase 2 study of gemcitabine combined with the humanized monoclonal antibody CS-1008, which was developed at UAB and targets tumor cells expressing death receptor 5.
A phase 1 study is evaluating cetuximab, an antiepidermal growth factor receptor antibody, as a radiosensitizer in combination with gemcitabine. Candidates for the trial are those with locally advanced tumors in the absence of distant metastasis. When indicated, surgical resection following treatment remains an alternative. Previous UAB trials of cetuximab and radiation produced significant gains in survival for patients with advanced head and neck cancer.
Surgery is an option for patients with tumors confined to the pancreas that do not invade or occlude surrounding structures. “Even after resection, the risk for recurrence is high, and 5-year survival for these patients is 10% to 15%,” says Arnoletti, who is UAB’s principal investigator for a phase 2 multicenter adjuvant trial of the therapeutic vaccine GI-4000. Investigators hope the vaccine, which targets ras gene mutations common in pancreatic cancer, will help modulate the immune response to eliminate diseased cells. Candidates are individuals with the mutations of interest who have undergone surgical resection.
Through UAB’s pancreatic cancer Specialized Program of Research Excellence, scientists from varied fields are searching for new therapeutic targets, studying markers of disease and treatment response, and investigating imaging methods that enable early detection.
For patients with pancreatic cancer, UAB’s program emphasizes compassionate, multidisciplinary care for patients and their families. “Severe pain, depression, and malnutrition are common among these patients,” he says. “As a high-volume center, our experience can make a big difference in the lives of people affected by pancreatic cancer. We provide care that addresses the unique needs of pancreatic patients and ensures they have the opportunity to explore all options.”
For more information:
Dr. Pablo Arnoletti
1.800.UAB.MIST
mist@uabmc.edu