A new treatment protocol for locally advanced pancreatic cancer can enable surgical removal of previously inoperable tumours and improve survival rates, according to a new study.
"Locally advanced" pancreatic cancer is confined to the pancreas, but the tumour still involves major abdominal blood vessels and usually cannot be removed by surgery.
It's one of the worst forms of an already deadly cancer, the Massachusetts General Hospital researchers explained.
However, the results of their clinical trial could offer such patients new hope.
The trial included 49 patients with previously untreated locally advanced pancreatic cancer who received a combination of intensive chemotherapy and radiation therapy, as well as the blood pressure drug losartan.
Use of the combo therapy allowed 34 of the 49 participants to go on to have their tumours surgically removed, the team reported in JAMA Oncology.
And in 30 (61%) of the patients, surgery ("resection") removed all evidence of cancer around the tumour.
The treatment protocol also significantly improved survival rates, the research team said.
As study co-lead author Dr Janet Murphy explained, "around 40% of pancreatic cancer patients have either locally advanced or borderline resectable disease, with historically poor rates of successful surgery." She works in the hospital's haematology/oncology division.
"To be able to successfully remove the primary tumour in 61% of patients sets a new benchmark and offers much hope," Murphy said in a hospital news release. "A key part of the success of our approach was our surgeons' willingness to attempt an operation even in patients who had the appearance of cancer at or near their blood vessels."
She said that prior research had suggested that tumor spread (as evidenced on CT scans), and the ability of surgeons to remove the tumour after chemotherapy and radiation "are no longer clearly correlated."
That could give surgeons the green light to proceed.
"While we did not see total blood vessel clearance in 61% of patients, 61% achieved a complete removal of their cancer [anyway]," Murphy said.
Results mark a dramatic improvement
"Locally advanced pancreatic cancer has been generally considered an incurable disease, so these results mark a dramatic improvement with respect both to rates of conversion to surgical resectability and to long-term disease outcomes," study co-lead author Dr Jennifer Wo said in the news release. She's from the hospital's department of radiation oncology.
"Based on these results we have launched a new, multi-institutional clinical trial that will also include the immunotherapy drug nivolumab, since losartan treatment has also been shown to activate several immune system pathways," Wo said.
One specialist not involved in the trial agreed that the approach could be a new option for these patients.
"Of utmost importance, the results showed that they were able to successfully remove the primary tumour in 61% of patients, which definitely sets a new benchmark," said Dr. Wasif Saif. He's deputy physician-in-chief and medical director of the Northwell Health Cancer Institute in Lake Success, NY.
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