According to the American Cancer Society, there will be an estimated 57,600 new pancreatic cancer cases this year in the U.S. Unfortunately, the rate of new pancreatic cancer cases has been on the rise over the last decade. However, while many patients still die from their disease, this proportion of patients has been stable for the last ten years, suggesting we are making progress in battling a very tough disease.
What We Know
Generally speaking, pancreatic cancer patients are placed in one of four clinical stages: localized disease that is resectable (removable) with surgery, localized disease that is borderline resectable (the tumor is too large or in a difficult spot to remove immediately), localized disease that is not resectable, and advanced disease. Advanced disease is treated with what we call systemic therapy, or therapy given by mouth or through an IV that treats the whole body. Localized disease that is resectable is surgically removed, while that which is borderline resectable is often given chemotherapy before and after surgical removal to help shrink the tumor for an easier and more successful surgery. Localized disease that is unresectable is treated with various combinations of systemic therapy and radiation therapy.
What We Don’t Know
Many questions remain for those of us treating pancreatic cancer patients. We continue to learn more about the best chemotherapy to give before and after surgery to borderline resectable patients. Similarly, while many would argue to remove a resectable tumor immediately, we are exploring if the addition of chemotherapy would improve outcomes for these patients. We also are studying the best way to incorporate radiation therapy. Finally, we are always looking for the next best therapy for patients with advanced disease. While in recent years immunotherapy has brought many successes for difficult-to-treat cancers, pancreatic cancer patients have not seen the same benefit, and it is still unclear to us why that is, or how to change it.
Research is key. At Rutgers Cancer Institute of New Jersey we are developing and conducting several clinical trials to address some of these questions. These include a study to test radiation and chemotherapy before surgery in borderline resectable patients, a study comparing chemotherapies in borderline resectable patients, and basic science research using vaccines and immunotherapies in pancreas cancer tumors. Along with the science, the participation of our patients in clinical trials is vital to our current successes and ongoing progress. Together, we will continue to offer hope where it may not have been before.
Kristen Spencer, DO, MPH, is a medical oncologist in the Gastrointestinal/Hepatobiliary Program at Rutgers Cancer Institute of New Jersey and an assistant professor of medicine at Rutgers Robert Wood Johnson Medical School.