Health Report: Pancreatic Cancer – A comprehensive approach to treatment

November is National Pancreatic Cancer Awareness Month, a time to take a closer look at what’s being done to address one of the deadliest forms of cancer.

According to the American Cancer Society, more than 48,000 people in the United States will be diagnosed with pancreatic cancer in 2015, making it the 12th most common cancer. However, more than 40,000 people in the U.S. are expected to die of the disease this year, making it the fourth most deadly type of cancer.

Darren Sigal, M.D., is a gastrointestinal oncologist at Scripps Clinic and a co-founder of Scripps’ Pancreatic and Biliary Cancer Program. Dr. Sigal, M.D. works with a multidisciplinary team of specialized surgeons, radiation oncologists, gastroenterologists and other clinicians to help patients overcome their disease. In addition, he collaborates with fellow researchers in San Diego and around the country to conduct clinical trials for new therapies.

Dr. Sigal offers his insights into the field of pancreatic cancer treatment and research.

Q: Why is pancreatic cancer so difficult to treat?

A:  Unfortunately, there are lots of reasons. First, it spreads early and the symptoms are quite vague: abdominal pain, sometimes jaundice, loose stools, bloating. As a result, even when we’ve removed the tumor and the patient has received chemotherapy, the cancer often comes back. Also, pancreatic cancer has a unique defense mechanism. It develops a scar, like a protective shell, which makes it difficult to get chemo to the tumor.

That’s why pancreatic is one of the deadliest cancers.  It’s the tenth most common cancer but the fourth leading cause of cancer death, right up there with breast and lung.

Q:  How is Scripps Clinic working to overcome these challenges?

A:  Scripps’ Pancreas and Bile Duct Cancer Program is a listed resource by the Pancreatic Cancer Action Network. Their focus is to improve patient outcomes and recognize centers, like ours, for our ability to help people with pancreatic cancer. We treat a lot of patients, participate in clinical trials and have special expertise when it comes to this disease.

Our team is composed of physicians from several medical sub-specialties, including medical oncology, radiation oncology, pancreas and biliary surgery, advanced gastrointestinal endoscopy and transplantation. Having this comprehensive perspective helps us give our patients a clear picture of their treatment options and also helps us identify opportunities to change course in treatment as needed. The group, which communicates daily on various patient care issues, includes myself and doctors Walt Coyle, Randy Schaffer, Jon Fisher, Warren Reidel and Ray Lin, along with nurse navigator Jane Williams.

We are also part of the Pancreatic Cancer Research Team, which is a nationwide consortium of medical facilities conducting clinical trials. This is great for patients because they have access to the latest therapies. Scripps Clinic has a level of expertise you would normally find at a large university medical center.

Q:  What can people do to reduce their risk of developing pancreatic cancer?

A:  First, and this won’t shock anyone, quit smoking. By far, it’s the number one thing you can do to lower your risk. I also recommend eating well, exercising, maintaining a healthy weight. These can all reduce your cancer risk incrementally.

As I mentioned before, this cancer spreads early. Right now, there aren’t any good screening tests, though a lot of people are working on that. We look forward to having a good diagnostic tool so we can catch it early.

Q:  Are there any promising developments for better treatments?

A:  As recently as a few years ago, there were only a couple of approved drugs for pancreatic cancer, but there have been some real advances lately. In 2013, the U.S. Food and Drug Administration approved a drug called Abraxane for metastatic, or late-stage pancreatic cancer. The one-year survival rate of patients with metastatic pancreatic cancer has improved from 10 percent to about 30 percent, thanks to this drug. Also, the combination therapy known as FOLFIRINOX is another option.

In the past few years, a number of other new treatments have shown promise and continue to move forward. Scripps is currently taking part in a clinical trial for a new therapeutic called PEG-PH20. This is an enzyme therapy designed by a local company called Halozyme Therapeutics to break down the cancer’s protective scar. The idea is that, without the shell, chemotherapy could be more effective. Early results have been encouraging, but we still have a ways to go.

There’s also an anti-inflammatory drug called Ruxolitinib, made by Incyte Pharmaceuticals. It’s thought that inflammation plays a big role in pancreatic cancer’s ability to resist chemo. This drug has already been approved for myelofibrosis and is approaching phase III trials for pancreatic cancer.

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Categories: Health