Further contributing to low rates of early diagnosis is that symptoms of pancreatic cancer tend to be vague, such as pain in the back or abdomen, unexplained weight loss or loss of appetite and the inability to digest fatty foods. A more specific symptom is jaundice, the yellowing of the skin and whites of the eyes when bilirubin, which is made in the liver, builds up in the blood because a pancreatic tumor is blocking the bile duct and keeping bilirubin from moving into the intestines.
According to the National Cancer Institute, the chance of recovering from pancreatic cancer depends on whether the tumor can be surgically removed; its size; whether it has spread beyond the pancreas; and whether it's a first-time diagnosis or a recurrence. Once the cancer has spread to other organs, it's no longer considered curable, and doctors use a variety of approaches to control symptoms and complications.
At Dartmouth, doctors are treating pancreatic cancer with five-day-a-week external beam radiation called intensity-modulated radiotherapy (IMRT) and twice-weekly low doses of the chemotherapy drug gemcitabine (Gemzar). "Gemcitabine for years was the standard of care in advanced disease," Pipas said. Doctors then discovered that it powerfully sensitizes cancer cells to the effects of radiation, preventing the cells from repairing themselves after sustaining radiation damage, so they began using lower doses in concert with radiation for six weeks. So far, in studies of more than 100 patients, "what we have shown is we can downsize many of these tumors, and we can downstage them, meaning we can pull them off vessels. The majority of people we treat in this fashion are able to go on and get a surgery."
Researchers are making inroads with targeted therapies and vaccines, too. Some of the targeted therapies inhibit certain growth factors, including those that encourage the sprouting of new blood vessels that nourish tumors. Researchers at Dartmouth and Stanford universities are collaborating on studies of a new drug called an anti-connective tissue growth factor antibody. This targets some of the connective tissue around tumor cells, and when given together with Tarceva, which inhibits epidermal growth factor receptor, and the chemo drug gemcitabine, hits tumors with a triple punch.
At the Johns Hopkins Kimmel Cancer Center in Baltimore, researchers have been fine-tuning and developing vaccines to stimulate patients' own immune systems to mount attacks on pancreatic tumor cells in newly diagnosed patients as well as those with advanced disease.
At the American Society for Clinical Oncology meeting last summer, French researchers presented results of a randomized clinical trial in which Folfirinox, a combination of four chemotherapy drugs, improved survival of patients with metastatic pancreatic cancer. It yielded a median survival of 11 months compared with about 7 months with gemcitabine. At the time, Dr. Andrew Ko, writing in the online publication HemOnc Today, said the findings "may be practice-changing in terms of establishing a new chemotherapy regimen as front-line treatment of metastatic pancreatic cancer." He called the Phase III study "the most positive …we have ever seen in advanced pancreatic cancer" with results "too striking to ignore."