Doctors boost pancreatic cancer survival by ‘using what we already have’
Patients live five times as long with breakthrough chemo-surgery combination by American surgeon
A diagnosis of pancreatic cancer has long been viewed as a death sentence, with fewer than 1% of people surviving for five years, and many dying within 12 months. But surgeons at the Mayo Clinic in Minnesota have spent seven years on a new treatment, and patients are living at least five times as long, with some of them even possibly cured.
Specialists have found that giving chemotherapy and radiotherapy to patients before surgery has had a dramatic outcome on survival. Previously, patients with cancer that had spread outside the pancreas into surrounding arteries were not offered lifesaving surgery because doctors believed it would be impossible to remove all of the cancerous tissue. It was difficult to repair the damaged blood vessels to the stomach, intestines and liver.
However, Dr Mark Truty, a surgical oncologist, has found that blasting cancer cells with drugs and radiation before removing a tumour, and replacing the arteries, has a remarkable effect on survival.
In a seven-year study of 194 patients who were given 12 to 18 months to live, the average survival time was increased to 4,9 years. Many are still alive today.
Dr Truty, whose father died of the disease, said: “Until recently pancreatic cancer has been a death sentence and it’s had a stigma for decades with good reason, but we’re trying to change that. My father died of pancreatic cancer. He was treated in the standard fashion and he got the standard outcome – complications and really no benefit from the operation. I said, wait a second. We have much better chemotherapy now, we have much better radiation, why can’t we do a different operation? If we put all those things together can we get a better outcome? We just need to put them in the right order.
“We gave chemotherapy prior to surgery and we found the more chemo they got the longer they lived. About 90% of patients were alive at five years. These are numbers you haven’t seen before.”
Pancreatic cancer has the lowest survival rate of any cancer, with five-year survival in men at 5.2% and women 6.2%. Even when caught early most people die within two years and the incidence is increasing, with doctors predicting a 6% increase in cases by 2035.
The new operation focuses on a third of pancreatic cancer patients where the tumour has not yet reached other organs, but has spread outside the pancreas to envelop veins and arteries. The chemotherapy kills off most of the cancer to make sure it will not spread after surgery. Surgeons then remove the tumour as well as the arteries and veins ensnared by cancer cells, before reconstructing the blood vessels using tissue from elsewhere in the body.
The team also found a way to monitor the success of treatment. Those who had more cycles of chemotherapy before surgery, survived for longer. They also did better if tumour biomarkers fell to a normal level after chemotherapy and tumour tissue was found to be all, or mostly, dead after removal.
Dr Truty believes that it is crucial to keep going with chemotherapy until cancer biomarkers drop before removing the tumour, and he is confident that if more of the patients in the trial had been given more cycles, they could have lived longer.
He hopes the study findings will convince oncologists that for many such patients, long-term survival is possible if they receive appropriate treatment before surgery. “We just need to use what we already have now,” he said. “It’s like when I try to make my wife’s chocolate chip cookies. I can’t make them as good as she can because I’m not using the right amount and doing it in the right order. In the case of pancreatic cancer, everyone has the right ingredients, they just need to put them in the right order. I’m extremely excited about these results.
“We had a hunch that this was going to work, but it took a lot of people here doing things in a different way. We want people to say: ‘I have pancreatic cancer and I have options’. I want to be able to say I can guarantee that 50% of people can have surgery and live for a lot longer, and perhaps even be cured.”
Half of the patients in the study came to the Mayo Clinic after being told elsewhere that their cancer was inoperable. Around a third of them have not had their average survival time calculated yet in the study because more than half of them are still alive.
The team is also using mouse “avatar” hosts to work out which drugs will be most effective, growing the patients’ own tumour in the animals and then using various types of chemotherapy on it. “These are lost cases we are giving hope to and it’s not just a handful, this is a third of patients who would normally have no hope,” said Truty.
Commenting on the results, Anna Jewell, the director of research at Pancreatic Cancer UK, said: “These findings are a promising indication of the impact chemotherapy could have for pancreatic cancer patients whose tumour is advanced, but yet to spread to other parts of the body.”
Currently only one in 10 pancreatic cancer patients has surgery – the only potential cure – because many are simply not treated fast enough. “We need to see significant changes to how treatment is delivered if patients are to benefit from new developments in understanding how best to take on pancreatic cancer.”
The research is published in The Annals of Surgery.
– © Telegraph Media Group Limited (2019)