Latest research offers promise in detection of pancreatic cancer
Thursday, February 13, 2014
Pancreatic cancer causes more than 38,000 deaths in the U.S. each year, and is the fourth-most common cause of cancer deaths in the western world. No routine screening methods for pancreatic cancer are available, due to the subtle differences among cancerous, atypical and healthy tissue.
Recently, however, two studies have identified biomarkers that show potential as a method for early detection of pancreatic cancer.
Researchers at the Cleveland Clinic found that a biomarker called VEGF (vascular endothelial growth factor) that can distinguish between pancreatic cancer and other common bile duct problems. They discovered that when they measured VEGF levels in bile aspirated from the pancreas, the marker could correctly identify pancreatic cancer accurately in 93 percent of the 53 patients in the study.
The study, presented in October at the 78th Annual Scientific Meeting of the American College of Gastroenterology, found that bile VEGF levels were significantly elevated in pancreatic cancer patients. The researchers were able to make a distinction among pancreatic cancer, cancer of the bile duct and other benign bile duct and pancreas problems.
In another study published in January, preliminary findings have identified microRNA panels in blood that can differentiate, to some degree, patients with and without pancreatic cancer. Researchers in Denmark identified two novel microRNA panels with potential for pancreatic cancer diagnosis and indicated that further research is necessary to understand the clinical use for the early detection of pancreatic cancer.
In yet another retrospective study of the records of 57 patients tested for pancreatic cancer, researchers from the University of Missouri evaluated biopsies under the microscope. Their analysis developed a group of four parameters that could allow a pathologist to diagnose pancreatic cancer with over 90 percent accuracy.
The four features include a wide variation in the size of pancreatic cells/nuclei, oversized nucleoli, the presence of single atypical epithelial cells, and mucinous metaplasia (mucin in cells that normally do not produce the substance.)
The three research projects each studied different ways to diagnose pancreatic cancer, which could help focus on the path to better, earlier, and thus more successful treatment for this deadly disease.
Treatment for pancreatic cancer typically includes radiation and chemotherapy. Individuals aged 75 and older account for approximately 40 percent of patients diagnosed with pancreatic cancer, and most people diagnosed with the disease are over 65. For those patients, many of whom are unable to undergo surgery or tolerate chemotherapy/radiation combination therapy, a form of targeted radiation therapy may offer a safer alternative.
A study conducted by researchers at Henry Ford Hospital in Detroit, used a process called stereotactic body radiotherapy (SBRT) to deliver to these patients a safe and effective treatment in two weeks that can provide them with a substantial quality of life with minimal side effects. While this treatment option is not a cure, it can be a short-term option that can offer a good quality of life to patients who might not receive any treatment due to other age-related risks.
Standard first-line treatment for pancreatic cancer has been with gemcitabine-based chemotherapy. Until recently, no consensus had been reached for additional therapy. However, a two-drug combination adding nab-paclitaxel to gemcitabine has been shown to significantly improve one and two-year survival rates.
A multicenter phase III study published in NEJM, showed an overall increase in survival rates over two years, for the two-drug combination versus the standard therapy alone (35 percent vs. 22 percent and 9 percent vs. 4 percent, respectively). According to the researchers, this combination will become the "new" reference against which all future drugs will be gauged.
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