First advance in pancreatic cancer treatment in a decade offers new hope

The first advance in pancreatic cancer treatment in a decade has been achieved by researchers in a Canadian-led study, and at last gives some encouragement to scientists and invigorates a field that has experienced more than its share of disheartening failures.

The research has found that combining a new targeted cancer drug, erlotinib, with conventional chemotherapy led to a modest increase in survival for people diagnosed with pancreatic cancer, one of the most treatment-resistant forms of the disease.

Lead investigator Dr. Malcolm Moore a medical oncologist at Princess Margaret Hospital in Toronto, says it has been 'a really tough nut to crack, and this is the first kind of crack they have seen in 10 years in terms of something that does appear to work on pancreatic cancer'.

Pancreatic cancer has one of the poorest survival rates and in that respect is probably one of the worst cancers you can get. The advances against the cancer have been few and far between.

Dr. Moore was asked to present the findings at the prestigious annual meeting of the American Society of Clinical Oncologists.

The study which was funded by the National Cancer Institute of Canada, the research arm of the Canadian Cancer Society, followed 569 patients from North America, Australia, Asia, Europe and Israel, and OSI Pharmaceuticals, which developed the drug, also supported the trial.

In the trial, the team found that patients who received erlotinib in combination with gemcitabine had a 24 per cent improvement in length of survival compared to patients who received gemcitabine alone. Unlike traditional chemotherapies, which cause unpleasant side-effects, erlotinib produced only mild side-effects and was generally well tolerated.

However on a sobering note they still found that survival times were short, and few, if any, of the people who took part in the trial are alive to learn of the findings.

To date, only 17 of 100 people with pancreatic cancer survive for a year after their diagnosis after traditional chemotherapy is used, but Dr. Moore says that in itself is a small miracle; 15 years ago when Dr. Moore entered the field, no one with pancreatic cancer lived to mark the anniversary of a diagnosis.

But with chemo and erlotinib - sold under the brand name Tarceva - 24 of 100 patients survived to one year.

Dr. Moore says even though the improvement is small, it is still important because it's better, but he says they obviously have a long way to go.

Heather Logan, director of cancer control policy at the Canadian Cancer Society, says the gains translate, on average, into an extra two weeks of life, although modest, when life expectancy is measured in weeks, modest gains are real gains, and any advances made to help people living with pancreatic cancer is a step in the right direction. She hopes the next study will build on that.

Pancreatic cancer is one of what are often called silent forms of the disease, producing few symptoms until the cancer is advanced. But unlike some forms of cancer, which have high cure rates even if found early, pancreatic cancer remains a very difficult disease to treat regardless of when it is diagnosed.

Dr. Moore says that only 15 per cent of cases are found early enough to undergo surgery to remove most of the pancreas. The pancreas produces essential insulin, so total removal is not a practical option, and only 15 per cent of those who undergo surgery are cured by it.

The average survival time from diagnosis is in fact just over six months, and only two per cent of people who are diagnosed with pancreatic cancer survive to five years.

Erlotinib is not currently approved in Canada. It is available in the United States, where it is licensed for the treatment of lung cancer.

Roche, which distributes the drug, applied late last year to bring it to market in Canada as a lung cancer therapy. Roche Canada spokeswoman Samantha Ouimet said Friday the company is hoping Health Canada will approve the drug this summer.

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