UTHealth Houston clinical trial therapy shrinks tumor of pancreatic cancer patient

Demetrios Stroubakis, 55, thought he was having a gallbladder attack when he arrived at the emergency room in August 2021 with jaundice. Instead, he was shocked to be diagnosed with pancreatic cancer.

I was floored. I consider myself to be relatively healthy, so I wasn't expecting it. I was fortunate my wife Shannon recognized the jaundice conditions. She rushed me to the emergency room and after several scans and a tissue biopsy over the course of few days, I got the bad news."

Demetrios Stroubakis

The pancreas produces enzymes to help digest food and makes the hormone insulin, which controls blood sugar. About 64,000 people will be diagnosed with pancreatic cancer this year, and nearly 51,000 will die from it. Pancreatic cancer is the third leading cause of cancer death in the U.S. and has a five-year survival rate of 12.5%.

Stroubakis was referred to Nirav Thosani, MD, professor in the Department of Surgery with McGovern Medical School at UTHealth Houston, to learn more about a unique clinical trial. Thosani is the co-lead investigator of PANCARDINAL-1, a single-site, single-arm, Phase II study that is evaluating the treatment of endoscopic ultrasound guided radio frequency ablation (EUS-RFA) in combination with standard-of-care chemotherapy.

The supplemental radiofrequency ablation treatment, in combination with chemotherapy, works to shrink tumors so there is less chance of the cancer spreading into blood vessels and patients can have a less invasive tumor removal procedure.

In a minimally invasive procedure, EUS-RFA is performed with an ultrasound-guided endoscope that delivers a high-frequency alternating current, which increases the temperature inside the cells of the targeted tissue, or tumor. This induces coagulative necrosis, or cell death, in solid tumors.

"We currently have two ongoing clinical trials and most patients with pancreatic cancer may qualify for one or the other trial. We have strict inclusion criterion for the PANCARDINAL-1 trial and we determined that he was a good candidate for the trial. His tumors were near critical blood vessels, so it was crucial to shrink them before surgery," said Thosani, who is the director of the Center for Interventional Gastroenterology with McGovern Medical School.

In the span of a week, Stroubakis was enrolled in the trial and began receiving rounds of chemotherapy in September. By the end of 2021, he began the EUS-RFA treatment.

"What Dr. Thosani is doing with EUS-RFA made complete sense to me. You attack it from the inside out," Stroubakis said.

After four months of chemotherapy and three EUS-RFA treatments, Stroubakis went to exploratory surgery for resection of the cancer on Feb. 4, 2022. However, there was significant inflammation of the pancreas, and the surgery could not be completed. Stroubakis recovered from the initial exploratory surgery and went back to systemic chemotherapy and RFA. After 14 months and nine more ablation treatments, Stroubakis' tumor size was significantly reduced and he underwent the Whipple operation for resection of the pancreatic cancer on April 5, 2023. Stroubakis went home six days after surgery.

"From the beginning, Mr. Stroubakis and his wife have had an amazing, positive attitude. They have been through so much to get to this point today where he is six months out from surgery," said Curtis Wray, MD, professor in the Department of Surgery with McGovern Medical School and co-lead investigator on the study. "Pancreatic cancer treatments have largely remained unchanged for the past 30 years. This new RFA treatment may help to improve outcomes and survival in a cancer with a high mortality rate. This pilot study may provide information to help design further trials involving RFA."

Stroubakis is back working as an engineer and spending quality time with his wife and kids. He is amazed at how good he feels. "The team never lost hope; they got it done and now I'm back on track," Stroubakis said.

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