By Yue Zhang, MD, MPH
For years, physicians have fought to develop new treatments for metastatic pancreatic ductal adenocarcinoma, a highly aggressive and lethal form of cancer.
While advances in chemotherapy agents and radiation therapy over the past decade have helped reduce pain and improve quality of life, overall survival length has only increased by a matter of months. Immunotherapy also has yielded disappointing results to date.
Metastatic pancreatic cancer, the most malignant of any solid tumor, has a 5-year survival rate of about 3 percent. Patients often do not live a year past diagnosis, as the disease tends to cause no early symptoms and there is no widespread screening mechanism.
At the same time, rates of pancreatic cancer are climbing nationwide. Along with genetic factors, age, obesity, physical inactivity, diabetes, smoking and heavy alcohol consumption can increase the risk of disease.
However, specialists remain determined to discover novel agents as well as increase multi-disciplinary support that draws in palliative care, emotional aid from a social worker or another expert, genetic counseling and nutritional consultations in response to reduced appetite.
One particularly exciting opportunity is an ongoing clinical trial through US Oncology Network to test if adding a third medication to standard first-line chemotherapy can enhance treatment efficacy. Virginia Oncology Associates is honored to be among the participating sites.
The novel agent in the multicenter trial, NIS793, an investigational recombinant human anti-TGFß IgG2 monoclonal antibody (mAb), aims to regulate the microenvironment and reduce fibrous tissue in the pancreas – which can block medications from accessing tumors – render cancerous cells more sensitive to chemotherapy and improve overall survival.
The Phase III, randomized and double-blind study will utilize NIS793 in combination with gemcitabine and nab-paclitaxel, the two drugs in standard of care chemotherapy. A second group of patients will receive gemcitabine and nab-paclitaxel as usual.
Researchers hope to enroll 480 patients nationwide, or 240 in each group. Earlier trial phases on NIS793 suggest it has a tolerable medical toxicity.
Medical oncologists are also increasingly collaborating with surgeons and radiation oncologists immediately after diagnosing localized or metastatic pancreatic cancer.
For instance, starting chemotherapy on surgical candidates perioperatively – and possibly adding radiation therapy as well – might improve the odds of a full and successful resection for a higher chance of cure.
Additionally, genetic counseling and testing can help identify inherited or acquired mutations and ensure that at-risk family members undergo screens such as endoscopic ultrasound, MRI and cholangiopancreatography, which checks for blockages, narrowing or dilation in the pancreatic and bile ducts. One day, we hope that blood tests may be able to identify protein markers of pancreatic cancer even sooner.
By 2030, pancreatic cancer is projected to surpass breast, prostate and colorectal cancers to become the second-leading cause of cancer death in America. Our urgent mission is to give as many patients as possible a chance for a longer and better life.
Dr. Zhang is a Medical Oncologist and Hematologist with Virginia Oncology Associates, based at the practice’s Norfolk and Virginia Beach offices. virginiacancer.com
