Dr. Nagourney's Blog

Hospice Nurse Confronts Stage IV Pancreatic Cancer:  Her Own

By Robert A. Nagourney, MD

Stage 4 Pancreatic Cancer Survival

With 53,000 new pancreatic cancers diagnosed each year and 41,000 deaths, pancreatic cancer is among the most lethal of human malignancies.

The 5-year survival of 7.7% drops to 2.6% for patients with advanced disease and most patients Get Our Pancreatic Cancer Guidepresent with advanced disease.

Not surprisingly, oncology specialists engaged in palliative and hospice care know pancreatic cancer very well. 

Case of Stage 4 Pancreatic Cancer - A Hospice Nurse Herself

Thus, there was a cruel irony when one of my long time colleagues, an accomplished hospice nurse, contacted me in February to inform me that she had been diagnosed with inoperable, metastatic cancer of the pancreas. 

The work-up identified the abdominal disease but it was the PET-CT scan that raised concern when a lymph node showed up in the neck.

The thoracic surgeon who conducted the biopsy found that the lymph node was completely replaced by adenocarcinoma. This enabled us to perform our functional profile.

Functional Profiling Results

The results proved extremely interesting as the patient was resistant to many drugs and combinations used in this disease.

Gemcitabine, Cisplatin plus Gemcitabine and the widely used FOLFIRINOX were inactive.

Despite this, Abraxane plus Gemcitabine showed good activity that was further enhanced by the addition of 5FU to the cancer cells in culture, revealing clear evidence of synergy.

Quite clearly the best regimen would be Abraxane plus Gemcitabine plus 5-FU, a somewhat novel twist on a drug combination known as GTX. 

As I analyzed the laboratory results I was struck by several findings, among them, the utter inactivity of Cisplatin. This drug, alone or in combination is the backbone of many pancreatic cancer treatments, but had absolutely no activity here.

The second was good activity for 5-FU.

This drug was the original (and for many decades the only) treatment for this disease.

Finally I was impressed by the substantial contribution that 5-FU made to the doublet of Abraxane and Gemcitabine.

One additional finding was the favorable profile for the diabetes drug Metformin. With this in hand we started Gemcitabine /Abraxane/ Capecitabine combined with low dose oral Metformin. 

Stage 4 Pancreatic Cancer Treatment

The patient tolerated the treatment well with moderate hand-foot syndrome from the Capecitabine.

Within a week the nagging, right-sided abdominal pain had disappeared and the patient's tumor marker fell by 50%. After an additional cycle, the PET/CT revealed a very good response.

The patient continues on therapy with a new lease on life. 

There is a quote from the bible, Luke 4:23, “Physician heal thyself.”

It is interpreted several ways. One interpretation is that physicians must focus upon their own needs before attending to the needs of others. While I have the utmost respect for our excellent hospice nurses, this is one stage IV pancreatic cancer patient for whom I hope hospice care will never be needed.  

As always, I appreciate your thoughts and comments.

 

Dr. Robert Nagourney, has been internationally recognized as a pioneer in cancer research and personalized cancer treatment for over 20 years.  He is a TEDX SPEAKER, author of the book OUTLIVING CANCER, a practicing oncologist and triple board certified in Internal Medicine, Medical Oncology and Hematology helping cancer patients from around the world at his Nagourney Cancer Institute in Long Beach, California.  For more info go to NAGOURNEYCANCERINSTITUTE.COM