Pancreatic cancer is one of the leading causes of cancer deaths and is often viewed by doctors and patients alike as a veritable death sentence. But it doesn't have to be.
Cancers arising in the pancreas may not exhibit any noticeable symptoms in the early stage. Because of this, pancreatic cancer is typically diagnosed at a late stage making treatment difficult and prognosis poor.
Surgery is the most effective way to manage pancreatic cancers if the disease remains confined to the pancreas (Stage I). If the disease has progressed, then radiation or combinations of radiation plus chemotherapy are typically employed.
Unfortunately, pancreatic cancers are often advanced when first diagnosed and the only option left is chemotherapy. Despite years of study, there are no curative therapies for metastatic pancreatic cancer. Nonetheless, some patients have dramatic and durable benefit from chemotherapy.
The truly drug sensitive patients who will respond to numerous treatments and can benefit from the least toxic drug combinations
A small minority of patients who are sensitive to "targeted agents" like Erlotinib (Tarceva)
A large group of patients have distinct sensitivity to one of the three standard drug regimens used in this disease: Platinum-based (GemOx, Cisplatin & Gemcitabine), Taxane-based (GTX, Abraxane/Gemcitabine), or Irinotecan-based (FOLFIRINOX, FOLFIRI)
A final group of patients are resistant to standard chemotherapeutics and should be considered for experimental therapies as early as possible.
Today, patients are often selected for treatment based on physician experience, ease of administration or the cost of the chemotherapy combinations. Think what would happen if each patient received the therapy that was best suited to their unique tumor makeup.
This is why we perform functional profiling on your tumor to determine which drug or drug combination will most likely kill YOUR specific cancer.
The liver is not typically a primary tumor site, especially in the United States. More often, cancer in this organ has originated elsewhere and metastasized. But, in adult primary liver cancer there are three subtypes.
The majority – about 90 percent – are hepatocellular carcinoma, which can either begin as a single tumor that increases in size or as a collection of tumors (multifocal). Hepatocellular carcinoma is particularly common in patients with underlying liver disease associated with hepatitis and cirrhosis.
Cancer of the bile duct, known as cholangiocarcinomas, occur in less than 10 percent of all cases. The cancer starts within the tubes that course through the liver carrying bile fluids and can then spread throughout the liver and to distant sites. These tumors also arise in the gallbladder itself.
The last type is even more rare, starting in the blood vessels within the liver. It can either be classified as angiosarcomas or hemangiosarcomas. These types of cancers are sometimes associated with exposures to hepatotoxins and typically grow rapidly.
Surgery is usually the first form of treatment. Other liver cancer treatment options are also used in conjunction with surgery: Including thermal ablation, radiation, transplantation, alcohol injection and chemoembolization.
Partly because the liver is so active in its role as a detoxifying organ, it is characteristically resistant to many forms of "cytotoxic" chemotherapy. As a result, many active forms of therapy have little effect on this disease. Nonetheless, doxorubicin, cisplatin, Mitomycin-C, 5-FU, FUDR, gemcitabine and some of the newer targeted therapies like sorafenib and bevacizumab have shown favorable results in select patients.
In April 2010, Steve Lockwood was diagnosed with Stage 4 pancreatic cancer. Steve met with a local oncologist, as well as experts at UCLA and City of Hope. All spoke of conventional treatments and advised Steve to get his affairs in order. Then Steve met Dr. Nagourney. Steve is alive and well today, seven years later.
— Steve Lockwood
Ken Baumheckel was experiencing pain in the area just above the lumbar curve in his spine. An abdominal ultrasound revealed that Ken’s pain was caused by a tennis-ball sized pancreatic tumor and five growths in his liver. An endoscopic exam with biopsy confirmed that Ken had Stage 4 pancreatic cancer that had spread to his liver.
Ken made an appointment with Dr. Robert Nagourney at Rational Therapeutics (now Nagourney Cancer Institute), after learning about his work from a friend in the health care system.
— Ken Baumheckel
As a nurse, Margaret Johns is aware of protocols and “Best Practices.”
But there she was in the doctor’s office hearing about the only treatment available to treat the Stage 4 Pancreatic Cancer she had. Fortunately for Margaret, she learned that standard protocols aren’t really the only or the even the best option.
"Six months or less is the prognosis my oncologist gave me as I sat in her office on May 4, 2009. My stage 4 pancreatic cancer had metastasized to my liver. All of this happened without having pain or symptoms.
Around the same time, I just happened to listen to a radio show where the host talked about Rational Therapeutics (now Nagourney Cancer Institute). It made perfect sense to hear about having chemo tailored to an individual. My daughter Googled some info and I knew immediately that I wanted to do this.
— Margaret Johns