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  • Writer's pictureDr. Robert A. Nagourney, MD

For Pancreatic Cancer Patients, “the More You Explain It, The More I Don’t Understand It.” -Mark Twain

With 66,440 new diagnoses and 51,750 deaths, patients diagnosed with pancreatic cancer face a daunting problem. It seems that advances in molecular biology, tumor immunology and pharmacology have had little impact on survival.


An update on pancreatic cancer patients from the American Society of Clinical Oncology Gastrointestinal meeting left more questions than answers.


If we examine potentially curable patients, there have been a few favorable findings. First, the addition of some form of chemotherapy clearly adds benefit in people who are considered resectable or borderline resectable. The question being, what chemotherapy, what sequence, and whether it should be combined with radiation? Regrettably, no one really knows.


Pancreatic Cancer Treatment Trial Compares Results


One trial reported at the European Society of Medical Oncology in 2023 compared the most widely used combination, FOLFIRINOX to the combination of Gemcitabine plus radiation, but showed no difference in outcome between the two treatments.


In a different study, the addition of brief course radiation to FOLFIRINOX provided results that were actually worse than FOLFIRINOX alone.


Perhaps more confusing is the choice of drugs for treatment. Since 2011, FOLFIRINOX has been the treatment of choice. Abraxane plus Gemcitabine used pre-operatively or post-operatively (neo-adjuvant or adjuvant) has generally proven less effective, while Japanese trials using the drug S-1 fall somewhere in between.


To address these deficiencies, investigators have launched an arms race, developing increasingly complicated multi-agent regimens. One group added cisplatin to gemcitabine and Abraxane. Another group has combined Cisplatin, Gemcitabine, Abraxane and Capecitabine. At this rate, there will soon be a time when every patient gets every drug.


Even here in the potentially curable patients, there is a great deal of disagreement on the best treatment. Things get even worse when it comes to advanced or metastatic disease.


Our laboratory recently published a study (D’Amora, Metabolites, Feb. 2024) where we evaluated the metabolic causes of pancreatic cancer using blood metabolites (amino acid, lipid, sugar) measured by Mass Spectrometry. We identified blood metabolite signatures that identified the patients with the most favorable outcome.


For pancreatic cancer patients, we can now combine our EVA/PCD tissue culture studies for drug selection with these new metabolic signatures to offer the potential to change the natural history of this disease.


Patients newly diagnosed with pancreatic cancer can avail themselves of these platforms that have already provided durable benefits, even in widely metastatic disease.


Pancreatic Cancer Diagnosis Doesn't Need To Be A Death Sentence


A diagnosis of pancreatic cancer need not be a death sentence. It is, however, a call to arms for those who are afflicted to rise to the occasion and seek their own best chance of survival.


Clinical protocols that randomize patients to treatment A versus treatment B without exhausting all of our abilities to define each individual patient’s likelihood of benefit from each treatment do a disservice to patients, and cannot provide the personalized care they desperately need.


The one issue repeatedly raised in these reviews is the need for personalized care. We offer personalized care.

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