David L. Sherr, MD
David L. Sherr, MD, radiation oncology, New York-Presbyterian/Weill Cornell Medical Center, New York City.
Pancreatic cancer has been in the news recently, not only because of high-profile patients like Supreme Court Associate Justice Ruth Bader Ginsburg, Apple company CEO Steve Jobs and actor Patrick Swayze, but also because researchers have been learning more about what causes this particularly virulent form of cancer and how to treat it.
Pancreatic cancer is the fourth leading cause of cancer death for men and women in the US. It strikes more than 35,000 Americans annually and has one of the lowest survival rates of all cancers — it’s fatal within five years in 95% of cases. The best chance of survival lies in early detection and treatment, but that’s made difficult by the fact that there are few, if any, early symptoms. The first signs are typically weight loss and jaundice, and these often don’t appear until the cancer is already advanced and has spread to other parts of the body.
I recently spoke with David L. Sherr, MD, radiation oncologist at New York-Presbyterian/Weill Cornell Medical Center, an expert on pancreatic cancer, to learn more about some promising new developments.
Dr. Sherr and his colleagues have discovered that delivering radiation treatment before surgical removal of a pancreatic tumor — rather than afterward, which was been standard treatment — nearly doubles the likelihood a patient will still be alive 23 months later. Dr. Sherr and his team examined the records of 3,885 patients who had surgery for pancreatic cancer between 1994 and 2003. Sixty percent (2,337) had surgery alone… 38% (1,478) received radiation after surgery… and 2% (70) received radiation before surgery. Though the number was very small, those who had pre-surgical radiation showed a survival advantage — they were still alive at 23 months, compared with average survival time of 17 months in those who had post-surgical radiation and only 12 months in people who only had surgery.
Dr. Sherr believes that the benefits of pre-surgical radiation are likely due to several different factors…
Pre-surgical radiation may also increase the number of candidates for pancreatic cancer surgery, says Dr. Sherr, since in borderline cases, radiation can reduce tumors to an operable size. These results were published in the November 15, 2008, issue of the International Journal of Radiation Oncology, Biology and Physics.
Other research suggests a distinct advantage for patients whose surgeons are highly experienced. According to a report from the Department of Veterans Affairs, the mortality rate for pancreatic resection surgery (known as Whipple procedure) was 16.3% at hospitals where fewer of these complex surgeries were performed, while the mortality rate for the same surgery at high-volume centers was just 3.8%. High-volume centers were considered to be those that performed 16 or more procedures a year.
Advances are being made in drug therapy as well. The drug Sunitinib malate (Sutent), already approved for the treatment of kidney and stomach cancer, may be effective against pancreatic cancer, Dr. Sherr told me. This past March, a clinical trial of Sutent for pancreatic cancer patients was halted so that all the patients — including the ones who’d been taking placebo — could get the drug, since early results showed it provided a clear benefit.
Given how difficult the disease is to treat, it has been especially frustrating that researchers have been thwarted in their attempts to pinpoint risk factors. While smoking is one that is well-known, the vast majority of people who develop cancer of the pancreas do not have clear-cut risk factors, Dr. Sherr said. However, several new studies have revealed more information about who is at risk…
Last but definitely not least, an herbal extract has been found to not only halt the progression of pancreatic cancer but also to slow development of new tumors. Research presented at the annual meeting of the American Association for Cancer Research (AACR) and soon to be published in HBP, the official journal of the International Hepato-Pancreato-Biliary Association, reports that Nigella sativa, widely used in Asian and Middle Eastern traditional medicine, has anti-inflammatory properties that are particularly beneficial to people with chronic pancreatitis, as well as those at risk for development or recurrence of pancreatic cancer. This is an initial finding that needs to be confirmed with more research, but it appears that the main ingredient in the oil pressed from the seeds of the herb (thymoquinone) has both preventive and therapeutic benefits, with no reported toxic effects when used in moderation.
Even though the outlook remains bleak overall, physicians and scientists are making slow but steady progress against deadly pancreatic cancer. In the meantime, individuals with pancreatic cancer, such as Ginsburg, Swayze and Jobs, continue to inspire with their own daily victories.