By Jessica Saenz
A diagnosis of pancreatic cancer is almost synonymous with hopelessness. Perceiving it as the least survivable cancer is understandable. "Once patients were diagnosed, the doctor often told them to start getting ready," he saysMark Truty, medical doctor, an oncologist surgeon at the Mayo Clinic specializing in pancreatic surgery.
However, things are turning around with new and improved treatments that help people with pancreatic cancer live longer. Doctor Truty andRobert McWilliams, MD, a medical oncologist at Mayo Clinic, discuss the Mayo Clinic approachtreatment of pancreatic cancerand how this leads to improved survival and quality of life.
Capturing the full picture from the moment of diagnosis
Dr. Truty says it's important to learn as much as possible about each person's cancer before starting treatment. “When a patient is first diagnosed, they need really good imaging and molecular testing to see not only where the tumor is but also if there is any evidence of it spreading. We do a lot of testing at the beginning and all the time to make sure the cancer is cured. really localized and didn't spread."
In most cases acomputed tomographythemagnetic resonance imagingis used to pinpoint tumor location and possible spread, but Dr. Truty says standard inspections are just one piece of the puzzle. “Historically, patients had an ultrasound where the tumor appeared to be localized and then operated on. However, this paradigm did not produce the expected results.”
Here's whereScanning an animaland additional molecular testing plays an important role.
dr. Truti says PET scans and newer genetic tests are the key to staging the cancer and accurately assessing its behavior. They can help determine whether treatment is effective in shrinking tumors, whereas traditional CT scans have clear limitations in evaluating the response to primary pancreatic tumors. “If we see the expected response in the PET scan, it means that these patients are doing really well. If we don't see an answer, we need to change their treatment to see if we can get a better outcome," he says. says. “We are also using an innovative genetic test developed at the Mayo Clinic to test patients' blood as well as abdominal fluidlaparoscopyto see if we can get cancer DNA."
This method helps Mayo Clinic oncology experts identify who may be at risk for pancreatic cancer recurrence and individualize treatment to reduce the risk of cancer recurrence. "We're the first center to do this routinely for every patient we see," says Dr. Truty.
Customize testing and treatment for each person
Initial pancreatic cancer screening and staging can help reveal weaknesses or potential risks in each unique case of pancreatic cancer. "As we learned more about the genetics of pancreatic cancer - and how to find patients who could benefit from it - we were able to tailor treatment to the patient's genetics and DNA, which are changes in the DNA specific to the cancer itself," says Dr. McWilliams. .
In a study he conductedMayo Clinic Center for Individualized MedicineScientists have discovered that approx1for 6 persondiagnosed with pancreatic cancer had a hereditary cancer-related gene mutation that may have predisposed them to pancreatic cancer. The most common genetic mutation in these patients was the BRCA2 gene, which is associated with breast cancer.
Niloy Jewel Samadder, MD, a Mayo Clinic gastroenterologist and hepatologist and lead author of the study, found that patients with the mutations lived 50 percent longer. Data fromit's a studyand others led to recent changes inGuidelineswho advocate genetic testing for all pancreatic cancer patients, regardless of the stage of the cancer or family history of cancer.
Although most people with pancreatic cancer don't have germline mutations, Dr. McWilliams says it's important to use all the tools available to each patient. While it may not provide a cure, it can help select therapies that improve quality of life so patients can live longer and more comfortably.
"There is a nationwide process underway, the so-calledPOLO testwhich showed that patients undergoing chemotherapy with BRCA1 or BRCA2 mutations were eligible for maintenance treatment with just one pill, rather than intravenous chemotherapy, which is very good in terms of side effects, says Dr McWilliams.
Redefining what is considered dysfunctional
dr. Truti says patients who can undergo surgery to remove pancreatic cancer can live much longer, but in cases where the tumor has grown outside the pancreas and blocked critical blood vessels, pancreatic cancer is considered inoperable.
About a third of pancreatic cancers grow to surround the blood vessels outside the pancreas. "In the past, these patients were not eligible for surgery," he says. “Theoretically, 50% of patients diagnosed with pancreatic cancer are eligible for surgery. The question is: how do we operate them? And how to optimize their performance to ensure they live as long as possible?”
dr. Truty, McWilliams and pancreatic cancer experts at the Mayo Clinic use an approach called neoadjuvant therapy, which involves chemotherapy -- or a combination of chemotherapy and radiation -- to destroy tiny cancer cells in the body before surgery. By combining this method with surgery tailored to each patient's anatomy, tumors can be completely removed and blood vessels reconstructed if necessary. This resulted in the possibility of surgical intervention in patients who had not previously had such an opportunity, which translated into better results than ever before.
“For each patient, we create operations tailored to individual needs that are not performed anywhere else in the world. This is why so many people come to us when they are told their tumor is inoperable,” says Dr. Truty.
While surgery can give the best results in many cases, Dr. Truti emphasizes that the goal of treating pancreatic cancer is not surgery. “The goal of every cancer patient is to prolong life and maintain its appropriate quality. Sometimes surgery is needed to achieve this, and sometimes it will reduce the risk of one or the other event or both. So before we even consider surgery, we need to be sure that surgery has the best chance of achieving both of these goals."
Pancreatic cancer continues to have the highest mortality rate, but Dr McWilliams says patients have plenty to be optimistic about. "It's a very serious cancer. For many people, it is life threatening, but not necessarily a death sentence,” he says. "It's something we have treatments for and our treatments are getting better and better."
According to him, this progress is driven by clinical trials. “Clinical trials are a way of advancing science. For patients who are looking for the latest and greatest solutions and want to help develop new cancer treatment options, participation in clinical trials is extremely important.”
dr. Truti hopes more people with pancreatic cancer will seek a second opinion at cancer centers that are taking a new approach and giving patients more options. “Historically, it was a nihilistic disease, but things have really changed. We did not compromise on the standard of care, which resulted in not very good standard results. We need to treat patients differently - starting from scratch." He says. "And if you can do that throughout the treatment period, patients will get really great results."
Find out more
Learn more aboutpunkReat craband findpancreatic cancer clinical trialat the Mayo Clinic.
Read these articles:
- "5 things you need to know about pancreatic cancer"
- "Studies have shown that PET/MRI biomarkers help in the personalized treatment of people with pancreatic cancer"
- "Identification of inherited gene mutations in pancreatic cancer could lead to targeted therapies with better survival"
- "An aggressive approach to pancreatic cancer produces excellent results"
Also watch this video:Mayo Clinic Data: Advances in Pancreatic Cancer Treatment Extend Life