Pancreatic cancer research
This page of the pancreatic cancer section is about research into the causes, prevention and treatments of cancer of the pancreas. You can find the following information
- A quick guide to what's on this page
- Why we need to do research
- Research into the causes of pancreatic cancer
- Tests to diagnose pancreatic cancer
- Combined radiotherapy and chemotherapy
Pancreatic cancer research
All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know they are safe.
First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe to test are they tested in people, in clinical trials.
Researchers are looking into causes, screening and diagnosis of pancreatic cancer, chemotherapy, radiotherapy, biological therapies (including vaccines, monoclonal antibodies and growth factor blockers), gene therapy, treatment using light (photodynamic therapy) and controlling symptoms.
You can view and print the quick guides for all the pages in the treating pancreatic cancer section.
All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that
- We can be sure they work
- We can be sure they work better than the treatments that are available at the moment
- They are known to be safe
First, researchers develop and test potential new treatments in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If we describe a treatment as laboratory research, it is not ready for patients and is not available either within or outside the NHS.
Tests in patients are called clinical trials. The trials and research section has information about what trials are including information about the 4 phases of clinical trials. If you are interested in taking part in a clinical trial, visit our searchable database of clinical trials recruiting in the UK. If there is a trial that interests you, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to refer you to the research team. The database also has information about closed trials and trial results.
All the new approaches we cover here are the subject of ongoing research. Until studies are completed and new effective treatments found, these treatments cannot be used as standard therapy for cancer of the pancreas.
- Trying to find out more about the causes of pancreatic cancer
- Looking at the genes of people with pancreatic cancer
Cancer of the pancreas is often diagnosed when it is quite advanced and difficult to treat. Researchers want to learn more about why pancreatic cancer starts and what helps it to grow. To do this, there is a trial collecting samples of tissue from people who have pancreatic cancer and from people who don’t. Doctors hope that a better understanding of how pancreatic cancer develops may lead to better treatments in the future.
A few people are born one step closer to developing pancreatic cancer because they have inherited a high risk faulty gene. Families that carry the faulty BRCA2 gene (known as the breast cancer gene) or a faulty gene called p16 have an increased risk of pancreatic cancer. Some families with a strong history of melanoma in the family also have this p16 gene fault, but not all. If we can find out how to identify people at increased risk before cancer develops, they can have regular screening for early signs of that particular cancer.
From the pattern of pancreatic cancer in some families, experts can tell that there is likely to be a gene fault that only affects the pancreas. If you come from a family that carries this gene fault, statistically your risk of getting pancreatic cancer will be higher than it is for people in general. But we can't tell who in these families carries the gene because we haven't identified it yet. The risk will only be high for those family members who have inherited the gene.
Cancers most often develop because cells have developed gene faults during your life, not because you have inherited a gene fault. When genes are faulty, the proteins they tell the body to make are faulty too. An abnormal protein called K-ras, is found in the pancreatic cancer cells of about 80 out of every 100 people diagnosed, even when the disease doesn't run in the family. This may be a clue to how normal cells develop into pancreatic cancer cells. If we can find out how genes have been affected in cancerous cells, this may lead to the development of new treatments, possibly with fewer side effects than current cancer treatments.
Scientists and doctors at Liverpool University are looking for ways to diagnose cancer as early as possible in people at high risk. They know that people who have a family history of inflammation of the pancreas (hereditary pancreatitis) tend to have a higher than average risk of getting pancreatic cancer.
They are running a study called EUROPAC. This is a screening study for people over 40 with hereditary pancreatitis or a significant family history of pancreatic cancer. Significant family history means at least 2 or 3 people diagnosed with cancer of the pancreas on the same side of your family, depending on how close a relative they are and on their age. Sometimes people as young as 30 are considered for the study, depending on their family history.
The doctors in the EUROPAC study are testing pancreatic juice for changes in 3 genes (the genes are called K-Ras, p16 and p53). If any of these genes are abnormal, then you may have a higher risk of getting pancreatic cancer. To get at the pancreatic juice, doctors do a test called an ERCP. This stands for endoscopic retrograde cholangiopancreatography. You also have a baseline CT scan or endoscopic ultrasound (EUS) when you join the study. ERCP and EUS both involve having a tube down your throat (an endoscopy). In this study, if your tests show that you have any of these abnormal genes, you will have the tests repeated yearly to check for pancreatic cancer. If not, you carry on having the tests 3 yearly.
Other early research suggests that using EUS and ERCP together can help to find pre cancerous cell changes in people from high risk families. If these tests show that you have pre cancerous cells, your specialist may suggest you have your pancreas removed to stop cancer developing. There are some serious side effects to this surgery but the benefits of the operation would nearly always outweigh the risk of pancreatic cancer. More research is needed and at the moment you can only have EUS and ERCP at a specialist centre if you have a very strong family history of pancreatic cancer. These are invasive tests and they can have complications. They are not recommended for those who have an average risk unless they have signs of already having pancreatic cancer.
Scientists are researching a new test that may help diagnose pancreatic cancer. This is called the Mcm5 protein test. Mcm stands for minichromosome maintenance protein. The researchers have to take a biopsy from your pancreas and test it for this protein. The TRANSBIL study is looking at how reliable this test might be.
If you are interested in UK clinical trials, look on our clinical trials database. Choose 'pancreatic' from the drop down list of cancer types.
The 2 chemotherapy drugs doctors use most often for pancreatic cancer are gemcitabine (Gemzar) and 5-fluorouracil (5FU). Doctors continue to try and find better ways of treating pancreatic cancer with chemotherapy. There is now a tablet form of 5FU called capecitabine (Xeloda). As it is a tablet, you can take it at home and so some patients may prefer it. The CAP 001 study is trying to find out how well the body absorbs capecitabine chemotherapy after surgery for pancreatic cancer that includes removing part of the small intestine.
A trial called ESPAC 3 compared 5FU with gemcitabine after surgery to remove pancreatic cancer. Chemotherapy given after surgery is called adjuvant treatment. The aim is to try to delay the return of the cancer. There is a small chance that the treatment may stop the cancer from coming back altogether, but this is more unlikely for pancreatic cancer than it is for other cancers. The results showed that the two drugs worked equally as well.
A small trial called SONG compared gemcitabine with gemcitabine and cisplatin before surgery for pancreatic cancer. Giving chemotherapy before surgery is called neo adjuvant treatment. The idea is that the drugs shrink the cancer and make it easier to remove. The early results of the trial found that it was safe to give chemotherapy before surgery. And that people who had the combination of the two drugs were more likely to have an operation to remove their cancer, and more likely to live for at least a year, than those who just had gemcitabine. More research into chemotherapy before surgery for pancreatic cancer will give us a fuller picture of how well this treatment works.
An international study of chemotherapy for locally advanced and metastatic pancreatic cancer reported in 2009. It compared gemcitabine alone with gemcitabine and capecitabine (GemCap). The researchers found that GemCap controlled the cancer for longer, although it did not help people live longer. The combination therapy gave slightly higher rates of side effects, such as low white blood cells and hand-foot syndrome. A meta analysis of 2 other trials showed that GemCap did help some people live longer than gemcitabine alone. So the researchers recommend that GemCap should be considered as a first treatment option for people with locally advanced or metastatic pancreatic cancer.
A new type of paclitaxel chemotherapy, called nab-paclitaxel or Abraxane, has been looked at alongside gemcitabine in early trials in America. The results for people with advanced pancreatic cancer have so far been promising and so larger trials are planned.
Other drugs have been investigated for cancer of the pancreas, including pemetrexed (Alimta), oxaliplatin, tegafur with uracil (Uftoral), and docetaxel. Pemetrexed is a type of chemotherapy drug. It is a little similar to another drug in regular use for other cancers, called methotrexate. But the results so far show that none of these work as well as the current standard chemotherapy.
Other combinations doctors have tested include uftoral with gemcitabine and docetaxel with gemcitabine or cisplatin. These were small trials for advanced cancer. Unfortunately, the results have not been very promising so far, but doctors will continue to try out new combinations.
A phase 2 trial is looking at PM01183 for pancreatic cancer. PM01183 is a new chemotherapy drug that affects how cancer cells divide and grow. Doctors want to find out if this drug helps people with advanced pancreatic cancer that has come back or did not go away with chemotherapy. And to learn more about the side effects.
Trials are using PET-CT scans and PET scans to see how well chemotherapy is working for people with cancer of the pancreas. Doctors often use chemotherapy to treat pancreatic cancer. They usually do a CT scan to see if the treatment is working. The aim of these studies is to find out how good PET-CT scans or PET scans are at showing how well chemotherapy is working for people with pancreatic cancer.
There is more information about UK pancreatic cancer trials on our clinical trials database. Pick 'pancreatic' from the dropdown menu of cancer types. You should ask your specialist if you are interested in finding out whether you can take part in any trials.
Researchers are looking at whether new ways of giving radiotherapy can help to treat pancreatic cancer. The PACER trial looked at conformal radiotherapy with a biological therapy called cetuximab. The trial team found that cetuximab and radiotherapy had fewer side effects compared with other treatments. It worked well for localised cancer. But it didn't work as well as other treatments in recent clinical trials at preventing the cancer from spreading. Further research is now needed to find out why this treatment worked better in some people but not in others, and to find better ways of preventing pancreatic cancer from spreading.
Cyberknife is a new type of radiotherapy machine used for giving stereotactic radiotherapy to cancers that doctors cannot remove with surgery. Early research trials in the USA have looked at treating locally advanced pancreatic cancer with cyberknife and chemotherapy. Only small numbers of patients have been treated so far and it is not yet known how effective this treatment may be. In the early research studies, cyberknife and fluorouracil chemotherapy treatment seemed to stop the cancer from growing and causing symptoms for some time but did not help patients to live longer. We have information about cyberknife treatment elsewhere on this website.
There has been a lot of research into combining radiotherapy and chemotherapy after surgery for cancer of the pancreas. Treatment after surgery is called adjuvant treatment. One of the largest adjuvant treatment trials, ESPAC-1, showed that chemotherapy on its own was most helpful after surgery, rather than combination treatment. This led to the ESPAC-3 trial.
Other studies have looked at giving the combined treatment before surgery. This is called neo adjuvant treatment. Trial results have shown that this treatment may help to shrink cancers so that they can be removed or are easier to remove. This is called down staging. Doctors are still looking at the best way of giving chemotherapy and radiotherapy together before surgery.
The chemotherapy drugs used, for example capecitabine or 5FU, are radiosensitisers. You have them to make the cancer more sensitive to the radiotherapy.
The SCALOP trial looked at GemCap chemotherapy followed by radiotherapy with either gemcitabine or capecitabine for locally advanced pancreatic cancer. Although there were only a small number of people in this trial, the results suggest that after initial chemotherapy it may be better to use capecitabine rather than gemcitabine as part of chemoradiation for locally advanced disease. This is because capecitabine had a slightly better outcome and fewer side effects compared to gemcitabine.
The PERU study is looking at GemCap chemotherapy followed by capecitabine and radiotherapy for locally advanced pancreatic cancer. Half the people taking part will also have the biological therapy drug cetuximab during radiotherapy.
More research is planned to try to find the best combination of chemotherapy drugs and radiotherapy. You can find more details about open trials on our clinical trials database. Choose 'pancreas' from the dropdown menu.
The small BioSilicon trial looked into using a type of internal radiotherapy to treat advanced pancreatic cancer, alongside gemcitabine chemotherapy. People on the trial had a new treatment called 32P BioSilicon injected directly into the tumour. 32P BioSilicon is made up of small particles of silicon attached to radioactive phosphorus. The radiation aims to kill the cancer cells nearby. The trial found that the treatment seemed to stop the cancer growth and did not cause bad side effects. We need more research before we know how helpful this treatment is for advanced pancreatic cancer.
Biological therapies are treatments that act on processes in cancer cells. They can work in different ways such as changing the way cells signal to each other or by stimulating the body to attack or control the growth of cancer cells. Biological therapies being used in pancreatic cancer research include
There is detailed information about biological therapies on this website.
Cancer vaccines are designed to try to stimulate the body's own immune system to fight cancer. The immune system will naturally attack foreign cells that are invading the body, such as bacteria and viruses. Cancer cells are foreign, in that they are not like normal cells. But because cancer cells develop originally from normal body cells, they are harder for the immune system to spot.
The vaccine finds the cancer because it is designed to recognise abnormal proteins made by pancreatic cancer cells. Examples of these abnormal proteins are CEA (carcinoembryonic antigen) and the K-ras protein. Then the idea is for the vaccine to lock on to the cancer cells, triggering the immune system to attack them.
The TeloVac trial looked at a vaccine called GV1001 for advanced pancreatic cancer. Doctors wanted to see how well it worked with gemcitabine and capecitabine (GemCap) chemotherapy. The trial team found that adding GV1001 to GemCap didn't improve treatment for people with pancreatic cancer. Further analysis of the results is being done to find out if there is a small group (sub group) of people who may benefit from this combination of treatment.
Another vaccine, called G17-DT, targets a hormone called gastrin, which is normally made by the pancreas. It is also made by pancreatic cancer cells. The idea is that the vaccination with an altered form of gastrin could help to stimulate the immune system to attack the pancreatic cancer cells. But trials of this vaccine have so far shown mixed results.
Unlike vaccines used to prevent infection, cancer vaccines are aimed at treating a disease that has already taken hold. They are most likely to be combined with standard therapies, such as chemotherapy. Removing as much cancer as possible reduces the amount of cancer that the immune system needs to attack. So there is more chance that the treatment will be able to work.
Vaccine treatment is still highly experimental. It is unlikely to be available outside of clinical trials for cancer of the pancreas for some time.
Scientists are doing a huge amount of work into what makes cancer cells abnormal and what makes them grow uncontrollably. They have found that cancer cells make too many proteins that encourage the cells to grow.
There are proteins called growth factors or kinases. And receptors for the growth factors on the surface of cells. There are lots of different types of growth factors and receptors. One receptor that is common in cancer cells is epidermal growth factor receptor (EGF receptor). Different drugs are being developed that block these proteins and receptors. The drugs are named after the type of growth factor or receptor they block - tyrosine kinase inhibitors, protein kinase C inhibitors, or EGFR inhibitors, for example.
Erlotinib (Tarceva) is a tyrosine kinase inhibitor that is being tested for pancreatic cancer. Results from an international clinical trial show that people with advanced pancreatic cancer may benefit from erlotinib. This phase 3 clinical trial involved 529 patients with advanced pancreatic cancer. Patients were put into treatment groups at random and had either the standard dose of gemcitabine chemotherapy plus a dummy pill (placebo), or the standard dose of gemcitabine plus erlotinib tablets.
The patients who had gemcitabine and erlotinib did very slightly better than those who had gemcitabine and a dummy pill, but had more side effects. Erlotinib in combination with gemcitabine is licensed in Europe for advanced pancreatic cancer. This treatment will not be widely available on the NHS in England unless it is approved by NICE (the National Institute of Health and Clinical Excellence). The SMC (Scottish Medicines Consortium) have decided not to approve this treatment for use on the NHS in Scotland. There is more about the drug licensing process on our website.
Another growth factor blocker called sunitinib has been tried for people with advanced endocrine pancreatic tumours. A recent phase 3 trial compared sunitinib with a dummy drug (placebo). The results were promising. Sunitinib helped control the cancer for longer and some people lived longer, but it did cause side effects. Sunitinib has now been licensed in Europe for pancreatic endocrine tumours that have spread or cannot be removed with surgery.
Another recent trial looked at a drug called everolimus for advanced endocrine pancreatic tumours. Everolimus stops a particular protein called mTOR from working properly. mTOR controls other proteins that trigger cancer cells to grow. So everolimus helps to stop the cancer growing or may slow it down. This trial showed that everolimus helped to control the cancer for longer compared to a dummy drug, and the side effects were generally mild.
The COOPERATE 2 trial is looking at everolimus with a drug called pasireotide for neuroendocrine tumours (NETs) of the pancreas. Pasireotide is a new type of somatostatin analogue. These types of drugs help control the symptoms of NETs. They work by binding to receptors on the tumour cells. Research suggests that these drugs may also help stop NETs growing. This trial will compare taking everolimus and pasireotide with everolimus on its own.
Another trial is comparing BEZ235 with everolimus for advanced pancreatic neuroendocrine tumours. BEZ235 is also a cancer growth blocker, but it stops more signals that cancer cells use to divide and grow than everolimus does. So researchers think that BEZ235 may work better than everolimus for advanced NETs of the pancreas. The aim of the trial is to find out which is the better treatment for this group of patients and how safe the drug is.
A new drug called vandetanib is a type of tyrosine kinase inhibitor. Researchers in one trial are comparing vandetanib and gemcitabine to gemcitabine alone for pancreatic cancer that cannot be removed with surgery. They want to see if adding vandetanib helps gemcitabine to control the cancer for longer.
Dasatinib is another tyrosine kinase inhibitor. A trial is looking at dasatinib with gemcitabine chemotherapy for pancreatic cancer that has spread into surrounding tissue (locally advanced). The researchers want to find out how well the 2 drugs work together and to learn more about the side effects.
An early UK trial is looking at a type of biological therapy called MK-0752. It is a type of notch inhibitor. It works by blocking some of the enzymes needed for cell growth. The trial will be looking at MK-0752 with gemcitabine chemotherapy for people with advanced pancreatic cancer.
Another early trial is looking a new drug called LDE225 with gemcitabine for advanced pancreatic cancer. LDE225 blocks a type of cell signalling called the hedgehog pathway. This pathway can affect the growth of several types of cancer, including cancer of the pancreas. Researchers want to find the highest safe dose of LDE225 you can have alongside gemcitabine and to learn about the side effects of having both drugs together.
You can search for UK trials on our clinical trials database.
Monoclonal antibodies (MABs) are proteins, made in the laboratory from a single copy of a human antibody. They act in the same way as immune system proteins that kill foreign matter when they find it in your body.
When these laboratory made antibodies are injected into patients, they are designed to seek out cancer cells that have abnormal proteins. The monoclonal antibodies that are being investigated for cancer of the pancreas include cetuximab, bevacizumab and AMG 479.
To find out about these trials go to the clinical trials database. Go to the advanced search and choose 'pancreatic cancer' from the dropdown menu of cancer types and 'biological therapy' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.
Immunotherapy is another type of biological therapy. It works by encouraging the immune system to attack cancer cells. It may also help chemotherapy drugs work better. Doctors are looking at a new immunotherapy drug called IMM-101 alongside gemcitabine chemotherapy in a phase 2 trial for advanced pancreatic cancer. The main aim of the trial is to compare the safety and effects of gemcitabine and IMM-101 with gemcitabine alone.
This is one of the newer approaches to cancer treatment and is in the very early stages of clinical trials. There are technical issues to solve, such as finding a reliable way of getting genes into cancer cells.
A small UK trial is looking at using gene therapy and cyclophosphamide for advanced pancreatic cancer. The researchers are seeing if the gene therapy can increase the chance of chemotherapy killing the cancer cells. But in this early phase trial, they are mainly looking at the doses to use and making sure this potential treatment is safe.
Another gene therapy is called OncoVex. This has been tested in a few different cancers. A small trial found that it was safe to give and helped to shrink pancreatic cancers in some patients.
This is an experimental treatment involving a drug activated by light. We do not know yet how much this might help people with cancer of the pancreas.
A small trial is looking at photodynamic therapy using a drug called verteporfin for people with locally advanced pancreatic cancer. The people taking part have the drug injected into a vein. After the drug has had time to circulate through the body and get into the tumour, the doctor puts fibres through the skin and into the area of the tumour. The doctor guides the fibres into place using an ultrasound or a CT scan to make sure they are in position. Then a laser light is shone directly into the pancreas. The light activates the drug, which kills the cancer cells.
This is known as irreversible electroporation or IRE. It is a new treatment for pancreatic cancer. The aim of the treatment is to destroy cancer cells in the pancreas by giving short pulses of electricity to the tumour and causing less damage to the surrounding tissue.
You have this treatment under general anaesthetic. Special needles are put through the skin and around the tumour in the pancreas. Short pulses of electricity fire repeatedly between the needles over several minutes. The doctor may move the needles and repeat the process until the whole tumour and a small area of surrounding tissue is treated. In February 2013, the National Institute of Health and Care Excellence (NICE) issued guidance on this treatment. They said that it is not clear yet how well this treatment works and there are some risks. More research is needed and so NICE recommend you only have this treatment as part of a clinical trial.
Laboratory studies have shown that omega 3 fish oil may slow down the growth of pancreatic cancer cells and speed up the rate that the cancer cells self destruct (apoptosis). Researchers have also found that the chemotherapy drug gemcitabine worked better against pancreatic cancer cells when patients had omega 3 fish oil at the same time. A phase 2 trial is looking at gemcitabine with omega 3 fish oil for pancreatic cancer that has started to grow into the surrounding tissues or has spread to other parts of the body.
Cancer of the pancreas is one of those cancer types that is linked to severe weight loss. It is difficult for people with advanced pancreatic cancer to eat. But there is also an effect of the cancer itself on the way your body absorbs and processes food. There are trials that are trying to find ways to control the weight loss associated with advanced cancer of the pancreas.
The NUT study looked at giving a nutritional supplement to people having chemotherapy for advanced cancer anywhere in the digestive system. The study did not show improved survival or quality of life for those taking the supplement.
Cachexia is severe weight loss. Cachexia seems to be linked to the production of body chemicals called cytokines. Cancers can produce cytokines in larger amounts than normal. The cytokines can then cause the body to break down fat and muscle faster than normal.
Researchers think that thalidomide may be able to help with cachexia. Thalidomide can reduce the amount of cytokines in the body. So it may be able to slow down, or even stop, the weight loss they cause. Early trial results are promising, but no one is quite sure yet how well it works. Another trial is looking at a new drug called BYM338 to see if it can help build up muscle and stop weight loss. BYM338 is a drug that blocks an enzyme called myostatin. This enzyme controls muscle growth. By blocking myostatin muscle is able to grow. You can find more information about these trials on our clinical trials database. They are not just for those with pancreatic cancer, so are listed under 'all types of cancer' in the drop down search menu.
Another study is looking at the role of exercise in people with lung or digestive system cancer (this includes pancreatic cancer) who have weight and muscle loss. The researchers hope to understand more about exercise in this group of patients so they can design suitable exercises to help people in the future.
The pre-MENAC study is looking at possible treatments for cachexia. The researchers are looking at a supplement drink, a non steroidal anti inflammatory drug called celecoxib, and advice on exercise and diet.
Some people with advanced cancer of the pancreas develop severe pain. A trial called NaTTS compared three different ways of controlling pain. These were opioid painkillers on their own, opioid painkillers and a coeliac plexus nerve block, or opioid painkillers and an operation to cut the splanchnic nerve. Researchers found no difference between the 3 groups in how well pain was controlled.
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