A study looking for proteins that can show how well chemotherapy has worked after surgery for pancreatic cancer (ESPAC-Tplus)

The researchers looked at a particular biomarker called human equilibrative nucleoside transporter 1 (hENT1). They wanted to find out if hENT1 levels can help doctors know which chemotherapy will work better after surgery, either gemcitabine or fluorouracil (5FU).

They found that gemcitabine was not helpful to people who had low levels of hENT1 but it was helpful for people with high levels. The opposite applies to 5FU.

The researchers looked at tissue samples taken from

• 202 people treated with gemcitabine
• 201 people treated with 5FU
• 31 people who had surgery only

They used the results from 380 people and 1808 tissue samples (cores).

They looked at the average length of time that people lived (the median survival).

For people who had gemcitabine this was

• Just over 17 months (17.1) for people who had low levels of hENT1
• Just over 26 months (26.2) for people who had high levels of hENT1

For people who had 5FU this was

• Over 25 months (25.6) for people who had low levels of hENT1
• Just under 22 months (21.9) for people who had high levels of hENT1

The researchers think that these findings support the idea that people with pancreatic cancer could have a particular chemotherapy drug based on their hENT1 levels.

The researchers have told us that this work is continuing. They have also looked at a process called cytidine deaminase transcript analysis. They found that when this process is used as well as looking at hENT1 levels, it helps to show how well people might do on gemcitabine.

Other research has also used some samples from the ESPAC-3 trial. This has confirmed that levels of hENT1 can help to show who might benefit from gemcitabine after surgery. Also, the levels of a biomarker called intra tumoural dihydropyrimidine dehydrogenase can help show who will benefit from having treatment with 5FU.

The researchers highlighted some additional research which has looked at a specific protein. This protein is called GATA6. It plays an important role in pancreatic cancer cell function.

They looked at the level of GATA6 in people who had 5FU. They found that those who had a low level of GATA6 in their cancer did not do well compared to people who had a high level of GATA6. There was no difference in people having gemcitabine.

All this information is now being put together so doctors are better able to see which treatment is best for people. The hope is that this will improve survival.

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed ) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.