Although survival for many types of cancer has improved over the last few decades, there hasn’t been the same improvements for pancreatic cancer. This is partly because it is often diagnosed at a late stage. Research into pancreatic cancer is one of Cancer Research UK’s top priorities.
Research and clinical trials
All cancer treatments must be fully researched before they can be used for everyone. This is so we can be sure that:
- they work
- they work better than the treatments already available
- they are safe
The video below shows what it is like to take part in a trial.
Ash: I was offered a place on a trial by my cancer nurse
Jean: There was a new trial with new drugs and they were confident it would work and they offered it to me and I’m so glad I took it.
Nilesh: What we did, my wife and I, was to do some research on the internet. We came across the source trial which is what I went on and we took that to the doctor and then requested that we be put on to that.
Amy: The only thing that did sort of trouble us as a family when they did tell us was that it was possibly quite painful and there may be some side effects that they didn’t know about.
Ash: I was quite concerned about taking part in a trial because you hear the word trial and you think its test.
Nilesh: You know you hear about trials, clinical trials, drug trials things like that. My reservations were what the side effects were going to be.
Ash: I decided it was the right thing for me because it would potentially offer patients in the future less side effect risk.
Jean: There were lots of questions I had to ask and they were all answered and I was confident in going through the trial and the after care.
Nilesh: Right from day one they’ve been monitoring me. You know I have regular checkups and all that.
Amy: Any symptoms that arose with Poppy, somebody was always there to make sure that she wasn’t in any pain or any suffering.
Ash: I didn’t feel that they were hiding anything from me which when you’re talking about a clinical trial is so important.
Jean: It’s a really warm feeling knowing that what you did has helped other people.
Nilesh: I just hope that I played a part in a new drug that’s out there.
Ash: For other patients and also for society in general.
Nilesh: You’ve got to feel comfortable about the trial itself before you sign up for it. So do your background knowledge and just be 100% that that’s where you want to go.
Ash: Think about it very carefully. Read all of the background literature and ask lots and lots of questions because there’s no harm in doing that.
If you are looking to take part in a trial for pancreatic cancer in the UK, go to Cancer Research UK’s clinical trials database. You need to talk to your specialist if there are any trials that you think you might be able to take part in.
Research into the causes of cancer
Cancer of the pancreas is often diagnosed when it is advanced and difficult to treat. Researchers want to learn more about why pancreatic cancer starts and what helps it to grow.
Some researchers have been collecting samples of pancreatic tissue from people who have pancreatic cancer and from people who don’t. Doctors hope that a better understanding of how pancreatic cancer develops might lead to better treatments in the future.
Tests to diagnose pancreatic cancer
Doctors are always looking for better ways to diagnose pancreatic cancer. Some researchers are collecting blood, urine and tissue samples from people with symptoms of a possible pancreatic or bile duct cancer. They are looking to see if there are particular proteins (biomarkers) in people with cancer.
Some other researchers have collected blood samples from people with pancreatic cancer and other types of cancer, to look for circulating tumour cells. These are cancer cells, or parts of cancer cells, that are in the bloodstream. They hope to be able to develop a test that can pick up pancreatic cancer at an early stage.
Other researchers are looking at breath samples to see if substances in the exhaled breath can show if someone has cancer.
Some researchers are looking at the blood samples of people over 50 years old who have recently been diagnosed with type 2 diabetes. For a small number of people diabetes may be linked with pancreatic cancer. Researchers want to find out if there is a way of telling the difference between type 2 diabetes and diabetes linked to pancreatic cancer. They hope it may help to identify early signs of pancreatic cancer.
Screening means testing people for early stages of a disease before they have any symptoms. Diagnosing a cancer earlier may mean that treatment is more successful and may save lives. There is no national screening programme for pancreatic cancer, but people at high risk of developing it, may be able to have regular tests.
Doctors for the EUROPAC study are looking to see if tests can pick up early signs of pancreatic cancer in people who are at high risk of developing it.
Research into treatment
Researchers are always looking into ways to improve treatment, reduce side effects, and control symptoms.
Matching treatment to an individual cancer - PRECISION-Panc
This is a large programme of research aiming to understand more about the individual make up of pancreatic cancers. The researchers want to collect samples of pancreatic cancer tissue to examine its genetic make up.
Genes contain coded messages that tell cells how to behave. They control the growth and development of cells.
The researchers hope that understanding more about the genetic make up of pancreatic cancers will help doctors decide the best treatment. The researchers also want to learn more about when, how and why people develop pancreatic cancer. And to predict who is more at risk of developing it.
The researchers are doing their research in 2 stages. The PRECISION Panc study is stage 1. Based on the information from the tissue samples, they will ask people to join a study to have treatment in stage 2.
In stage 2, the researchers will look at new treatments for pancreatic cancer.
- PRIMUS 001 for people with pancreatic cancer that has spread
- PRIMUS 002 for people with pancreatic cancer that can be removed with surgery
PRIMUS 003 looked at second treatments for pancreatic cancer that had spread elsewhere in the body. This part of the study has now closed.
Before surgery (neo adjuvant)
Chemotherapy before surgery is called neo adjuvant treatment. The idea is that the treatment might shrink the cancer enough to make it possible for the surgeon to remove it. Several studies have shown that neo adjuvant treatment may be helpful for pancreatic cancer. But more research is needed to get a fuller picture of how well neo adjuvant treatment works, who benefits most and what the best treatment is.
After surgery (adjuvant)
Having chemotherapy after surgery to remove pancreatic cancer helps to reduce the risk of the cancer coming back. It is due to the results of trials that FOLFIRINOX and GemCap are now standard treatments after surgery for people well enough to have them.
Advanced pancreatic cancer
Advanced pancreatic cancer means cancer that has spread away from the pancreas to another part of the body. One of the standard chemotherapy regimes for advanced pancreatic cancer is gemcitabine and nab-paclitaxel. The PRIMUS 001 trial (part of PRECISION PANC study) is comparing this with a newer combination of drugs called FOLFOX-A. It includes folinic acid and the chemotherapy drugs:
- fluorouracil (5FU)
- nab paclitaxel
Stereotactic body radiotherapy (SBRT) directs radiotherapy beams at the cancer from different positions around the body. It accurately delivers a high dose of treatment to the cancer, while surrounding tissue only receives a low dose.
Early trials are looking at SBRT to shrink pancreatic cancer before surgery.
Combined radiotherapy and chemotherapy (chemoradiotherapy)
The chemotherapy drugs used with radiotherapy, for example capecitabine or 5FU, are radiosensitisers. You have them to make the cancer more sensitive to the radiotherapy.
Doctors want to know if chemotherapy on its own or chemotherapy and radiotherapy together is better before surgery to remove pancreatic cancer.
Researchers also want to see if giving another drug (called nelfinavir) with chemoradiotherapy makes the treatment better.
Targeted cancer drugs and immunotherapy
Targeted cancer drugs are newer drugs and work in a different way to chemotherapy.
Targeted cancer drugs change the way that cells work. They can boost the body’s immune system to fight off or kill cancer cells. Or they can block signals that tell cells to grow.
One targeted cancer drug that has been looked at is olaparib. The POLO trial looked at olaparib as maintenance therapy for people with an inherited gene change in the BRCA 1 or 2 genes. The people taking part had pancreatic cancer that had spread (metastatic disease) and the cancer had not grown after at least 4 months of FOLFIRINOX chemotherapy. They had olaparib or a dummy drug (placebo).
The average length of time without any signs of the cancer getting worse (progression free survival) was about twice as long for those people taking olaparib compared to the placebo.
Generally, pancreatic cancer doesn't appear to respond to drugs called checkpoint inhibitors that are used to treat some other types of cancer. These drugs include nivolumab and pembrolizumab. But there may be some pancreatic cancers that have certain abnormal genes that may have a higher chance of responding to these types of drugs. So research continues into this area.
Checkpoint inhibitors are a type of immunotherapy. They block proteins that stop the immune system from attacking cancer cells.
Irreversible electroporation (IRE)
This treatment uses needles to pass an electrical current to the cancer cells. This destroys the cancer cells. Your doctor might call this Nanoknife.
This treatment is not a standard treatment in the UK. You might have it as part of a clinical trial.
We need much more research about how this treatment might work in pancreatic cancer.