Impact of Non-Toxic Metabolic Disruptors on Overall Survival and One Year Survival Rate in Exocrine Pancreatic Cancer. Update and Observations on Early Intervention

Background and Aims: Pancreatic cancer has the lowest survival rate of all cancers (4%), and it accounts for 1.9% of new cancer cases in Hong Kong. Combined treatment with Chinese herbal medicine (CHM) and Western medicine has yielded promising results, leading to improved prognosis and overall survival. This retrospective case series aimed to illustrate the improved survival and quality of life outcomes of pancreatic cancer patients administered CHM based on traditional Chinese medicine theory. Methods: To investigate the effectiveness of CHM in prolonging overall survival, 182 patients diagnosed with pancreatic cancer who received CHM treatment were observed from 2005 to 2015. Results: One hundred eighty-two pancreatic cancer patients were treated with CHM; 21 patients died. The mean and median survival of these patients were 29.6 and 15.2 months, respectively; the 1-year survival rate was 76% (range = 4 months to 9 years). These results are better than those reported in patients treated with Western medicine, suggesting the need for further study of CHM. Conclusion: A superior clinical outcome may be obtained with CHM treatment. The case series illustrates the potential benefits and safety issues of CHM in pancreatic cancer patients that could be relevant for developing strategies to increase individualization of pancreatic cancer treatment and improve survival. This study may facilitate interprofessional communication and improved clinical management of pancreatic cancer patients.

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Targeted Therapies for Pancreatic Cancer

Cancers ◽

10.3390/cancers10020036 ◽

2018 ◽

Vol 10 (2) ◽

pp. 36 ◽

Cited By ~ 30

Author(s):

Idoroenyi Amanam ◽

Vincent Chung

Keyword(s):

Lung Cancer ◽

Pancreatic Cancer ◽

Overall Survival ◽

Monoclonal Antibodies ◽

Small Molecule ◽

Targeted Therapies ◽

Median Overall Survival ◽

The Third ◽

One Year ◽

Targeted Approach

Pancreatic cancer is the third leading cause of cancer related death and by 2030, it will be second only to lung cancer. We have seen tremendous advances in therapies for lung cancer as well as other solid tumors using a molecular targeted approach but our progress in treating pancreatic cancer has been incremental with median overall survival remaining less than one year. There is an urgent need for improved therapies with better efficacy and less toxicity. Small molecule inhibitors, monoclonal antibodies and immune modulatory therapies have been used. Here we review the progress that we have made with these targeted therapies.

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Incidence and characterization of venous thromboembolic events (VTE) in patients with pancreatic cancer: Effect of timing of VTE on survival.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.4037 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 4037-4037

Author(s):

Maithili A Shethia ◽

Aparna Hegde ◽

Xiao Zhou ◽

Michael J. Overman ◽

Saroj Vadhan-Raj

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Survival Analysis ◽

Kaplan Meier ◽

Hazard Ratios ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

One Year ◽

The Impact

4037 Background: Patients (pts) with pancreatic cancer are at high risk for VTE, and the occurrence of VTE can affect pts’ prognosis. The purpose of this study was to evaluate the incidence of VTE and the impact of timing of VTE (early vs. late) on survival. Methods: Medical record of 260 pts with pancreatic cancer, newly referred to UT MDACC during one year period from 1/1/2006 to 12/31/2006, were reviewed for the incidence of VTE during a 2-year follow-up period from the date of diagnosis. All VTE episodes were confirmed by radiologic studies. Survival analysis was conducted using Kaplan-Meier analysis and Cox proportional hazard models. Results: Of the 260 pts, 47 pts (18%) had 51 episodes of VTE during the 2-year follow-up. The median age of the pts with VTE was 61 years (range: 28-86) and 53% were males. Of the 47 pts with VTE, 27 (57%) had PE, 19 (40%) had DVT and 1 had concurrent PE/DVT. Three pts had recurrent VTE during the study period. Median follow-up time for OS was 192 days (range: 1-1652 days). Kaplan-Meier Survival analysis showed that those who developed VTE earlier (within 30 or 90 days) had shorter median overall survival (OS) compared with those who had VTE beyond these time points. The hazard ratios, 95% CI, and median OS at 1 year are summarized in the table below. Conclusions: The incidence of VTE is high in pts with pancreatic cancer. The timing of VTE had a significant impact on OS; pts who had an early development of VTE had a shorter overall survival. [Table: see text]

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Clinical Limitations of Photon, Proton and Carbon Ion Therapy for Pancreatic Cancer

Cancers ◽

10.3390/cancers12010163 ◽

2020 ◽

Vol 12 (1) ◽

pp. 163 ◽

Cited By ~ 2

Author(s):

Mikaela Dell’Oro ◽

Michala Short ◽

Puthenparampil Wilson ◽

Eva Bezak

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Radiation Therapy ◽

Survival Rate ◽

Particle Therapy ◽

Current Status ◽

Published Data ◽

Carbon Ion Therapy ◽

Carbon Ion ◽

Ion Therapy

Introduction: Despite improvements in radiation therapy, chemotherapy and surgical procedures over the last 30 years, pancreatic cancer 5-year survival rate remains at 9%. Reduced stroma permeability and heterogeneous blood supply to the tumour prevent chemoradiation from making a meaningful impact on overall survival. Hypoxia-activated prodrugs are the latest strategy to reintroduce oxygenation to radioresistant cells harbouring in pancreatic cancer. This paper reviews the current status of photon and particle radiation therapy for pancreatic cancer in combination with systemic therapies and hypoxia activators. Methods: The current effectiveness of management of pancreatic cancer was systematically evaluated from MEDLINE® database search in April 2019. Results: Limited published data suggest pancreatic cancer patients undergoing carbon ion therapy and proton therapy achieve a comparable median survival time (25.1 months and 25.6 months, respectively) and 1-year overall survival rate (84% and 77.8%). Inconsistencies in methodology, recording parameters and protocols have prevented the safety and technical aspects of particle therapy to be fully defined yet. Conclusion: There is an increasing requirement to tackle unmet clinical demands of pancreatic cancer, particularly the lack of synergistic therapies in the advancing space of radiation oncology.

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A phase II trial of gemcitabine in combination with oxaliplatin and capecitabine in previously untreated metasetatic or recurrent pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14685 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14685-e14685

Author(s):

Sun Jin Sym ◽

Junsik Hong ◽

Minkyu Jung ◽

Yang Seo Koo ◽

Yeon Ho Park ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Disease Progression ◽

Pancreatic Adenocarcinoma ◽

Single Agent ◽

Objective Response ◽

Survival Rates ◽

Advanced Pancreatic Cancer ◽

Survival Duration ◽

One Year

e14685 Background: Treatment with single agent gemcitabine provides modest benefits in patients with metastatic pancreatic cancer.This study was performed to determine the efficacy of gemcitabine in combination with oxaliplatin and capecitabine in patient with recurrent or metastatic pancreatic adenocarcinoma. Methods: This was a prospective, single-arm, single center study in patients with chemotherapy-naive metastatic or recurrent pancreatic adenocarcinoma. The primary endpoint was objective response. The study was designed as a Simons two-stage optimal design and was divided into two stages. The first stage was to recruit up to 18 patients. If at least two objective responses were obtained, then a further 25 patients would be enrolled into the study. If no more than two responses were obtained among these 18 patients, the study would be halted. The study patients received gemcitabine 800 mg/m2 on day1, plus oxaliplatin 100 mg/m2 on day 1 and capecitabine 800 mg/m2/day on days 1-7 every 14 days. Treatment was to be administered until disease progression or until withdrawal from the study due to unacceptable toxicity or other reasons. Results: Eighteen patients were enrolled. Median age was 63 years (range, 39-73 years). Among these 18 patients, only one patient (5.5%) achieved an objective response. Therefore, the accrual terminated. The median time to disease progression was 2.1 months, and the median overall survival duration was 4.9 months. One-year overall survival rates were 35.3%. The most frequently reported grade 3 or 4 adverse events were asthenia (16.6%), and nausea (5.5%). There were no unexpected toxicities. Conclusions: The addition of oxaliplatin and capecitabine to gemcitabine did not improve objective response in the first-line treatment of advanced pancreatic cancer patients.

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A phase II trial of gemcitabine in combination with oxaliplatin and capecitabine in previously untreated metastatic or recurrent pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.344 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 344-344

Author(s):

Sun Jin Sym ◽

Junsik Hong ◽

Minkyu Jung ◽

Yang Seo Koo ◽

Yeon Ho Park ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Disease Progression ◽

Pancreatic Adenocarcinoma ◽

Single Agent ◽

Objective Response ◽

Survival Rates ◽

Advanced Pancreatic Cancer ◽

Survival Duration ◽

One Year

344 Background: Treatment with single agent gemcitabine provides modest benefits in patients with metastatic pancreatic cancer. This study was performed to determine the efficacy of gemcitabine in combination with oxaliplatin and capecitabine in patient with recurrent or metastatic pancreatic adenocarcinoma. Methods: This was a prospective, single-arm, single center study in patients with chemotherapy-naive metastatic or recurrent pancreatic adenocarcinoma. The primary endpoint was objective response. The study was designed as a Simons two-stage optimal design and was divided into two stages. The first stage was to recruit up to 18 patients. If at least two objective responses were obtained, then a further 25 patients would be enrolled into the study. If no more than two responses were obtained among these 18 patients, the study would be halted. The study patients received gemcitabine 800 mg/m2, plus oxaliplatin 100 mg/m2 and capecitabine 800 mg/m2/day on days 1-7 every 14 days. Treatment was to be administered until disease progression or until withdrawal from the study due to unacceptable toxicity or other reasons. Results: Eighteen patients were enrolled. Median age was 63 years (range, 39-73 years). Among these 18 patients, only one patient (5.5%) achieved an objective response. Therefore, the accrual terminated. The median time to disease progression was 2.1 months, and the median overall survival duration was 4.9 months. One-year overall survival rates were 35.3%. The most frequently reported grade 3 or 4 adverse events were asthenia (16.6%), and nausea (5.5%). There were no unexpected toxicities. Conclusions: The addition of oxaliplatin and capecitabine to gemcitabine did not improve objective response in the first-line treatment of advanced pancreatic cancer patients.

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A multicenter clinical randomized phase II study of investigating duration of adjuvant chemotherapy with S-1 (six versus 12 months) for patients with resected pancreatic cancer: PACS-1 study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.669 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 669-669

Author(s):

Yo-ichi Yamashita ◽

Shinji Itoh ◽

Mototsugu Shimokawa ◽

Hiroshi Takamori ◽

Kengo Fukuzawa ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Survival Rate ◽

Adjuvant Chemotherapy ◽

Median Overall Survival ◽

Group Performance ◽

Eastern Cooperative Oncology Group ◽

Progression Free Survival ◽

Rank Test ◽

Overall Survival Rate

669 Background: Although adjuvant chemotherapy with S-1 has improved overall survival and progression-free survival (PFS) in patients with resected pancreatic cancer, the duration evaluation of adjuvant chemotherapy with S-1 have not established yet. Methods: We did a randomized, multicenter, phase 2 trial undertaken at 15 hospitals in Japan. Patients who were Eastern Cooperative Oncology Group performance states of 0 or 1 and aged 20 years or older were eligible. Patients with resected pancreatic cancer were randomly assigned (in a 1:1 ratio) to receive S-1 [40 mg, 50 mg, or 60 mg according to body-surface area, orally administered twice a day for 28 days followed by a 14 day rest, every 6 weeks [one cycle], for up to four cycles (6 months)] or up to eight cycles (12 months). The primary end point was overall survival rate. Secondary endpoints included PFS and safety. Results: The population consisted of 82 patients in the S-1 for 6 months group and 82 patients in the S-1 for 12 months group. The 2-year overall survival rate was 71.4% in the S-1 for 6 months group and 65.4% in the S-1 for 12 months, and the median overall survival was 31.0 months in the S-1 for 6 months group and 26.3 months in the S-1 for 12 months group [hazard ratio (HR) 1.23, 95% confidence interval (CI) 0.76-1.99, p = 0.377]. The PFS at 2 years was 56.8% in the S-1 for 6 months group, and 51.2% in the S-1 for 12 months. The HR for recurrence of S-1 for 6 months, compared with S-1 for 12 months, was 1.23 (95%CI 0.76-1.99, p = 0.392). Twenty-nine (35.3%) patients in the S-1 for 6 months group and 46 (56.0%) in the S-1 for 12 months group discontinued treatment before completion. In regard to patients completed treatment, the S-1 for 12 months group showed tendency to favorable prognosis on PFS compared with the S-1 for 6 months group (log-rank test; p = 0.175). Conclusions: In patients with resected pancreatic cancer, adjuvant chemotherapy with S-1 for 12 months is not superior to that for 6 months in terms of median overall survival and PFS. For patients who can tolerate adjuvant chemotherapy with S-1 for 6 months well, continuing treatment for up to 12 months may improve the prognosis.

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Predictors of Locoregional Failure and Impact on Overall Survival in Patients With Resected Exocrine Pancreatic Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2015.11.003 ◽

2016 ◽

Vol 94 (3) ◽

pp. 561-570 ◽

Cited By ~ 7

Author(s):

Kenneth W. Merrell ◽

Michael G. Haddock ◽

J. Fernando Quevedo ◽

William S. Harmsen ◽

Michael L. Kendrick ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Locoregional Failure ◽

Exocrine Pancreatic Cancer

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Pancreatic Cancer: 80 Years of Surgery—Percentage and Repetitions

HPB Surgery ◽

10.1155/2016/6839687 ◽

2016 ◽

Vol 2016 ◽

pp. 1-15 ◽

Cited By ~ 5

Author(s):

Birgir Gudjonsson

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Survival Rate ◽

Actual Number ◽

Resection Rate ◽

Survival Percentage ◽

The Us ◽

Original Group ◽

The Mean ◽

Actual Survival

Objective. The incidence of pancreatic cancer is estimated to be 48,960 in 2015 in the US and projected to become the second and third leading causes of cancer-related deaths by 2030. The mean costs in 2015 may be assumed to be $79,800 per patient and for each resection $164,100. Attempt is made to evaluate the results over the last 80 years, the number of survivors, and the overall survival percentage. Methods. Altogether 1230 papers have been found which deal with resections and reveal survival information. Only 621 of these report 5-year survivors. Reservation about surgery was first expressed in 1964 and five-year survival of nonresected survivors is well documented. Results. The survival percentage depends not only on the number of survivors but also on the subset from which it is calculated. Since the 1980s the papers have mainly reported the number of resections and survival as actuarial percentages, with or without the actual number of survivors being reported. The actuarial percentage is on average 2.75 higher. Detailed information on the original group (TN), number of resections, and actual number of survivors is reported in only 10.6% of the papers. Repetition occurs when the patients from a certain year are reported several times from the same institution or include survivors from many institutions or countries. Each 5-year survivor may be reported several times. Conclusion. Assuming a 10% resection rate and correcting for repetitions and the life table percentage the overall actual survival rate is hardly more than 0.3%.

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