While surgery is the only treatment that can cure pancreatic cancer, many patients are inoperable initially because their cancer has invaded blood vessels. At the Pancreas Center, we utilize chemotherapy and radiation therapy to shrink tumors and are able to offer surgery to many of the patients with locally inoperable pancreatic cancer who would otherwise never have a chance for cure. The decision to use chemotherapy prior to surgery is complex and each patient is discussed in a multidisciplinary meeting by the surgeons, medical oncologists, radiation oncologists, radiologists, gastroenterologists and others.
Chemotherapy drugs are designed to kill cancer, and are generally given in cycles, with a period of treatment followed by a period of rest.
These drugs can be administered before surgery, after surgery, or both. When given before surgery, chemotherapy is called neoadjuvant. When given after surgery, chemotherapy is called adjuvant. Chemotherapy can be administered orally, by injection, or intravenously depending on the regimen and the drug.
The best course of therapy is selected after considering the specific characteristics of the patient's cancer to maximize the results of the treatment and increase survival.
The most commonly used drugs used for treating pancreatic adenocarcinoma, are gemcitabine (Gemzar®), nab-paclitaxel (Abraxane), oxaliplatin, irinotecan, docetaxel (Taxotere®), cis-platinum (Platinol®), and 5-fluorouracil (5-FU) or capecitabine. These drugs are sometimes used alone or in combination.
For neuroendocrine tumors, we typically use sunitnib, everolimus, or chemotherapy. Locoregional treatments and sometimes liver transplantation are also considered.
Research and Clinical Trials
In addition to being up to date with the current standard of care for pancreatic cancer, our team also strives to develop and deliver cutting-edge treatment options that can lengthen patient survival.
For instance, our research group, led by Dr. Ken Olive, has pioneered a new understanding of how the cells which surround the pancreatic tumor (or stroma) relate to cancer growth. Currently a new drug, called hyaluronidase, is being studied at Columbia to further investigate this concept.
The Pancreas Center at NewYork-Presbyterian/Columbia also offers patients the opportunity to participate in clinical trials examining other new drug combinations, as well as targeted therapies that kill only cancer cells and not normal cells. Other therapies that we are testing in clinical trials include vaccines against pancreatic cancer cells and specialized treatments for patients with specific genetic mutations (BRCA mutations). We have many active clinical trials for patients with adenocarcinoma and neuroendocrine cancers and recommend that every patient be evaluated for participation in an appropriate study.