Sponsored content by Ipsen; Dr. Wainberg was compensated for his time

As a medical oncologist, one of the most challenging aspects of providing care to patients is delivering a cancer diagnosis. As someone who specializes in gastrointestinal cancers, most of the patients I treat with pancreatic cancer present with advanced disease, which unfortunately, makes delivering the news even more difficult.

Pancreatic cancer is extremely elusive partially because there are no standard early screening guidelines outside of high-risk family history or genetic predispositions, and also, symptoms are often rather subtle making it difficult to diagnose in early stages. Biologically, with the pancreas located in middle of the abdomen, by the time it’s diagnosed, a number of lymph nodes, blood vessels and even other organs are typically involved making it very often not surgically resectable.

Despite decades of extensive research, the 5-year survival rate from metastatic pancreatic cancer is below five percent.

 The most common type of advanced disease is metastatic pancreatic ductal adenocarcinoma (PDAC) – a hostile, solid malignancy with an extremely high mortality rate measured in months. Metastatic PDAC is the third leading cause of cancer-related mortality and is projected to become the second leading cause of cancer-related mortality by 2030.

One of the most common questions I get asked after explaining the treatment plan is “are there other options for me?” Not surprising, patients can be apprehensive about receiving treatment and even have misconceptions.

I believe in balancing logical rationale focused on individual outcomes and research that supports outcomes of improvement with treatment versus without. It’s important to explain that treatment is not just about prolonging life for a few months, but trying to make them feel better. Clinical judgement and experience is an extremely important aspect of providing care, but bringing the patient into the decision making by listening and adjusting to individual patient characteristics and needs is what really helps overcome apprehension.

Poor survival rates in PDAC result from a combination of the elusive clinical presentation causing late-stage diagnoses and the complexity of the cancer. To improve clinical outcomes, we must gain a better understanding of the genetic aspects of the disease.

Even ten years ago, lung cancer was a very poor prognosis. Incremental improvements have been made because research into patient subgroups has led to a better understanding of different biomarkers. As a result, treatments have become more personalized and slowly outcomes have improved.

 While we are at the very beginning of research in potential subgroups and biomarkers in pancreatic cancer, I believe our learnings will help us better understand the disease and the types of treatments that can improve patient outcomes.

While clinical research in metastatic PDAC has been slow with no new therapies approved in the U.S. in more than seven years beyond the small subgroup of BRCA, patient outcomes have improved slightly by better utilizing the available treatment options.

 It’s not rapid, but subtle improvements must not be ignored. Small margins are building blocks that keep us moving the field forward.

https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html

https://pubmed.ncbi.nlm.nih.gov/24840647/

https://www.nejm.org/doi/full/10.1056/NEJMoa1916623

https://www.sciencedirect.com/science/article/pii/S1424390314009971

Articles

Pancreatic cancer remains elusive with extremely low survival rates. Through better utilization of existing therapies and identifying patient subgroups, some believe we are incrementally improving patient outcomes and making more significant advances in care.

Zev A. Wainberg, M.D. Professor of Medicine at UCLA and co-director of the UCLA GI Oncology Program

Articles

Improving outcomes in metastatic pancreatic cancer