ORLANDOA number of therapies now in clinical trials may make a
difference in outcome for patients with pancreatic cancer, and some
may indefinitely prolong survival, Alexander S. Rosemurgy II, MD,
said at the Joint Cancer Conference of the Florida Universities. The
conference is sponsored by the Univerity of South Florida College of
Medicine and presented by the H. Lee Moffitt Cancer Center &
Research Institute, University of Florida Shands Cancer Center, and
University of Miami Sylvester Comprehensive Cancer Center..
Dr. Rosemurgy, director of the Center for Digestive Diseases, Tampa
General Hospital, said that pancreatic cancer causes about 30,000
deaths a year, a number that seems to be rising for reasons that are
not clear. It is the ninth most common cancer and ranks fifth as a
cause of cancer deaths.
Pancreatic cancer often involves no signs or symptoms, although
some patients do get jaundice, and they tend to go see a doctor
earlier, he said, Today, by and large, the death rate
equals the number of diagnoses.
Often with pancreatic cancer, both the diagnosis and the initiation
of treatment drag. The lack of signs or symptoms leads to
patient delays. Most physicians see an average of one or two patients
a year with this disease, so it may take a month to make the
diagnosis. Then come the system delays. Patients need referrals for a
specialists care, and that takes time.
Dr. Rosemurgy described one man he treated whose diagnosis had
occurred in September but who only reached him for treatment in
February of the next year. He described another patient whose
insurance company denied his request for treatment at Dr.
Rosemurgys institution. The insurance company instead sent the
man to a surgeon who had not performed a pancreatic cancer resection
in 5 years. Dr. Rosemurgys group performs about 100 each year.
Resection should be aggressively sought even if the tumor
cannot be completely removed, Dr. Rosemurgy said. Medical
therapies can then be employed to deal with the remaining cancer.
Cure rates with resection are as high as 20%, he said,
but very few people ever get to the operating room.
On the horizon are a number of therapies that may make a difference
in outcome. Dr. Rosemurgy distinguished between therapies that add
just a few weeks or months to a patients life and those that
increase survival for longer periods and thus are commensurate
with the inconvenience and cost.
Promising Cancer Medications
He discussed several categories of drugs that may be useful after
surgery. Genetic manipulation compounds comprise one such category.
These might change the genetic structure of tumors by introducing
segments of DNA to regulate the genes, such as p53, that govern the
Another promising category is cytotoxic boosterscompounds that
increase the efficacy of cytotoxic therapies. A host of these
compounds, all known by numbers rather than names, are now in
placebo-controlled trials, Dr. Rosemurgy said.
Research is also ongoing as to the value of enzyme inhibitors,
including marimastat, which inhibits metalloproteinases, enzymes that
break down the bonds within cells. Such inhibition stabilizes the
bonds within cells, thus limiting cancerous growth into adjacent
People need to be registered into these studies, Dr.
Rosemurgy said, and if physicians were more willing to enroll
patients in trials, we would complete these trials faster. Patients
need to ask for this participation, too.