The battle against pancreatic cancer is hard-fought and ongoing. Success has been elusive and fleeting, without appreciable gain. Fortunately, many researchers, both tireless and tenacious, are
The battle against pancreatic cancer is hard-fought and ongoing. Success has been elusive and fleeting, without appreciable gain. Fortunately, many researchers, both tireless and tenacious, are
making progress in the development of new surgical techniques and new chemotherapeutic drugs. They are making impressive strides in limiting disease, prolonging life, and achieving cures.
Details of the APACT Study for Treating Pancreatic Cancer
One important study at the forefront of the siege on pancreatic cancer is the Adjuvant Pancreatic Adenocarcinoma Clinical Trial, known as APACT. The purpose of the study is to compare whether there is a delay or prevention of recurrence or death in patients with surgically removed pancreatic cancer, who then receive nab-paclitaxel (Abraxne) in combination with gemcitabine, or with gemcitabine alone.
Early studies of nab-paclitaxel are encouraging. In patients with metastatic pancreatic adenocarcinoma, nab-paclitaxel plus gemcitabine significantly improved overall survival, progression-free survival, and response rate.
Normal cells grow by cell division. When they come into contact with like cells they stop dividing; it’s called contact inhibition. Cancer cells also grow by dividing, but they lack contact inhibition, dividing and accumulating uncontrollably. Chemotherapy is most effective against cells that are dividing rapidly – like pancreatic cancer cells.
Gemcitabine is an antimetabolite, similar to some substances inside cells. The cancer cells incorporates the drug into their own metabolism, rendering the cells unable to divide. Gemcitabine is infused into a vein. There is no pill form. The most common side effects (occurring in more than 30 percent of patients) include:
- Flu-like symptoms
- Fever, within 6-12 hours of the first dose
- Nausea (mild)
- Vomiting
- Poor appetite
- Skin rash
- Low blood counts
Nab-paclitaxel is a substance derived from a yew tree; it’s called a plant alkaloid. It halts cell division. The drug is given intravenously or by injection. There is no pill form. Nab-paclitaxel is an irritant. It can cause inflammation in the vein into which it’s infused. If it escapes from the vein it can cause tissue damage. The side effects are the same as those seen with gemcitabine, plus:
- Arthralgias and myalgias
- Peripheral neuropathy (numbness and tingling in the hands and feet)
- Mouth sores
For both drugs, the severity of side effects is not an indication of its effectiveness.
Beneficial results early in the APACT study means, that for the first time, there are two effective combination drug protocols (nab-paclitaxel with gemcitabine and FOLFINOX) for the treatment of pancreatic cancer.
References
[1] Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, Seay T, Tjulandin SA, Ma WW, Saleh MN, Harris M, Reni M, Dowden S, Laheru D, Bahary N, Ramanathan RK, Tabernero J, Hidalgo M, Goldstein D, Van Cutsem E, Wei X, Iglesias J, Renschler MF. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013 Oct 31;369(18):1691-703. doi: 10.1056/NEJMoa1304369. Epub 2013 Oct 16. PubMed PMID: 24131140; PubMed Central PMCID: PMC4631139.
[2] Clinical Trials, National Cancer Institute. https://clinicaltrials.gov/ct/show/NCT01964430
[3] Abbruzzese JL, Hess KR. New option for the initial management of metastatic pancreatic cancer? J Clin Oncol. 2014 Aug 10;32(23):2405-7. doi: 10.1200/JCO.2013.54.4155. Epub 2014 Jun 30. PubMed PMID: 24982449; PubMed Central PMCID: PMC4121501.