The European Society for Medical Oncology annually updates recommendations for the treatment of pancreatic cancer due to the active development of new therapeutic methods for improving the quality of life and longevity of people with this pathology. The National Comprehensive Cancer Network and specialized medical societies are also actively involved in the development of international protocols. According to current recommendations, the treatment regimen for pancreatic carcinomas includes surgical interventions, combination chemotherapy, as well as the use of humanized monoclonal antibodies and PARP inhibitors.
Surgical treatment and alternative methods
The comprehensive diagnostics of pancreatic cancer is of crucial importance for the selection of optimal starting therapy. This includes:
- Abdominal, endoscopic and intravascular ultrasound
- Abdominal CT and MRI, PET
- Angiography of the great vessels
- Diagnostic laparoscopy, in some cases with a biopsy
At the moment, the only methods that can significantly increase survival and improve prognosis are surgery and chemotherapy. Depending on the results of studies, they can be carried out in a different order.
Surgery is indicated for patients with localized tumors, without signs of the abdominal arteries damage or metastases in the peritoneum, liver or lungs. Thanks to the modern options of vascular surgery, invasion of a malignant neoplasm into the lumen of the superior mesenteric or portal vein is no longer an absolute contraindication for surgery.
After determining the stage of cancer according to the international classification of the American Joint Committee on Cancer, the surgeon will select the suitable type of intervention:
- Segmental pancreas resection or distal resection can be performed when carcinoma is located in the tail or body of the organ. The spleen can be removed as well. Depending on the patient’s anatomical features, resection can be endoscopic or open.
- Total resection, multivisceral resection involves the removal of the entire pancreas with spleen, regional lymph nodes, mesentery and affected areas of the intestine and liver. A total resection requires the subsequent replacement of the endocrine and exocrine functions of the removed pancreas by digestive enzymes and insulin injections.
- Whipple procedure involves the partial removal of the stomach, duodenum, gallbladder and bile ducts, pancreatic head, as well as the subsequent reconstruction of the gastrointestinal tract.
In case of inoperable tumors, the following alternative methods can be used instead of a classical surgical intervention:
- Radiofrequency or microwave ablation
- Irreversible electroporation using the NanoKnife
- Tumor destruction by high-intensity focused ultrasound
- Photodynamic therapy
Palliative surgery can become an option of choice in this situation as well. It aims to alleviate pain, jaundice, bowel obstruction and other symptoms of cancer.
Chemotherapy for resectable and unresectable tumors
European clinics specializing in the treatment of pancreatic cancer carry out chemotherapy in the following cases:
- In patients with inoperable tumors
- In presence of contraindications to surgical treatment
- As a consolidation therapy after the radical surgery
- To enhance the effects of radiation therapy
- In case of distant metastases revealing
As a rule, chemotherapy regimens for pancreatic cancer include the simultaneous administration of several drugs. This mutually enhances their effect and allows to fight against the chemoresistance of malignancies. The highest efficacy in treating the disease was demonstrated by gemcitabine, oxaliplatin, paclitaxel, docetaxel, and capecitabine.
According to the results of clinical trials conducted in 2018, combination therapy using 4 chemotherapeutic agents prolongs the average life of patients by 2 years. In the course of the trial, the patients received oxaliplatin (Eloxatin), leucovorin (folinic acid), irinotecan (Camptosar) and 5-fluorouracil (Adrucil). Once safety and effectiveness have been confirmed, this treatment regimen was called mFOLFIRINOX. To date, it is used in patients with distant metastases in the liver and lungs.
Systemic therapy and innovative methods
In 2018, a reputable international organization FDA approved the use of poly (ADP-ribose) polymerase (PARP) inhibitors for the treatment of pancreatic cancer. The action of the drugs is based on the phenomenon of "synthetic mortality" – cell destruction with insufficient expression of two or more related genes, while blocking only one of them does not have the similar effect.
The main mutant gene affected by PARP inhibitors is the BRCA gene. Such a mutation is detected rarely, in only 4-7% of pancreatic carcinomas. Fortunately, PARP inhibitors are also effective in other mutations that are potentially associated with BRCA genes, namely mutations in the ATM, PALB2, and CHEK2 genes. Genetic tumor testing is carried out in large laboratories using special test systems to search for target mutations.
The first molecule from the group of PARP inhibitors was olaparib (Lynparza). Olaparib is used in first-line maintenance therapy in patients with metastatic pancreatic cancer. According to the results of further clinical trials, rucaparib (Rubraca), niraparib (Zejula) and talazoparib (Talzenna) were implemented into the clinical practice.
The 2019 studies also explore the combination of stereotactic radiation therapy with immunotherapy. The studies in mice have demonstrated that such a therapeutic regimen can not only destroys the tumor, but also retrain the patient’s immune system to recognize and destroy atypical cells. Potentially, this will allow to fight pancreatic carcinoma metastases in the liver.
Selection of a specialized clinic in any country with Booking Health
The choice of a medical institution and a doctor significantly affects the final result of treatment. If you plan to seek medical help at a foreign clinic, it is important to study reliable information and plan the administrative aspects of the trip in advance. Booking Health, which is a certified medical tourism operator, has been helping foreign patients and their relatives with the comprehensive organization of treatment abroad for more than 12 years.
The specialists of Booking Health will help you with the following issues:
- Selection of the right clinic according to information from the annual qualification report
- Direct communication with your attending physician (oncologist, surgeon)
- Preliminary preparation of a diagnostic or treatment program without repeating previous examinations
- Provision of a favorable cost of medical services, without additional coefficients for foreign patients (saving up to 50%)
- Preliminary appointment with a doctor on the desired date
- Monitoring of implementation of all stages of the medical program
- Insurance against the cost of treatment increase in case of complications (а coverage of 200,000 EUR, valid for 4 years)
- Assistance in buying and forwarding medicines
- Communication with doctors after discharge from the hospital
- Control of invoices and return of unspent funds
- Organization of additional examinations, maintenance therapy and rehabilitation
- Top-class service: booking hotels, airline tickets, transfer
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova