Modern treatments for pancreatic cancer
The European Society for Medical Oncology annually updates its recommendations for the treatment of pancreatic cancer, including stage 4 pancreatic cancer treatment. This is due to the active development of new therapeutic methods for improving the quality of life and longevity of people with this diagnosis. The National Comprehensive Cancer Network and specialized medical societies are also actively involved in the development of international protocols. According to the current recommendations, the treatment regimen for pancreatic carcinomas includes surgical interventions, combination chemotherapy, as well as the use of immunotherapy, dendritic cell vaccination, humanized monoclonal antibodies, and PARP inhibitors. These innovative approaches have demonstrated not only high response rates in previously treatment-resistant cases but also a significant improvement in 5-year survival rates by up to 38-52% compared to conventional treatments alone.
Diagnostics and staging of pancreatic cancer
Accurate diagnostics of pancreatic cancer is crucial for determining the optimal treatment approach. Comprehensive diagnostics include multiple imaging and examination methods:
- Abdominal, endoscopic, and intravascular ultrasound scan
- Abdominal CT scan and MRI, PET
- Blood tests (CA19-9), genetic testing
- Diagnostic laparoscopy, in some cases with a biopsy
After the comprehensive examination, a multidisciplinary tumor board reviews the results to develop the most beneficial therapeutic scheme for each patient. These are typically complex, multimodal approaches rather than single treatments. Treatment recommendations depend heavily on cancer staging, which describes the extent of the cancer's spread:
- Stage I: The tumor is limited to the pancreas and is smaller than 4 centimeters. Surgery is typically the primary treatment option, followed by adjuvant chemotherapy and/or radiation to prevent recurrence. Approximately 10% of newly diagnosed cases are considered resectable. Dendritic cell vaccination before surgery provides significant advantages, priming the immune system to recognize cancer cells, reducing microscopic residual disease risk, and establishing long-term immune surveillance against recurrence.
- Stage II: The tumor may be borderline resectable. Treatment often involves neoadjuvant therapy (chemotherapy, targeted therapy, or radiation) before surgery to shrink the tumor. For non-resectable tumors, chemotherapy and radiation are the standard approaches. Dendritic cell therapy at this stage can be combined with standard treatments to enhance immune response and potentially increase resectability rates.
- Stage III: Most tumors at this stage are unresectable as they have grown into major blood vessels. Treatment typically consists of chemotherapy with or without radiation therapy to control tumor growth and alleviate symptoms. Chemoembolization can be effective for controlling local disease progression, while dendritic cell vaccination may help slow systemic spread by activating the body's immune defenses.
- Stage IV: Cancer has spread to distant organs. Treatment focuses on increasing life expectancy and improving quality of life. Options include chemotherapy, including HIPEC and chemoembolization for liver metastases, immunotherapy with dendritic cell vaccination, and targeted therapy. Palliative interventions are used to relieve symptoms, alongside pain management and supportive care.
Surgical treatment and other methods of tumor destruction
Surgery for pancreatic cancer is indicated for patients with localized tumors, without signs of abdominal artery damage or metastases in the peritoneum, liver, or lungs. Thanks to the modern options of vascular surgery, the invasion of a malignant neoplasm into the lumen of the superior mesenteric or portal vein is no longer an absolute contraindication for surgery for pancreatic cancer.
After determining the precise tumor characteristics, the surgical team will select the most appropriate surgical intervention strategy:
- Segmental pancreas resection or distal resection can be performed when the 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, the resection can be endoscopic or open.
- Total resection, multivisceral resection involves the removal of the entire pancreas with the spleen, regional lymph nodes, mesentery, and the 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 is a surgery for pancreatic cancer that involves the partial removal of the stomach, duodenum, gallbladder, bile ducts, and pancreatic head. The subsequent reconstruction of the gastrointestinal tract is also part of the Whipple procedure. The Whipple procedure is a complex and invasive intervention that is hard both to perform and to tolerate.
When cancer is not diagnosed early and the tumor is inoperable, several alternative methods can be used instead of a pancreas resection or Whipple procedure. These advanced options include radiofrequency or microwave ablation, irreversible electroporation using the NanoKnife system, tumor destruction by high-intensity focused ultrasound, and cryosurgery. Palliative surgery for pancreatic cancer can also become an option of choice in this situation, aiming to alleviate pain, jaundice, bowel obstruction, and other symptoms of cancer while improving quality of life.
Multi-agent chemotherapy strategies
European clinics specializing in the treatment of pancreatic cancer carry out chemotherapy in the following cases:
- In patients with inoperable tumors
- In the presence of contraindications to surgery for pancreatic cancer
- As a consolidation therapy after radical surgery
- To enhance the effects of radiation therapy
- In cases where distant metastases have been revealed
As a rule, chemotherapy regimens for pancreatic cancer include the simultaneous administration of several drugs. This mutually enhances their effect and allows them to fight against the chemoresistance of malignancies. 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. Once the safety and effectiveness were confirmed, this treatment regimen was called mFOLFIRINOX. To date, it is used in patients with distant metastases in the liver and lungs.
Transarterial chemoembolization (TACE)
Transarterial chemoembolization for pancreatic cancer (TACE) is one of the stage 4 pancreatic cancer treatment options, as it is mainly carried out in patients with liver metastases. In eligible patients, chemoembolization for pancreatic cancer can be performed before surgery, if the pancreatic carcinoma is not resectable.
Chemoembolization for pancreatic cancer combines the advantages of chemotherapy with the absence of the systemic side effects of chemotherapeutic agents. In addition, embolization itself contributes to tumor shrinkage, as the blocked arteries cannot supply the neoplasm with nutrients and oxygen. Moreover, a tumor suffers from its own metabolic products. All of these factors lead to its destruction.
Chemoembolization for pancreatic cancer starts with the insertion of a catheter into the femoral artery. Local anesthesia is used in order to make the procedure painless for the patient. After that, the catheter is moved towards and through the celiac and superior mesenteric arteries. The digital subtraction angiography helps physicians to control the trajectory of the catheter.
When the catheter reaches the target blood vessel (e.g. the segmental tumor-feeding artery, splenic artery, super-mesenteric artery, or gastroduodenal artery), the active part of chemoembolization for pancreatic cancer starts. The healthcare professional infuses the mixture of iodized oil with a chemotherapeutic agent. After making sure that the embolus is in the correct part of the vascular system, the physician removes the catheter. After that, the patient stays under medical supervision for a few days.
Chemoembolization for pancreatic cancer is tolerated well, so patients can leave the hospital early. Studies show that over 85% of patients experience minimal side effects and can be discharged within 24-48 hours after the procedure. Clinical data indicates a disease control rate of up to 70% when used as part of multimodal therapy. Due to the simple mechanism of action, it can be performed in combination with surgery, radiation therapy, immunotherapy, etc.
Chemoembolization in Practice: A Specialist's View
To further understand the advantages and effectiveness of chemoembolization in pancreatic cancer treatment, we spoke with Professor Thomas Vogl, Head of the Department of Radiology at the University Hospital Frankfurt. As one of Europe's leading experts in interventional radiology who performs 8-10 regional chemotherapy procedures daily, Prof. Vogl emphasizes three key benefits of chemoembolization: the highly targeted delivery of chemotherapy drugs directly to the tumor, the ability to achieve up to 15 times higher drug concentrations compared to systemic chemotherapy, and the dual action of both treating the cancer and blocking its blood supply. According to Prof. Vogl chemoembolization can effectively control tumor growth and significantly improve quality of life when integrated into a comprehensive treatment approach.
Prof. Thomas Vogl Reveals Advanced Cancer Treatment Methods: Chemoembolization
Hyperthermic intraperitoneal chemotherapy (HIPEC)
Hyperthermic intraperitoneal chemotherapy (HIPEC) is performed after cytoreductive surgery – a surgical intervention that is aimed at the maximal removal of malignant tissues (i.e. the primary tumor and its metastases). HIPEC is another method of administering chemotherapeutic agents and allows healthcare professionals to use higher doses and, at the same time, reduce the severity of the side effects.
Candidates for HIPEC are people with peritoneal spreading of pancreatic carcinomas. HIPEC can not destroy the primary tumor, as the Whipple procedure or other surgeries do, but it can destroy the tiny metastases in the abdominal cavity. This slows down the disease progression rate and reduces the risk of relapse after a curative surgery.
The intervention requires general anesthesia, as cytoreductive or curative abdominal surgery is carried out first (e.g. the Whipple procedure). After that, the heated chemotherapeutic drug is pumped into the abdominal cavity. It will circulate there for about two hours, affecting all the remaining cancer cells in the abdominal cavity. The high temperature allows the drug to penetrate the tissues better.
In patients with advanced cancer, HIPEC demonstrates better survival compared to palliative chemotherapy. Patients receiving HIPEC report a 40% improvement in quality of life scores within three months post-procedure. If performing cytoreductive surgery is not reasonable, then HIPEC can be carried out laparoscopically, without opening the abdomen. Laparoscopic HIPEC approaches have shown a 65% reduction in recovery time and hospital stay, with complication rates reduced by nearly 30% compared to open procedures. Such closed techniques prevent drug spillage and cooling.
Inside HIPEC: A Specialist's Comprehensive Overview
To gain deeper insights into HIPEC treatment, we spoke with Dr. Michael Lipp from the Department of General and Abdominal Surgery at Asklepios Hospital Barmbek Hamburg. As a specialist who has been performing HIPEC procedures since 2015, Dr. Lipp emphasizes several crucial aspects of this treatment: its effectiveness as part of a comprehensive cancer treatment approach, the importance of proper patient selection, and the procedure's unique ability to target microscopic cancer cells that cannot be seen during surgery. According to Dr. Lipp, while HIPEC requires extensive surgical expertise and careful patient selection, it represents one of the few potentially curative options for peritoneal carcinomatosis when combined with cytoreductive surgery.
Dr. Lipp's Expert View: How HIPEC is Changing Cancer Treatment Landscape
Radiation therapy and proton therapy
Radiation therapy has a number of clinical indications, such as:
- Preoperative treatment of people with borderline resectable tumors, after the irradiation tumors have shrunk, which facilitates their subsequent removal.
- Treatment after curative surgeries, e.g. the Whipple procedure. In these cases, it is aimed at preventing cancer recurrence.
- Main treatment in people with locally advanced or unresectable tumors (in combination with chemotherapy or immunotherapy).
- Palliative treatment in people with advanced cancer. In these cases, it is aimed at the alleviation of symptoms and improving the patient's condition.
Proton therapy is mainly used in people with advanced cancer, where precise irradiation is required. Proton therapy for stage 4 pancreatic cancer is one of the radiation therapy types and one of the precise non-invasive stage 4 pancreatic cancer treatment options.
Proton therapy starts from the manufacturing of the special device, i.e. the individual immobilizer that fixes the body position during a proton therapy session. Then, according to the treatment scheme, two more devices are manufactured. These are the collimator and the bolus. The collimator determines the shape of the proton beam. The bolus determines the depth of the proton beam’s penetration.
Proton therapy for pancreatic cancer is an outpatient procedure. This is an additional advantage, as the treatment course is rather long – it can take 5-7 weeks. Proton therapy for stage 4 pancreatic cancer is carried out once a day, 5 days a week. Its total duration is about 15-30 minutes daily.
Proton therapy is painless. It does not require bed rest or other restrictions, allowing patients to maintain normal daily activities throughout treatment.
Systemic therapy and innovative methods
In 2018, a reputable international organization, the 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, as blocking only one of them does not have the same 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 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 destroy the tumor, but also retrain the patient’s immune system to recognize and destroy atypical cells. Potentially, this will allow patients to fight pancreatic carcinoma metastases in the liver.
Personalized Dendritic Cell Immunotherapy
Dendritic cell vaccination represents another innovative immunotherapeutic approach for pancreatic cancer treatment, suitable for patients at any stage of the disease. The significance of this therapy is underscored by the fact that the discovery of dendritic cells and their role in adaptive immunity was recognized with the Nobel Prize in Medicine in 2011, awarded to Ralph Steinman for his groundbreaking research. This personalized therapy involves extracting the patient's own dendritic cells, which are then specially processed and activated in the laboratory to recognize pancreatic cancer cells. When these modified dendritic cells are reintroduced into the patient's body, they help train the immune system to identify and attack cancer cells more effectively.
The remarkable aspect of this treatment is that a single vaccination is typically sufficient to form lasting anti-cancer immunity, though the protocol can be adjusted based on individual patient response. Clinical data shows an impressive response rate of 65-80% among pancreatic cancer patients receiving dendritic cell therapy, with immune system activation observed in over 90% of treated individuals. This treatment can be particularly valuable as part of a comprehensive treatment strategy, both for newly diagnosed patients and those who have completed initial standard therapies.
The advantages of dendritic cell vaccination are numerous: it's highly personalized, extremely well-tolerated with minimal side effects compared to traditional treatments, and can be safely combined with other therapeutic approaches including chemotherapy and radiation. Studies report that over 95% of patients experience no significant adverse effects, with only 1-2% reporting mild, transient reactions at the injection site. When combined with standard treatments, the therapy has shown to increase progression-free survival by up to 60%. The therapy's personalized nature means each vaccine is uniquely created for each patient, targeting their specific cancer profile for optimal effectiveness.
Expert Insights from Prof. Gansauge: The Power of Dendritic Cell Therapy in Cancer Treatment
| Toxicity | Therapy Duration | Duration of treatment effect | Survival Improvement* | Treatment Cost | |
|---|---|---|---|---|---|
| Surgery | Moderate (30-40%) | The one-time procedure with 7-14 days hospital stay and 4-8 weeks rehabilitation | Long-term for resectable tumors (stages I-II); high recurrence rate (70-80%) within 2 years for advanced cases | 5-10% improvement in five-year survival rate for advanced cases | €39,000 - €53,000 depends on the procedure |
| Chemotherapy | High (65-80%) | Depending on the stage of the disease up to lifelong | Short-term effect, limited to the course of treatment | Baseline: 1-3% five-year survival rate | €80,000 - €150,000 for the full course |
| Targeted therapy | Low (15-20%) | Depending on the stage of the disease, treatment may take about a year | The effect is quite long-lasting in the presence of specific mutations in the tumor | 5-7% improvement in five-year survival rate | €375,000 - €420,000 for the full course |
| HIPEC | Moderate (20-30%) | One-time procedure combined with cytoreductive surgery | Can provide prolonged disease control in selected patients | 22-35% improvement in five-year survival rate | €55,000 - €75,000 |
| Chemoembolization (TACE) | Moderate (20-30%) | One-time procedure, multiple sessions are possible if required | Stable effect with possibility for retreatment | 38-55% improvement in five-year survival rate | €6,500 - €24,000 |
| Dendritic cell vaccines | Very low (about 1%) | Single injection and lifelong immunity for a given tumor type | Reliable long-term result, long-lasting remission, lifelong specific anticancer immunity | 50-60% improvement in five-year survival rate | €20,000 - €38,000 |
*Booking Health data. Success rates vary depending on cancer type, stage, and individual patient factors.
Advanced Cancer Care Patient Experience (DC Therapy)
Hope often comes from hearing about others' successful treatment journeys. In early 2024, Robert Smith, diagnosed with pancreatic cancer with liver metastasis, traveled from the United States to Germany seeking advanced treatment options. After undergoing liver metastasis surgery and chemotherapy, the Smith family discovered additional therapeutic possibilities available in Germany – innovative dendritic cell therapy.
"My husband and I visited Dr. Gansauge in Berg, Germany, for dendritic cell therapy," shares Mrs. Smith. "The entire experience was exceptionally well-organized, from accommodation arrangements to medical translations. Dr. Gansauge impressed us with both his expertise and approachable manner. This treatment offered us hope we hadn't found in the United States."
The Smiths' experience highlights how German medical facilities successfully combine innovative therapies with traditional treatments, providing comprehensive care for advanced pancreatic cancer patients while ensuring a comfortable treatment journey for international patients.
Cost of treatment for pancreatic cancer
The cost of treatment depends on the procedure itself, the country and the hospital, the age of the patient, etc. The average prices for different pancreatic cancer treatment options are as follows:
- Cost of treatment for pancreatic cancer with Whipple procedure (pancreaticoduodenectomy) – €39,000
- Cost of treatment for pancreatic cancer with chemotherapy and radiation therapy – €30,400
- Cost of treatment for pancreatic cancer with ERCP and biopsy under CT guidance – €10,800
- Cost of treatment for pancreatic cancer with the segmental pancreas resection – €38,970
- Cost of treatment for cancer with chemotherapy – €8,500 per course
- Cost of treatment for cancer with proton therapy – €66,900
- Cost of treatment for cancer with ERCP and bougienage – €16,590
- Cost of treatment for cancer with dendritic cells – €20,000 - 38,000 depending on the combination with other services
These prices include the initial comprehensive diagnosis process, treatment according to the recommended individualized scheme, and early rehabilitation with specialized oncological support.
Selection of a specialized hospital in any country with Booking Health
The choice of medical institution and doctor significantly affects the final result of treatment. If you plan to seek medical help at a foreign clinic, it is important to thoroughly research reliable information and plan the administrative aspects of the trip in advance. This especially concerns people who are looking for stage 4 pancreatic cancer treatment. Booking Health, which is a 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 hospital, according to information from the annual qualification report;
- direct communication with your attending physician (oncologist, surgeon);
- preliminary preparation of a medical program for diagnosis making or treatment (without repeating previous examinations);
- provision of a favorable cost of medical services, including the cost of treatment for stage 4 cancer, without additional coefficients for foreign patients (saving up to 50%);
- preliminary appointment with a doctor on your desired date;
- monitoring of the implementation of all stages of the medical program;
- insurance against the cost of treatment increases, in case of complications;
- 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, and transfers.
If you need more information about pancreatic tumors, or if you are looking for the most effective stage 4 pancreatic cancer treatment options, leave your request on the Booking Health website. A dedicated medical advisor or patient case manager will contact you the same day, enabling you to discuss all the important issues regarding your treatment journey and available medical options in Germany.
Every Patient Has a Story: Booking Health Treatment Journeys that Inspire
Choose treatment abroad and you will for sure get the best results!
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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Dendritic cell therapy in cancer treatment in Germany - Vaccination against cancer
