For patients with advanced pancreatic cancer who cannot have their tumors removed surgically, the focus of treatment involves symptom prevention and control. This may involve the use of: 1)surgery to relieve intestinal blockage or to perform nerve blocks for pain; 2) radiation therapy to relieve painful disease sites; or 3) chemotherapy to reduce the rate of tumor growth and to prolong survival. For some patients whose tumors cannot be removed surgically, chemotherapy and radiation therapy are sometimes given together to reduce the size of the tumor. The response of patients to treatment is frequently monitored using CAT scans or blood markers.
However, for most patients whose tumors cannot be removed by surgery, chemotherapy alone is the recommended treatment. The standard therapy at present is a drug called gemcitabine (Gemzar�). Several studies are ongoing at The Johns Hopkins Hospital for patients who have not received any treatment, or for those whose tumor is not responding to standard treatments.
Cancer Vaccine
Dr. Elizabeth Jaffee and colleagues at The Johns Hopkins Hospital have been developing new vaccines for the treatment of cancer. These vaccines are aimed at activating a patient's immune system to fight their cancer. These vaccines usually involve taking a patient's own cancer cells and genetically modifying them to express immune stimulatory proteins at the site of the tumor. The tumors are then irradiated and injected intradermally back into the patient as a vaccine. Dr. Jaffee's group has already tested this approach in patients with metastatic renal cancer. The results were promising in that we observed both clinical and immunologic activity. Her group therefore developed a similar approach for patients with pancreatic cancer. Because it is not technically feasible to develop a vaccine from each patient's cancer, she developed an allogeneic approach. Allogeneic pancreatic tumor cells are genetically modified to secrete the immune stimulatory protein granulocyte-macrophage colony stimulating factor. This vaccine received FDA approval in June of 1997, and a phase I trial of the vaccine has just been completed. This clinical trial demonstrated that the vaccine is safe, it has only relatively minor side effects and it appears to have bioactivity at the highest dose. Based on these exciting findings, a phase II trial of this vaccine has begun. Patients with adenocarcinoma of the pancreas who have surgery at Johns Hopkins Hospital to remove their pancreas cancer and who have no clinical evidence of spread of the cancer outside the pancreas will be eligible for this study. Patients with bile duct cancer or neuroendocrine tumors or islet cell cancer are not eligible. Please contact The John Hopkins Cancer Center for more information on eligibility criteria (contact information on the Links page).
Radiation and Chemotherapy
Since October 1991 at Johns Hopkins, a multidisciplinary team of surgeons, pathologists, medical oncologists, and radiation therapists has evaluated all patients with adenocarcinoma of the pancreas post-pancreaticoduodenectomy and recommended adjuvant combined modality chemoradiation therapy, based on data from the Gastrointestinal Tumor Study Group. The adjuvant therapy used in these patients combines external beam radiotherapy to the tumor bed and adjacent tissues delivered over the course of five to six weeks, with 5-fluorouracil-based chemotherapy given concurrently during the radiotherapy and for four months after the conclusion of the radiotherapy. Of 78 patients evaluated since October 1991, 56 patients elected adjuvant therapy, and 22 declined such therapy. The early outcome results comparing these two groups demonstrate a significant outcome difference, with a median survival of 20 months and an actuarial two-year survival of 35% in the group receiving adjuvant therapy, compared with the median survival of 12 months and an actuarial two-year survival of 0% in the group receiving no such therapy.
Dwight Reicks Memorial Ribbon