Gemcitabine injections may help treat advanced pancreatic cancer

Last Updated: 2016-12-19

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Gemcitabine injections may safely treat locally advanced and metastatic pancreatic cancer, a small study suggests.

Endoscopic ultrasound-guided fine needle injection (EUS-FNI) of gemcitabine may help downstage pancreas cancers, decrease recurrence, improve quality of life, prolong survival, and increase the cure rate, the authors wrote.

"The findings of this study suggest that the approach used of injecting chemotherapy directly into the tumor in conjunction with radiation did have a meaningful clinical impact," co-author Dr. Steven R. Alberts, chair of medical oncology at Mayo Clinic in Rochester, Minnesota, told Reuters health.

"Among the greatest hurdles to pancreatic cancer (PC) therapy is the limited tissue penetration of systemic chemotherapy due to tumor desmoplasia," he added in an email. "It is somewhat surprising to see 20% of patients who were initially felt to have unresectable cancer be able to go to surgery. With a traditional approach that combines chemotherapy and radiation (without the initial use of chemotherapy alone), the response rate (i.e., tumor shrinkage) is less than 5%."

As reported online November 23 in Gastrointestinal Endoscopy, the authors investigated the toxicity profile of EUS-FNI with gemcitabine; the ability to downstage disease and enable R0 resection; and overall survival at 6 months, 12 months, and 5 years after therapy.

Thirty-six patients with pancreatic cancer were given 38 mg/ml gemcitabine EUS-FNI before conventional therapy; initial and delayed adverse events were assessed within 72 hours, and 4 to 14 days after EUS-FNI.

Three patients had stage II disease, 20 had stage III disease and 13 had stage IV disease.

No initial or delayed adverse events were reported. Thirty-five patients (97.2%) were deceased at the time of analysis, with 10.3 months of median followup. Overall survival was 78% at six months and 44% at 12 months, and the median overall survival was 10.4 months. Of the patients with stage III unresectable cancer, four (20%) were downstaged and underwent a R0 resection.

"Pancreatic cancers commonly form a hard layer - the extracellular matrix - around the cancer cells, making it more difficult for chemotherapy to penetrate to the cancer cells," Dr. Alberts explained. "Also, the blood supply to this tumor is often more limited than it is in other tumors."

"The most common form of pancreatic cancer, when limited to the pancreas but unresectable, has been poorly responsive to traditional approaches involving either chemotherapy or radiation or both therapies combined," he noted.

"Current approaches with multi-agent chemotherapy given over several months followed by radiation with chemotherapy may allow up to 20% to 30% of patients to undergo surgery when their tumors are not initially felt to be resectable," Dr. Alberts added.

Dr. Steven N. Hochwald, chief of gastrointestinal surgery, and vice chair of the Department of Surgical Oncology at Roswell Park Cancer Institute in Buffalo, New York, said in an email that being able to determine whether local chemo injections were tolerable and providing a sense of whether a response was associated with the injections made the study worth noting.

"This is an interesting study to try to circumvent the difficult problem of high interstitial pressure in pancreatic cancer associated with poor chemotherapy penetration into the tumor," Dr. Hochwald said. "However, as pancreatic cancer is an advanced disease upon presentation, this strategy of local tumor injections is unlikely to make a significant impact when given alone."

"Whether it can be utilized with more effective drugs in the future and with other strategies remains to be determined. It is likely that systemic agents will be much more effective than the strategy of local tumor injection," added Dr. Hochwald, who was not involved in the study. "Radiation is also playing a smaller role in the treatment of pancreatic cancer now and likely in the future."

SOURCE: http://bit.ly/2h3HjLF

Gastrointest Endosc 2016.