Pancreatic cancer, what progress?

Pancreatic cancer, what progress?

Unloved by research, it nevertheless kills more than 300,000 people worldwide each year. Silent for a long time, it is diagnosed late and treatments struggle to cure it. is taking advantage of World Pancreatic Cancer Day to detail its treatments and research.

Insidious but dreadful, pancreatic cancer begins silently and its evolution can last for years quietly. When symptoms appear, they are not very specific: loss of appetite, difficulty digesting, prolonged nausea, intense and persistent pain behind the stomach or in the back, jaundice… In fact, an often long period of time elapses. between their appearance and the diagnosis of cancer, which is eight times out of ten discovered at an advanced and inoperable stage.

This explains the short survival: only 6 to 7% of patients* are alive 5 years after diagnosis… And if research is not mobilised, it could go from the fourth cause of death by cancer to the second.

Currently, the only treatment capable of curing pancreatic cancer is surgery. The operation is heavy, it is only possible in 20% of cases and it requires regular monitoring by oncologists and nutritionists because of the digestive sequelae.

However, chemotherapy is increasingly effective and has doubled the life expectancy of inoperable patients, from 6 to 12 months. Moreover, when they are prescribed in addition to the operation, they lengthen survival by up to 2 years.

Radiotherapy also has its place in treatment, in combination with chemotherapy.

Hopes for early detection…

Today, there is no simple, sufficiently sensitive and specific screening test. But according to Professor Pascal Hammet, digestive oncologist at Beaujon Hospital (Clichy), “there are ways to take care of it earlier by, for example, targeted screening of people likely to have “familial” forms of this cancer. (5% of all cases)”.

The remaining 95% could one day benefit from advances in research, when it manages to develop a test to measure early markers of the disease in blood or urine.

More effective treatments, promising research

The Folfirinox protocol is a “cocktail” of three molecules combined with a vitamin. It has considerably improved the prognosis of inoperable forms, but its side effects such as neuropathies and digestive disorders limit its prescription.

Since 2014, nab-paclitaxel (Abraxane®) has been indicated in the treatment of metastatic cancers and manages to slow the progression of highly inflammatory forms.

On the research side, given the low effectiveness of targeted therapies, other avenues are being studied. A clinical trial has just started at the National Institute of Health and Medical Research (Inserm) in Toulouse and is testing a modified virus specifically targeting pancreatic cancer cells. The researchers use for this the modified herpes virus, not to infect healthy cells, but to multiply in cancerous cells and destroy them. In mice, a single injection of the modified virus, coupled with chemotherapy, reduced tumor size.

Genetic profiles are also carefully analyzed to determine which are most sensitive to a particular treatment. For example, we know that patients with genetic predispositions respond better to certain treatments, such as platinum salts in the event of a BRCA2 gene mutation (source: ARC foundation).

Finally, the researchers are working on other avenues, targeting the metabolism, the environment or the architecture of the tumour.

*Source: Pr Michel Ducreux, in an Allodocteurs of December 22, 2014

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