ASCO GI Interview Series: Improving Patient Outcomes in Pancreatic Cancer: A Conversation with Mitchell C. Posner, MD

Charles Bankhead
Published: Wednesday, Mar 02, 2011


Few cancers have a bleaker outlook than pancreatic cancer. The 5-year survival rate hovers at around 5%, according to the American Cancer Society. But ongoing trends in research and clinical care offer reason for optimism that this outlook will improve. Overcoming the pessimism and clinical nihilism surrounding pancreatic cancer is the first challenge toward achievement of better outcomes, according to Mitchell C. Posner, MD, an oncologic surgeon at the University of Chicago. During the Gastrointestinal Cancers Symposium, Posner shared his thoughts on the current state of research and clinical care for pancreatic cancer, as well as his thoughts about the potential to improve patient outcomes.

OBTN: In general, the prognosis for pancreatic cancer remains poor. Can you point to any bright spots that might offer hope for better outcomes in the future?

Dr. Posner: Oh, definitely. I think there has been a lot of focus, from the patient's perspective and that of doctors, to ensure that patients get to high-volume institutions, where they will see surgeons who are very experienced in pancreatic resection. Since pancreatic resection is the only potentially curative measure, I think that's a plus. I think you can see that patients, in fact, are going to high-volume centers, and that's a good thing. Clearly, the mortality from surgery been reduced to 2% or less, which I think is remarkable.

However, we still don't cure [very many] people with surgery. We know there is adjuvant therapy that has value. The question is how do you build on that? There are studies going on to try to unravel that dilemma. There are trials looking at preoperative therapy, which I think is something that has the potential to be a difference maker, primarily in the fact that if we can eventually have more access to a patient's tissue before treatment and after treatment, we'll answer a lot more questions than we have in the past.

Of course, people are looking at new targeted agents. People are looking at ways of affecting not only the cancer cell but the surrounding environment the cancer cell sits in, to try and enhance therapy.

I think all of those things are exciting. Is there a home run in there? No, but I think a single in this game is a big hit.

Given that surgery remains the only potentially curative therapy for pancreatic cancer, early diagnosis is a given if a patient is to have a realistic chance at long-term outcome. Unresectable disease is universally fatal. Has any progress been made toward identifying potential risk factors for pancreatic cancer? For example, have any genetic traits or other markers been identified that could lead to earlier diagnosis or at least identify patients who have an increased risk and might benefit from close follow-up?

There was a discussion session and several abstracts related to cystic neoplasms, which we think are precursors to pancreatic cancer or premalignant conditions. By getting a better understanding of these lesions, we might be able to identify patients who require surgery and might derive a lot of benefit from surgery. Studying these cystic neoplasms might also help us identify the patients who are going to "cross the line," so to speak, and develop a full-blown cancer. The lesions might have certain characteristics or undergo certain changes that provide an early indication about the subsequent course the condition might take. There is a lot of effort being devoted to determining which patients should have surgery and which patients should be followed.

Everyone is always looking [to] predict a patient's risk or to find a mechanism to identify patients who are at risk, and therefore give us an opportunity to intervene earlier. The best way to treat a cancer is to prevent a cancer, especially this one.

At one of this meeting's principal sessions on pancreatic cancer, all of the abstracts presented revolved around efforts to predict what will happen to patients after treatment or to identify patients who might be a higher or lower risk. What is the significance of that? Does that reflect the current most active area of research in pancreatic cancer?

The fact is that everyone with pancreatic cancer is high risk. All you have to do is look at the incidence and mortality, and when they match up, everyone is at high risk. A lot of the research is trying to identify more effective therapy that is along the lines of more targeted agents, as opposed to classic chemotherapy, which has been the focus of much clinical research in the past. There is a lot of interest in looking at potential biomarkers to be able to predict who will benefit from a certain treatment, and if the patient isn't likely to benefit, he or she can be switched to something else that might give them a better chance.


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