Chemotherapy

Chemotherapy is a powerful treatment that works to slow or stop the growth of cancer cells throughout the body. While it can impact healthy cells, chemotherapy remains one of the most effective tools for targeting and managing cancer on a broad scale.

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Chemotherapy is the most basic standard-of-care for people diagnosed with Pancreatic Cancer. Chemotherapy is a cornerstone in the treatment of pancreatic cancer, utilizing cytotoxic drugs to destroy cancer cells by preventing their growth and division. This systemic treatment can be administered at various stages of the disease, either alone or in combination with other therapies like surgery or radiation.

Chemotherapy Regimens for Pancreatic Cancer

1. Gemcitabine (Gemzar): Often used alone or in combination with other drugs, gemcitabine is a standard treatment for pancreatic cancer.
2. FOLFIRINOX: A combination of fluorouracil (5-FU), leucovorin, irinotecan, and oxaliplatin, FOLFIRINOX is used for patients who are fit enough to handle its side effects.
3. Gemcitabine and Nab-Paclitaxel (Abraxane): This combination is commonly used for metastatic pancreatic cancer.
4. Gemcitabine and Capecitabine (GemCap): Used for its synergistic effects, this regimen is another option for treatment.
5. Oxaliplatin and Fluorouracil (FOLFOX): Often used when other treatments are not effective.
6. Irinotecan Liposome (Onivyde) with 5-FU and Leucovorin: Approved for metastatic pancreatic cancer that has progressed following gemcitabine-based therapy.

Chemotherapy is administered in cycles, allowing periods of recovery between treatments. It can be delivered intravenously or orally, depending on the drug and the patient's specific treatment plan. While effective, chemotherapy can cause side effects such as nausea, fatigue, and increased infection risk, necessitating careful management by your care team.

Immunotherapy

Immunotherapy is an emerging treatment that aims to harness the body’s immune system to recognize and attack pancreatic cancer cells. While still under research for pancreatic cancer, it offers hope for more targeted and personalized approaches in managing this challenging disease.

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Immunotherapy is a new way to treat pancreatic cancer by using the body’s immune system to fight cancer cells. Unlike standard treatments that attack tumors directly, immunotherapy helps the immune system find and destroy cancer cells, offering a more personalized treatment.

Keytruda® (pembrolizumab) is a notable immunotherapy drug. It blocks the PD-1/PD-L1 pathway, which can help the immune system detect and attack cancer cells. Keytruda has shown promise, especially in patients with certain genetic profiles.

To see if a patient might benefit from immunotherapy like Keytruda, doctors use tests like FoundationOne® CDx. This test looks at the tumor’s genetic makeup, including markers like Tumor Mutational Burden (TMB) and Microsatellite Instability (MSI). A high TMB means there are more mutations in the tumor’s DNA, which may make the cancer more visible to the immune system and more likely to respond to immunotherapy. Similarly, MSI-high status can also suggest a better response to treatments like Keytruda.

Not all pancreatic cancer patients will benefit from immunotherapy. Factors like the tumor’s environment and individual genetics affect how well the treatment works. Tests like FoundationOne CDx are important to find patients who might benefit most from immunotherapy. This personalized approach ensures treatments fit each patient’s unique cancer.

As research continues, immunotherapy could change how we treat pancreatic cancer. By using the body’s natural defenses, it offers hope for more effective and less harmful treatments. Patients should talk to their healthcare providers about immunotherapy and consider joining clinical trials, which are key to advancing this promising field.

Surgical Options

Surgery can play a crucial role in treating pancreatic cancer, especially when the cancer is detected early. Surgical options focus on removing tumours to improve outcomes and, in some cases, may be combined with other treatments to help prevent recurrence.

Surgical Options for Pancreatic Cancer

Radiation Therapy

Radiation therapy uses high-energy rays to target and destroy pancreatic cancer cells, often aiming to shrink tumors or reduce symptoms. It can be used alone or in combination with other treatments to improve outcomes in managing pancreatic cancer.

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Targeted Therapy

Targeted therapy focuses on specific genes or proteins that contribute to the growth and survival of pancreatic cancer cells. By honing in on these unique aspects, targeted therapy offers a more personalized approach that may lead to fewer side effects compared to traditional treatments.

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Targeted therapy is a promising approach in the treatment of pancreatic cancer, focusing on attacking specific characteristics of cancer cells while minimizing damage to healthy cells. This method blocks processes that convert normal cells into cancerous ones, thereby inhibiting cancer cell growth. Targeted therapies are often personalized based on the unique biological makeup of a patient's cancer, possibly leading to fewer side effects compared to traditional treatments.

Key Concepts

• Molecular Profiling: This involves analyzing the genetic makeup of cancer cells to identify specific mutations or biomarkers that can be targeted by therapies. It helps tailor treatment plans to individual patients.
• Targeted Medicine: Refers to treatments developed to interfere with specific molecules involved in tumor growth and progression. This approach aims to improve efficacy and reduce side effects.
• Next-Generation Sequencing (NGS): A technology that allows for rapid sequencing of DNA and RNA, providing detailed information about genetic mutations in cancer cells. NGS is crucial for identifying targets for therapy.
• Somatic Testing: Involves testing tumor tissue to identify non-inherited mutations that occur in cancer cells. This helps in selecting appropriate targeted therapies.
• Biomarkers: Biological molecules found in blood, other body fluids, or tissues that indicate a normal or abnormal process, or a condition or disease. In cancer, biomarkers can guide treatment decisions.
• Mutations: Changes in the DNA sequence of cancer cells that can drive cancer progression. Identifying these mutations is essential for developing targeted therapies.

Both the US and Canada are advancing in integrating these targeted therapies into clinical practice, often through clinical trials that explore new biomarkers and treatment methods.

Clinical Trials

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