In the early 2000s, there was only one drug available for pancreatic cancer, gemcitabine. This was not a cure – at best, it delayed the ultimate outcome by a few months. At this time, there was a mentality that pancreas cancer trials were too difficult; that patients were too sick and it wouldn’t be possible to conduct successful trials.
In 2002, the PA.3 study was conducted by the AGITG, which found that treating patients with the drug OSI-774 had a positive effect. This was notable as many doctors had previously been sceptical about prescribing a combination of drugs to such an unwell population.
Since then, the AGITG conducted a number of studies examining new treatment approaches. The GAP trial in 2016 tested the effectiveness of chemotherapy given before surgery rather than afterwards. The results of this trial were positive: neoadjuvant chemotherapy did not impact on the ability to operate, and all patients who needed surgery were able to have it.
Professor David Goldstein, one of the GAP trial’s Principal Investigators, noted that this trial took longer to complete than expected as many patients survived for longer than researchers had predicted.
“It’s a wonderful position to be in,” he noted. “I’m extremely happy that I’m still waiting.”
Dr Lorraine Chantrill says that involving patients and giving them more options has been integral to progress in pancreatic cancer treatment.
“As doctors, we have to stop saying, ‘We can’t do that because it might hurt people’. We have to start asking the person in front of us, ‘Would you be willing to do this study? I’ll give you as much safety information as I can, but would you be willing to take the risk?’ In my experience, most people are willing to take that risk.”
New research concepts continue to be developed to build on what has been discovered. The AGITG-sponsored MASTERPLAN trial is currently in activation. This trial will investigate the potential of sterotactic body radiotherapy (SBRT) in addition to chemotherapy in improving patient outcomes. This is a new technique that could allow more targeted treatment for patients.
Incremental changes and developments have led to a much larger shift in pancreatic cancer treatment over time, meaning that clinical trials and research continue to lead to more options being available, and more hope for patients in the future.