The Lancet Oncology: Targeted treatments for pancreatic cancer may help eligible patients live an extra year

March 02, 2020

Results from 46 patients given treatments that target specific molecular changes in tumour cells suggest that these therapies could help patients with pancreatic cancer whose tumours harbour those changes survive an extra year.

Patients with molecular changes in their tumours who received a targeted therapy alongside other treatment survived for an average of one year longer after being diagnosed with advanced disease compared with patients who received standard chemotherapy (survival of 31 vs 18 months), according to an observational study published in The Lancet Oncology journal.

Pancreatic cancer is often diagnosed late and there are few treatment options available. Previous studies have shown that up to a quarter of patients [1] have molecular alterations in their tumours that could potentially be treated with targeted therapies. The new study is the first to show that this approach could be a successful treatment option for people with a pancreatic tumour that has molecular alterations.

One limitation to the study is that many of the patients who received a targeted therapy were also treated with other therapies at the same time, making it difficult to definitively determine the precise benefits of this approach over standard care. However, because both groups received chemotherapy, the only variable was whether or not the patients also received the molecularly targeted therapy.

Dr Michael Pishvaian, of The University of Texas MD Anderson Cancer Centre, USA, said: "Although only a small number of patients in this study received a targeted therapy, the results are promising. No other type of therapy has offered a survival benefit of this magnitude to patients with pancreatic cancer. Our findings suggest that adopting a precision medicine approach, where patients are given a therapy targeted to the specific conditions of their tumour, could have a substantial effect on survival prospects for these patients."[2]

Targeted therapies work by targeting the specific molecular changes inside tumour cells that contribute to cancer growth and survival, unlike chemotherapy that works more generally against cancer cells. [3] Targeted therapy has already helped improve survival for many forms of cancer, such as PARP inhibitors for ovarian cancer and Herceptin for breast cancer.

However, the new study is the first to assess the benefits of targeted therapies for patients with pancreatic cancer, by analysing information from patients who had been prescribed targeted therapy by their own doctors.

The number of patients with pancreatic cancer carrying a particular molecular alteration are too low to carry out a clinical trial. However, as there are often no other treatment options for pancreatic cancer, in some countries doctors are permitted to prescribe therapies that have been approved for use in other types of cancer, a practice known as using a drug off-label. In this case, the use of targeted therapies off-label can be justified if the patient's tumour carries the same molecular alteration as the type of cancer the drug was approved for [4].

In this study, the authors carried out a retrospective analysis of data from the Pancreatic Cancer Action Network's Know Your Tumour® programme, a registry of patients with pancreatic cancer from across the USA who had undergone molecular testing of their tumours.

Around a quarter of pancreatic cancer patients registered in the programme who received molecular testing (282 of 1,082) were found to have tumours that harboured molecular changes that were potentially susceptible to targeted therapies. Treatment outcomes were only available for 189 of these patients because some had died before the report could be delivered and others had no documented information about their treatment.

Of those, 46 patients had received a targeted therapy matched to the specific molecular change associated with their tumour.

The researchers found the average survival for those who received a targeted therapy was a little over two and a half years (31 months). Average survival for patients who did not have one of the molecular changes for which a targeted therapy exists, and had been treated with standard chemotherapy, was 16 months.

143 patients were eligible for a targeted therapy, because they had tumours carrying one of the relevant molecular changes, but had been given standard chemotherapy alone. Their average survival was 18 months.

Lynn Matrisian, co-author of the study and Chief Scientific Officer of The Pancreatic Cancer Action Network, USA, said: "Access to high-quality molecular testing is variable. Future efforts should focus on addressing barriers to molecular testing so that more people can benefit from this personalised approach to cancer treatment. We will continue to work to close that gap through our Know Your Tumour programme and through patient and healthcare professional outreach and education." [2]

In addition, some 351 patients who had received molecular testing were not included in the final analysis owing to missing data on their initial treatment before they entered the study. This could affect the overall survival results but the researchers expect findings would be similar in this group.

Writing in a linked Comment, lead author Professor Jörg Kleeff (who was not involved in the study) from the Martin-Luther-University Halle-Wittenberg, in Germany, said: "There will be a number of important questions to be addressed. These will comprise technical details regarding sequencing of tumour tissues and of germline material but also clinical questions such as timing of treatment, choosing the right chemotherapy (backbone), as well as combination treatment regimens."

Pancreatic cancer is one of the hardest cancers to treat. It is often diagnosed late and survival rates are low, with fewer than one in ten patients surviving for five years or more after diagnosis. Globally, there were 458,918 new cases reported in 2018. [5] This study is publishing at the same time as a cross journal series from The Lancet Oncology, The Lancet Gastroenterology & Hepatology, and EBioMedicine on pancreatic cancer, tackling these challenges and highlighting the progress being made in all areas of pancreatic cancer research (series available under embargo via links below).
Peer reviewed / Observational study / People


This study was funded by the Pancreatic Cancer Action Network (USA), Perthera (USA), the US National Cancer Institute, National Institutes of Health and a 2015 Pancreatic Cancer Action Network American Association for Cancer Research Acceleration Network Grant. It was carried out by researchers at The University of Texas MD Anderson Cancer Centre (USA), Perthera (USA), Thomas Jefferson University (USA), The Pancreatic Cancer Action Network (USA), Ceders-Sinai Medical Center (USA), Zangmeister Cancer Center (USA), City of Hope Cancer Center (USA), University of Michigan (USA), University of Cincinnati (USA), Georgetown University Medical Centre (USA) and George Mason University (USA).

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: if you have any questions or feedback, please contact The Lancet press office

[1] M.J.Pishvaian et al 2018. Molecular Profiling of Pancreatic Cancer Patients: Initial Results from the Know Your Tumor Initiative. Clin Cancer Res

[2] Quote direct from author and cannot be found in the text of the Article.



[5] P.Rawla et al 2019. Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors. World J Oncol.

The Lancet

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to