Oncotarget: A comprehensive analysis of clinical trials in pancreatic cancer

September 23, 2020

The cover for issue 38 of Oncotarget features Figure 3, "Summary of the time and cost for drug development (modified from DiMasi et al [2016]," by Katayama, et al. which reported that Pancreatic cancer is the most aggressive common cancer and is desperately in need of novel therapies.

In this study, the Oncotarget authors perform the first comprehensive analysis of the current clinical trial landscape in pancreatic cancer to better understand the pipeline of new therapies.

In this study, the Oncotarget authors perform the first comprehensive analysis of the current clinical trial landscape in pancreatic cancer to better understand the pipeline of new therapies.
Studies were curated and categorized according to the phase of the study, the clinical stage of the study population, type of intervention under investigation, and biologic mechanism targeted by the therapy under study.

As of May 18, 2019, there were 430 total active therapeutic interventional trials testing 590 interventions.

The vast minority of trials are in phase III testing. 189 interventions are immunotherapies, 69 target cell signaling pathways, 154 target cell cycle or DNA biology, and 35 target metabolic pathways.

Dr. Jordan M. Winter from The Case Western Reserve University School of Medicine as well as The University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center said, "Pancreatic ductal adenocarcinoma (PDAC) is the most aggressive of the common cancers."

The institute allocates roughly $6 billion annually to cancer research, and just over $100 million is dedicated to studying pancreatic cancer.

Other agencies and organizations like the Pancreatic Cancer Action Network, American Cancer Society, and the Department of Defense contribute significantly to this mission, likely adding more than $20 million per year in totality.

Along these lines, the authors have likely neared a survival ceiling for our patients in the absence of new discoveries that target other aspects of cancer biology, due to the additive toxicities of chemotherapeutic combinations.

Patients, family members, primary care providers, and oncologists battling together against pancreatic cancer often consider the same important questions: what new treatments are coming down the pike, and how soon will they arrive?

This work is necessary to better anticipate the timeframe for novel therapies against pancreatic cancer to reach the market. More importantly, this 20,000-foot view provides a foundation to discuss optimal resource allocation, with a principal goal to accelerate the pace of innovation, with an eye towards improving patient outcomes.

The Winter Research Team concluded in their OncotargetResearch Paper that the majority of PDAC trials are focused on immunotherapy, chemotherapy, and radiation.

Following the herd has not yet worked well for PDAC research; immunotherapy and precision therapy have yet to strongly impact this disease.

Finally, this compendium focuses on therapeutic studies and not early detection.

It is possible that the greatest advance in the future could be the discovery of an effective PDAC biomarker.

If the authors can detect PDAC at the PanIN 3 stage, therapeutic trials of invasive cancer become inconsequential.
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DOI - https://doi.org/10.18632/oncotarget.27727

Full text - https://www.oncotarget.com/article/27727/text/

Correspondence to - Jordan M. Winter - Jordan.Winter@UHhospitals.org

Keywords - pancreatic cancer, pancreatic ductal adenocarcinoma, clinical trial, novel treatment, drug development

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