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11 Mar 2020
03-March 2020

Improving treatments for pancreatic cancer

  • Victorian Comprehensive Cancer Centre
Potential for standardised approach in localised pancreatic cancer

Standardising treatments for pancreatic cancer is an ongoing challenge – for a range of reasons.

Last year, the VCCC held the annual Pancreatic Cancer Symposium co-convened by Professor Peter Gibbs, Research and Education Lead in Gastro-intestinal Cancers and Dr Belinda Lee, consultant medical oncologist, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research. The December meeting sought to address an identified gap in agreed treatment standards in early and borderline resectable pancreatic cancer.  

The meeting also coincided with Professor Gibbs’s award of an Innovation Fund grant of $200,000 for a study offering personalised medicine to colorectal cancer patients. 

Cross-disciplinary analysis

The latest cross-disciplinary evidence in radiology, surgery, medical oncology and radiotherapy was shared during the symposium. Radiology was revealed as important for both diagnosis and monitoring of disease, however staging is considered an on-going challenge, and a centralised review of radiology reports is recommended. There is some good news for patients, with toxicity from radiotherapy improving due to newer techniques being employed. Extremely precise, intense doses of radiation know as SBRT and MRI-guided radiotherapy are showing better outcomes and fewer side effects than conventional radiation therapy.

Patients need a defined treatment plan

The use of neoadjuvant chemotherapy is not clearly resolved. Reasons are complex but may involve surgery presenting as the most persuasive first option for the patient. There is also a lack of current studies providing a clear line of sight to the best options because resectable and borderline resectable pancreatic incidence have been mixed together in studies. American and European Society of Clinical Oncology guidelines do not currently recommend neoadjuvant chemotherapy, however retrospective and meta-analyses suggest a benefit.

PURPLE translational registry

The PURPLE translational registry for patients is a multi-site, multi-disciplinary cancer registry which aims to increase data sharing and collaboration in clinical and research settings and is proving effective in providing comparisons for research.

Current data is showing that the use of neoadjuvant chemotherapy in borderline resectable pancreatic cancer remains infrequent in Australia, despite evidence suggesting impact of overall survival for patients with this disease, particularly with the use of the chemotherapy treatment FOLFIRINOX. What is clear though is that more high-quality prospective randomised evidence is needed to enable the adoption of newer treatment regimens in borderline resectable pancreatic cancer. 

Close to 100 delegates of clinicians and researchers, medical oncologists and surgeons attended the symposium in-person and online. Allied health, nurses and industry representatives also took part. In all, delegates represented 19 organisations including 7 VCCC alliance members: Western Health, Walter and Eliza Hall Institute of Medical Research, University of Melbourne, Royal Melbourne Hospital, St Vincent’s Hospital, Peter McCallum Cancer Centre and Austin Health. 

When asked to consider whether Victoria is ready to implement a standardised approach in early stage pancreatic cancer, the response was divided. The greater majority agreed the symposium allowed them to explore research, educational or clinical practice issues in localised pancreatic cancer. A number of delegates noted their interest in forming an expert group to annually review the latest treatment evidence and make recommendations for practice guidelines in Victoria.

For more information on the VCCC Research and Education Lead Program, Gastro-intestinal Cancers, contact Lauren King, Program Manager, e: lking1@unimelb.edu.au.