Medical Treatment

Chemotherapy

Q: What is Radiation Therapy? A: Radiation therapy uses high-energy rays directed at a tumor. This therapy damages the cancer cells and stops them from growing and dividing. It may be used before or after surgery to shrink the tumor alone or with chemotherapy for patients with inoperable tumors. side effects: fatigue, skin becomes red, tender, itchy, nausea, vomiting, diarrhea, digestion problems. Usually subside when treatment ceases.

For patients with advanced pancreatic cancer who cannot have their tumors removed surgically, the focus of treatment involves symptom prevention and control. This may involve the use of:

1. Surgery to relieve intestinal blockage or to perform nerve blocks for pain;
   
2. Radiation therapy to relieve painful disease sites; or
   
3. Chemotherapy to reduce the rate of tumor growth and to prolong survival

However, for most patients whose tumors cannot be removed by surgery, chemotherapy alone is the recommended treatment. The standard therapy at present is a drug called gemcitabine (Gemzar®). Dr. Dan Laheru at Johns Hopkins is also very interested in developing new agents for the treatment of pancreatic cancer. Several studies are ongoing at The Johns Hopkins Hospital for patients who have not received any treatment, or for those whose tumor is not responding to standard treatments.

This page will describe a new vaccine approach being pioneered by Dr. Elizabeth Jaffee, as well as some of the work we have done treating patients with pancreatic cancer with radiation and chemotherapy.

While the standard of care is chemotherapy for advanced pancreas cancer remains Gemcitabine as single agent, there have been a number of promising studies that have tried to improve upon the standard of care. These schedules remain investigational as they have not been definitively compared prospectively against Gemcitabine. The Eastern Cooperative Oncology Group (ECOG) has proposed looking at two promising schedules against the standard of care: Gemcitabine with standard doses and infusion schedule Gemcitabine with prolonged infusion schedule Gemcitabine with prolonged infusion administered with Oxaliplatin Trials are now open at Johns Hopkins. If you would like to learn more about these research studies, please contact Dr. Dan Laheru at: The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins The Bunting-Blaustein Cancer Research Building Room G89 1650 Orleans Street Baltimore, MD. 21231-1000 Phone: 410-955-8974 fax: 410-955-0125 email: laherda@jhmi.edu

Cancer Vaccine

Click here for animation describing vaccine in detail.

Dr. Elizabeth Jaffee and colleagues have been developing new vaccines for the treatment of cancer. These vaccines are aimed at activating a patient's immune system to fight their cancer. These vaccines usually involve taking a patient's own cancer cells and genetically modifying them to express immune stimulatory proteins at the site of the tumor. The tumors are then irradiated and injected intradermally back into the patient as a vaccine. Dr. Jaffee's group has already tested this approach in patients with metastatic renal cancer (Cancer Research vol 57, 1537-1546, 1997). The results were promising in that we observed both clinical and immunologic activity. Her group therefore developed a similar approach for patients with pancreatic cancer. Because it is not technically feasible to develop a vaccine from each patient's cancer, she developed an allogeneic approach. Allogeneic pancreatic tumor cells are genetically modified to secrete the immune stimulatory protein granulocyte-macrophage colony stimulating factor. This vaccine received FDA approval in June of 1997, and a phase I trial of the vaccine has been completed. This clinical trial demonstrated that the vaccine is safe, it has only relatively minor side effects and it appears to have bioactivity at the highest dose (See The Journal of Clinical Oncology (volume 19; 2001: pages 145-156). Based on these exciting findings, a phase II trial of this vaccine has begun. As much as we would like to offer the vaccine to everyone, eligibility criteria had to be established for this study. Patients with adenocarcinoma of the pancreas who have surgery Johns Hopkins Hospital to remove their pancreas cancer and who have no clinical evidence of spread of the cancer outside the pancreas will be eligible for this study. Patients with bile duct cancer or neuroendocrine tumors or islet cell cancer are not eligible. Please contact Dr. Elizabeth Jaffee (ejaffee@jhmi.edu) or Barbara Biedrzycki, R.N. (biedrba@jhmi.edu) for more information on eligibility criteria.

Radiation and Chemotherapy

Since October 1991, a multidisciplinary team of surgeons, pathologists, medical oncologists, and radiation therapists has at Johns Hopkins evaluated all patients with adenocarcinoma of the pancreas post-pancreaticoduodenectomy and recommended adjuvant combined modality chemoradiation therapy, based on data from the Gastrointestinal Tumor Study Group. The adjuvant therapy used in these patients combines external beam radiotherapy to the tumor bed and adjacent tissues (> 45 Gy) delivered over the course of five to six weeks, with 5-fluorouracil-based chemotherapy given concurrently during the radiotherapy and for four months after the conclusion of the radiotherapy. Of 78 patients evaluated since October 1991, 56 patients elected adjuvant therapy, and 22 declined the therapy. The early outcome results comparing these two groups demonstrate a significant outcome difference, with a median survival of 20 months and an actuarial two-year survival of 35% in the group receiving adjuvant therapy, compared with the median survival of 12 months and an actuarial two-year survival of 0% in the group receiving no therapy.

Click here about Adjuvant Therapy after the "Whipple" Operation