Last Saturday, thousands of people around the UK took part in Pancreatic Cancer UK’s Big Step Forward. Simply by going for a walk, they raised over £200,000 for pancreatic cancer research and specialist nurses.
They were also raising awareness of a disease that is the fifth biggest cause of death from cancer in the UK. Pancreatic cancer kills over 10,500 people in this country every year. Of these, 50% of deaths occur within three months of diagnosis, because diagnosis tends to occur only in the late stages of the disease. Only 7.3% of people in the UK with pancreatic cancer will survive beyond five years, and just 5% in the US.
Awareness of the disease is low, with 76% of people unable to name any of the many symptoms – including jaundice, upper abdominal and/or mid-back pain, changes in bowel habits (including pale and smelly stools), loss of appetite, nausea, vomiting, indigestion unresponsive to medication, fatigue, weight loss, and new onset diabetes not associated with weight gain.
Despite these shocking statistics, only 3% of UK cancer research spending goes to pancreatic cancer.
Global statistics are not much better, with the World Cancer Research Fund International reporting almost 496,000 cases and 466,000 deaths in 2020.
HIPEC in pancreatic cancer treatment
Our Combat PRS+Agitation System (Peritoneal Recirculation System with CO2 agitation) has recently been used in a pilot study for a randomised, open phase II-III clinical trial to administer HIPEC (hyperthermic intraperitoneal chemotherapy) with gemcitabine, following cytoreductive surgery in patients with ductal pancreatic adenocarcinoma, which accounts for more than 95% of all pancreatic cancer cases.
This may retard tumour progression through the reduction of the neoplastic volume and the subpopulation of residual pancreatic cancer stem cells, thereby improving patient survival and decreasing recurrence of the disease. These stem cells have a great propensity for locoregional invasion, leading to increased local recurrence and mortality, and they are highly resistant to chemotherapy, remaining dormant throughout treatment then proliferating after treatment completion. To prevent this, a new therapeutic model has been developed using HIPEC with gemcitabine, following promising results in experimental models and clinical practice.
The pilot study to assess the safety of this approach was published in the Journal of Gastrointestinal Oncology last year by Padilla-Valverde et al. It included 10 patients in the experimental group (resection plus HIPEC gemcitabine) and six patients in the control group (resection plus adjuvant treatment). No significant differences in perioperative complications, biochemical and gasometric values were found between the two groups. Recruitment, which was paused during the Covid pandemic, is now ongoing for the main clinical trial.