September/October – Volume 2, Issue 5
Georgetown
Applies Technology, Advances Research to Improve Pancreatic Cancer Care
Cancer experts at Georgetown University Hospital are taking important steps to improve pancreatic cancer treatment by applying new therapeutic technologies, taking research from the bench to the bedside, and building a strong clinical team.
Advances in pancreatic cancer treatment at Georgetown come at a time when new avenues are needed to combat the disease, which each year takes the lives of 30,000 people in the United States. According to the American Cancer Society, pancreatic cancer is the fourth leading cause of cancer death. Only one in five people with cancer of the exocrine pancreas survives more than one year after diagnosis, and only five percent survive five years.
Lombardi Cancer Center Director Richard G. Pestell, MD, PhD, emphasizes that a multi-disciplinary approach is critical. “When you have a disease such as pancreatic cancer, for which the statistics are so poor, you need to bring together surgeons, oncologists, researchers, and even computer modelers to try to design new approaches,” he said.
“The basic problem with pancreatic cancer is that it’s not a local disease,” explained Georgetown University Hospital oncologist John L. Marshall, MD. “When it’s diagnosed, it’s often not removable surgically. Even if it is removable surgically, a very high proportion of patients—80 percent or so—will have microscopic spread of the disease that will ultimately come back and kill them.”
Dr. Marshall and colleagues at Georgetown’s Lombardi Cancer Center emphasize that a multi-modality, multi-disciplinary approach to treatment and research offers the best hope for people with cancer of the pancreas. Lombardi’s clinical team combines surgery, when possible, with the latest radiation therapy and chemotherapy technologies.
With the non-invasive CyberKnife radiosurgery technology used in conjunction with intensity modulated radiation therapy (IMRT), specialists can pinpoint high doses of radiation to the tumor site while avoiding normal tissue. Most patients receiving this procedure have pancreatic cancer that is unresectable. The CyberKnife represents a new generation of robotic, image-guided technology that delivers multiple beams of radiation to a very targeted area. Georgetown is one of only a few hospitals in the nation to use the CyberKnife technology. IMRT also uses computer-generated images to match radiation beams from many directions to the tumor size and shape.
“These technologies use modern imaging techniques to shape the radiation to the tumor more precisely,” explained Anatoly Dritschilo, MD, chair of the Department of Radiation Medicine. “This allows us to get to the higher doses that are necessary to treat these tumors while sparing the dose to normal tissue structures such as the intestines.”
Dr. Dritschilo added that Georgetown’s radiation specialists are also joining forces with medical oncologists and researchers to pioneer systemic drugs to improve the odds of pancreatic treatment success. One of these drugs, C-raf-1, was developed by Dr. Dritschilo and others at the Lombardi Cancer Center and is now being tested through clinical trials. The drug is designed to reach a particular molecular target to make pancreatic cancer cells more sensitive to radiation.
Other clinical trials at Georgetown focus on combining chemotherapies, including novel agents that target the molecular genetic abnormalities of pancreatic cancer tumors to kill only cancerous cells or that deliver normal copies of genes.
“For several decades, the only drug we had was 5-fluorouracil,” Dr. Marshall said. “Six years ago, a drug called gemcitabine was developed. That medicine has helped, but only a little. The next wave is to try to add other medicines to gemcitabine, whether they are vaccines or other chemotherapy medicines.”
Dr. Pestell noted that Georgetown’s clinical team is uniquely qualified to treat pancreatic cancer and continues to grow. In July, Georgetown University Hospital welcomed Patrick G. Jackson, MD, who offers expertise in performing highly specialized surgery for cancer and other diseases of the pancreas. Dr. Jackson is a graduate of Columbia University’s College of Physicians and Surgeons and comes to Georgetown from Massachusetts General Hospital, where he completed his surgical residency and was chief surgical resident. While at Massachusetts General, he gained significant experience in pancreatic surgery and taught the specialized Whipple procedure for removing pancreatic cancer.
Dr. Jackson is “a star” within our integrated oncology network, Dr. Pestell said. “The capabilities he brings allow us to integrate him within a broader group of researchers and clinicians that is working together to bring about new discoveries and to affect patient care and prevention directly.”
This team of physicians is now applying to the IRB to use CyberKnife pre-operatively for locally advanced pancreatic cancers, with the plan that, for at least some patients, surgery will become an option after the CyberKnife procedure. According to Dr. Jackson, “Most patients with pancreatic cancer present with either a locally advanced cancer that is unresectable, or cancer that has spread to other organs and is therefore incurable. The use of the CyberKnife pre-operatively in some cases is the attempt to move the patient from unresectable to resectable cancer. The CyberKnife can be used to improve not only the pre-operative, but also the operative and post-operative care of patients with pancreatic cancer.”
–S. Farrer
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Sep/Oct 2003
