Urgent Need: Pancreatic ductal adenocarcinoma (PDA), which accounts for more than 90% of pancreatic cancer cases, is highly lethal; for all stages combined, the 1- and 5-year relative survival rates are 27% and 7%, respectively, making it the only cancer with an overall 5-year survival rate in the single digits. Even for those people diagnosed with local disease, 5-year survival is only 27%. More than half of patients are diagnosed at a distant stage, for which 5-year survival is 2%.
Incidence and Mortality: Each year more than 53,070 people in the United States will be diagnosed with pancreatic cancer, and more than 41,780 will die. Worldwide, more than 337,000 people will be diagnosed, and more than 330,000 will die of the disease. The incidence of pancreatic cancer is rising, and some reports project that the number of new pancreatic cancer cases and pancreatic cancer deaths will more than double by 2030.
Detection/Diagnosis: Pancreatic cancer is very difficult to detect or to diagnose at early stages of disease. It often develops without early symptoms, there is no widely used method for early detection, and, although some risk factors have been identified (such as tobacco use, family history of pancreatic cancer, and a personal history of pancreatitis, diabetes, or obesity), few patients diagnosed with pancreatic cancer have identifiable risk factors.
The only curative treatment for pancreatic cancer is complete surgical resection. Unfortunately, fewer than 20% of patients are candidates for surgery, because pancreatic cancer is usually detected after it has spread. Cancers that cannot be treated with surgery are called “unresectable.” For those patients with localized disease and small cancers with no lymph node metastases and no extension beyond the capsule of the pancreas, complete surgical resection can yield 5-year survival rates of 18% to 24%. Approximately 80% of patients who undergo surgery eventually relapse and die from the disease, suggesting a need for effective strategies to eradicate minimal residual disease following surgery to prevent relapse.
For patients who undergo surgery, adjuvant treatment with the chemotherapy drug gemcitabine lengthens survival. The targeted anti-cancer drug erlotinib (Tarceva®) has also demonstrated a small improvement in advanced pancreatic cancer survival when used in combination with gemcitabine. More recently, combination chemotherapy with FOLFIRINOX has shown an overall survival (OS) benefit of approximately 11 months versus about 6.5 months for gemcitabine alone, and gemcitabine plus abraxane has shown an OS of 8.5 versus 6.5 for gemcitabine. Thus, for cancers that are unresectable, treatments including chemotherapy and targeted therapy may be able to control the disease and help patients live longer and feel better. Unfortunately, these treatments have not been shown to achieve longer term survival.
Because of the poor prognosis and lack of effective treatment options, for pancreatic cancer a clinical trial is nearly always preferred over existing treatment options for everything except localized tumors that can be removed surgically. Specifically, pancreatic cancer patients are encouraged to participate in clinical trials:
- As adjuvant treatment after surgery for local disease
- When pancreatic cancer returns after surgery
- For unresectable disease (locally advanced cancer that cannot be treated by surgery), when the patient is in good condition (has a good performance status)
- After first-line treatment for locally advanced cancer or metastatic, if the patient has good performance status
- As neo-adjuvant therapy to evaluate direct treatment effects on the tumor
Go to our Clinical Trial Finder to find clinical trials of immunotherapies for pancreatic cancer that are currently enrolling patients.