November 29, 2021 by John Fernandez
Innovative Care Provides Hope for Pancreatic Cancer Patients
Progress is being made in the treatment of pancreatic cancer, offering patients and their families hope for improved life expectancy and quality of life.
Experts at Miami Cancer Institute are using advanced surgical techniques, innovative treatment approaches and clinical trials to extend the lives of pancreatic cancer patients, who typically are not diagnosed until their disease is advanced.
“Pancreatic cancer is not a death sentence. We have to change that perception,” says Horacio Asbun, M.D., Miami Cancer Institute’s chief of Hepatobiliary and Pancreatic Surgery. “I’m not saying that it has a good prognosis, but it is not a death sentence.”
An estimated 60,000 people will be diagnosed with pancreatic cancer in the United States this year, according to the American Cancer Society. Receiving that news can seem devastating, especially in light of the high-profile people who have lost their lives to the disease, such as Jeopardy host Alex Trebek, Supreme Court Justice Ruth Bader Ginsberg, Congressman John Lewis, Apple CEO and co-founder Steve Jobs, singer Aretha Franklin, and actors Patrick Swayze and Michael Landon. But new treatment modalities are giving patients more time and better outcomes, Dr. Asbun says.
“There are plenty of new options that we’re doing here at Miami Cancer Institute. New things are being done all over the country and world,” says Dr. Asbun. “It’s going to take some years to see the impact on the overall prognosis statistics, but it appears that we are finally making progress in improving the prognosis of pancreatic cancer.”
Not all pancreatic cancer patients are candidates for surgery. But for those who are, Dr. Asbun evaluates whether they can undergo the less-commonly used minimally invasive surgery, which requires a high degree of expertise and experience. By using small incisions and a camera to see inside the abdomen rather than the large incision of traditional open surgery, the approach allows magnification and better access to difficult areas, and patients usually recover more quickly with far less pain, he explains.
Dr. Asbun, who just completed a term as president of the prestigious Society of American Gastrointestinal and Endoscopic Surgeons, is internationally renown for his skill with this procedure. In fact, he was instrumental in developing the first international evidence-based guidelines on minimally invasive pancreas resection surgery, a joint initiative of nine surgical societies and 70 pancreas experts from 20 countries. Because Dr. Asbun presided over the meeting in South Florida where the standards were adopted just before the pandemic, they were named The Miami Guidelines. He continues to lead and collaborate on research and clinical trials to establish the safest, most effective techniques for pancreas surgery.
Dr. Asbun notes that advances have vastly reduced the mortality and side effects associated with the most common pancreatic surgery, also known as the Whipple Procedure. During this operation, the surgeon removes all or part of the pancreas, along with all or part of other nearby organs that may be affected, such the small intestine, the bile duct, the gallbladder, and part of the stomach. For the best outcome, the American Cancer Society advises patients seek highly trained and experienced surgeons at large cancer centers.
Dr. Asbun estimates he has performed more than 1,000 procedures on the pancreas and liver, including laparoscopic Whipple Procedures.
“The large majority of my patients have almost, if not a completely normal quality of life after surgery,” Dr. Asbun says. “They recover well because of the new techniques that we do.”
New Approaches To Intervention
For patients with inoperable pancreatic cancer tumors, there is still hope. Miami Cancer Institute offers a wide range of groundbreaking treatments.
The Institute is one of just a handful of cancer centers in the country – and the only one in South Florida – with the ViewRay™ MRIdian MR Linac technology, which safely delivers extremely high doses of radiation directly to the tumor by allowing physicians to watch a real-time MRI scan during the treatment. When the patient breathes, the machine automatically recognizes that the tumor has moved — even by just a few millimeters – and will pause. This enables the safe and accurate delivery of double the usual dose of radiation without harming nearby healthy tissue. A clinical trial led by Michael Chuong, M.D., medical director of radiation oncology at the Institute, has shown so far that the stronger radiation results in significantly improved survival rates for pancreatic cancer patients, with little or no side effects.
Another clinical trial at Miami Cancer Institute is investigating a novel approach to treating pancreatic cancer with intra-arterial chemotherapy, a minimally invasive procedure that uses a catheter threaded through the patient’s arteries to deliver chemotherapy directly to the tumor using two balloons. Ripal Gandhi, M.D., an interventional oncologist at Miami Cancer Institute and a vascular interventional radiologist at Miami Cardiac & Vascular Institute, is the principal investigator of the phase 3 multicenter randomized controlled TigerPac clinical trial, which is evaluating the efficacy of this approach.
“Pancreatic cancer tends to be resistant and often does not get enough chemotherapy when it is delivered via an intravenous approach,” Dr. Gandhi explains. “With the intra-arterial approach of administering high doses of chemotherapy directly to the pancreatic tumor, we have the potential to control the disease and improve survival — and we can improve the patient’s quality of life.”
Yet another treatment approach uses an instrument called NanoKnife in a minimally invasive procedure called irreversible electroporation, or IRE. Using a CT scan for guidance, doctors make tiny incisions to place needle-like probes precisely at the tumor site and use an electrical current to disrupt the cancer cell’s membrane, causing it to die, without affecting nearby healthy tissue and veins. Govindarajan Narayanan, M.D., chief of interventional oncology at Miami Cancer Institute and a pioneer in the field, has been studying its use for more than 10 years. He is the principal investigator of a NanoKnife clinical study involving multiple research sites. Preliminary data from retrospective studies have indicated that NanoKnife treatment may extend the life of pancreatic cancer patients by an additional 14 months.
Dr. Asbun notes Miami Cancer Institute is also participating in trials of different chemotherapy drugs and how they might be combined for better results.
Miami Cancer Institute’s multidisciplinary philosophy, integrated care under one roof and collaborative approach opens up new possibilities for patients, Dr. Asbun says. The team works together to find the best interventions for each patient.
“It takes teamwork to make a difference, not just with surgery, but with oncologists, interventional radiology, interventional oncologists, gastroenterologists,” Dr. Asbun says. “That’s the kind of collaboration we have here. It is remarkable. You cannot be successful in pancreatic cancer unless you have that type of strong collaboration.”
Want to know more? Dr. Horacio Asbun and Dr. Ripal Gandhi, will host a 90-minute virtual symposium on advances in the management of pancreatic cancer on November 9 at 6 p.m. The event will feature various experts. Although geared to healthcare professionals, patients and their families are welcome to join. To sign up, click here.