Minimally Invasive Surgery Plus Chemotherapy for Locally Advanced Pancreatic Cancer

Credit:  Neelima Shah And Edna Cukierman; National Cancer Institute Visuals Online
Credit: Neelima Shah and Edna Cukierman; National Cancer Institute Visuals Online
Can a minimally invasive surgical technique combined with chemotherapy be successful against pancreatic cancer that cannot be removed surgically?

In this trial researchers are testing whether irreversible electroporation (IRE) makes it easier for standard chemotherapy to reach the cancer cells.

How Irreversible Electroporation Works

IRE is a method of killing body tissue using high-energy pulses of electricity. The electrical pulses create permanent holes in the membranes of the cells of the tissue, which causes the cells to die. A person undergoing this treatment has a general anesthetic and electrode needles are inserted around the tumor. Electrical pulses then move between the needles for a specific amount of time. If the technique is needed to treat cancer in more than one location, the needles are moved, until all areas with tumors have undergone IRE treatment.

There are a number of advantages to IRE. It does not generate a lot of heat, so the side effects seen with heat-based techniques (inflammation) do not occur. IRE does not affect the surrounding veins, ducts, and nerves, so it has great potential use on tumors that involve those tissues.

Allowing Chemotherapy to Enter the Tumor

One reason pancreatic cancer is hard to treat is that the cancer cells are surrounded by a thick and fibrous barrier of noncancerous cells. This barrier blocks drugs from reaching the cancer cells. Researchers are looking into whether IRE allows chemotherapy drugs to penetrate to the malignant cells.

This trial is for patients with stage III pancreatic cancer. Participants will receive IRE, followed by treatment with the standard treatment combination FOLFIRINOX. This combination is made up of four chemotherapy drugs: FOL (leucovorin calcium, also known as folinic acid), F (fluorouracil, also known as 5-FU), IRIN (irinotecan hydrochloride), OX (oxaliplatin). The 5-FU is an antimetabolite that disrupts different cellular processes, including DNA replication. Because it targets all cells, not just cancer cells, it causes uncomfortable side effects. Leucovorin enhances the effects of 5-FU. Irinotecan inhibits the replication and transcription of DNA, and so interferes with cell growth. Oxaliplatin is a platinum compound that damages DNA and kills cancer cells.

Researchers are looking for the highest tolerated voltage of IRE. Participants’ progress will be monitored by MRI and magnetic resonance spectroscopy.

We encourage you to consult your physicians for clinical trials that may be right for you. The website provides more details about this trial as well as many others. You can visit the Clinical Trials Finder for a listing of all active pancreatic cancer clinical trials.

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