June 11, 2020 • 3 Min

Chemotherapy Plus Minimally Invasive Surgery for Pancreatic Cancer

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Can a minimally invasive surgical technique combined with chemotherapy be effective against pancreatic cancer that cannot be removed surgically?

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

How Irreversible Electroporation Works

IRE is a method of killing body tissue using high-energy pulses of electricity. A person undergoing this treatment is given a general anesthetic before treatment starts. Electrode needles are inserted around the tumor and electrical pulses then move between the needles for a specific amount of time. This process creates permanent holes in the membranes of the tumor cells, causing the cells to die. 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 heat or cold, which could damage normal, adjacent tissues. Hence IRE is well suited to treat tumors that involve surrounding veins, ducts, and nerves.

Chemotherapy for Pancreatic Cancer

FOLFIRINOX is one of the standard treatments for advanced pancreatic cancer. It is a four-drug combination: FOL (leucovorin calcium, or folinic acid), F (fluorouracil, or 5-FU), IRIN (irinotecan hydrochloride), OX (oxaliplatin). Each of these drugs enhances the action of the others. Fluorouracil (5-FU) is an antimetabolite that disrupts a specific part of the cell replication cycle. Derived from folic acid, leucovorin enhances the effects of 5-FU. Irinotecan inhibits the replication and transcription of DNA, and so interferes with cell growth. Oxaliplatin, a platinum compound, disrupts DNA and kills cancer cells.

Gemcitabine is another standard treatment. It is converted into two metabolites that cause cell death. One reduces the number of building blocks necessary to make DNA; the other shortens the DNA strands. It is used to treat pancreatic cancer at all stages of the disease.

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, by perforating the cell membranes, allows chemotherapy drugs to penetrate to the malignant cells.

This trial is for patients with stage III pancreatic cancer. All participants will receive IRE and treatment with either gemcitabine or FOLFIRINOX, depending on which type of chemotherapy the patient was receiving before IRE. The chemotherapy will be given in escalating doses. Researchers are looking for how effective and well-tolerated the combination of IRE and chemotherapy is. Participants’ progress will be monitored by CT scan.

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 EmergingMed Trial Finder for a list of all active pancreatic cancer clinical trials.

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