Pancreatic cancer, malignant tumor of pancreas with KRAS mutation
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A clinical trial will seek to understand if a novel surgical procedure developed at Keck Medicine of USC will allow for the removal of pancreatic tumors that are currently considered inoperable. The research will focus on treatment of patients with locally advanced pancreatic cancer which has not yet spread to other organs, but has grown into or close to nearby blood vessels that surround the pancreas.

Typically, these forms of tumors cannot be removed surgically due to the danger of damaging the adjacent blood vessels which supply blood to a number of different internal organs, notes Steven Grossman, MD, PhD, co-lead investigator of the study and a medical oncologist with Keck Medicine.

One of the deadliest forms of cancer, pancreatic cancer usually develops asymptomatically until the cancer has become very large and/or metastasized to other areas of the body. Because it is normally caught so late, pancreatic cancer has a dismal five-year survival rate of 13%.

Locally advanced pancreatic cancer, which affects roughly one-third of all people with the disease, has an historical survival rate of around one year. Because surgery is often off the table for pancreatic cancer patients, the most common treatment options are chemotherapy and radiation, both of which have shown limited ability to kill cancer cells and shrink tumors.

“The situation is frustrating because research shows that in the rare cases where locally advanced tumors were safely removed, the progression of the disease was slowed and the patient’s length of survival on average increased from one year to 28 months, more than doubling life expectancy,” says Sandra Algaze, MD, a medical oncologist with Keck Medicine and one of the study’s investigators. “Surgery, therefore, appears to strongly benefit a patient’s survival rate, which is why the medical field has been eager for a surgical solution.”

The surgery team will be led by Yuri Genyk, MD, a hepatobiliary and pancreatic surgeon at Keck Medicine. Genyk, who is also co-lead investigator, specializes in vascular reconstruction and has already successfully removed 30 pancreatic tumors that were in close proximity to arteries. Genyk admits that this form of surgery is complex, but that the Keck team has the skills and expertise to conduct the surgery, as well as train other surgeons to perform the procedure.

“If the trial results are positive, we envision that the technique could become the gold standard for how this stage of pancreatic cancer is treated in the future,” Genyk says.

In the trial, the investigators will study the effectiveness of providing patients with chemotherapy to first shrink the size of the tumor. Laparoscopic surgery will then be performed two to eight weeks after the patient has completed their chemotherapy treatments to assess the position and size of the remaining tumor. Using this information, the surgeon then surgically removes the tumor and reconstructs any of the involved blood vessels.

The trial hopes to enroll 20 patients with locally advanced pancreatic cancer, which will also search for pancreatic biomarkers that may provide insight into patient outcomes.

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