Testing chemotherapy before surgery for pancreatic cancer

In the case of pancreatic cancer, only a fifth of patients are offered treatment aimed at curing them. They receive a combination of surgery to remove the tumor followed by chemotherapy for six months to combat tumor cells that may have spread throughout the body. It is a demanding operation with difficult recovery and a high risk of complications. As a result, not all patients can cope with a subsequent chemotherapy treatment, which is demanding enough. This fact leads to an increased risk of a relapse.

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“A proportion of patients undergoing treatment who also have a particularly aggressive form of tumors suffer early relapses, where the treatment has not been beneficial” says Svein Olav Bratlie. “If chemotherapy is administered before surgery, we see several possible benefits. We hope more patients can handle a complete combination treatment, with both chemotherapy and surgery.” ⁽¹⁾

Increase the chances of successful surgery
Pretreatment with chemotherapy involves a period where you can follow the behavior of the tumor, something that can be advantageous. If the tumor turns out to be a particularly aggressive variety, where the chance of a cure is likely to be small, the patient may be spared surgery. This avoids the negative impact that surgical trauma has on the quality of life during the final stages of life.

“In the clinical study known as PREOPANC-3, we want to investigate whether a change in treatment strategy can improve survival in the case of pancreatic cancer. We will test administering chemotherapy to a group of patients before surgery and compare them with a group who have received chemotherapy after surgery, the current method of treating pancreatic cancer,” says Bratlie.

Patients who agree to participate in the study are randomly assigned to either the experimental contingent or the standard one. The amount and type of chemotherapy administered in the study is a well-established treatment for pancreatic cancer and the same in both groups. Only the timing of the treatments differs. The experimental contingent has most of the chemotherapy treatment administered before surgery, while chemotherapy is administered to the standard contingent after surgery. The surgery does not differ between the groups, and the patients will be followed up in the same way.

Import to find key people
Lining up several centers to collaborate in study projects is in general challenging. It is important to find key people at each center, such as research nurses, surgeons, and oncologists.

“Including patients in a neutral and informative way presents a major challenge in this project. Patients who have been told that they have a tumor in their pancreas would like to have surgery to remove it as soon as possible. To then inform them about a study where they can be randomly assigned to chemotherapy first is difficult and requires dedication.”

The grant from the Swedish Research Council provides funding for research nurses and ancillary resources for which the clinic is not responsible. This applies both to Sahlgrenska University Hospital and to the other centers in the country participating in the study.

“It is unusual for clinical surgical research to receive grants of this magnitude, which feels very gratifying and promising for future clinical patient-related research.”

By: Susanne Lj Westergren