Oncologist: Delivery is key for improving pancreatic cancer treatment

By Anthony King

- Last updated on GMT

A new treatment may improve on other pancreatic cancer therapies
A new treatment may improve on other pancreatic cancer therapies
Pancreatic cancer is notoriously difficult to treat.  One problem is drug delivery, because pancreatic cells can cluster in a nest of scar-like tissue. 

If you can improve the drug delivery in pancreatic cancer, then you may have a chance to alter the nature course of this disease​,” says Andrea Wang-Gillam, a GI oncologist with a strong focus on pancreatic cancer at Washington University in St. Louis and an author of a new study, which points to a way forward in improving second-line treatment for metastatic pancreatic cancer patients. 

She and her colleagues reported at the European Society for Medical Oncology 2014​ World Congress on Gastrointestinal Cancer, held this summer in Barcelona, that adding MM-398 to the standard treatment for patients who had already received gemcitabine-based regimen improves overall survival.  

MM-398 consists of around 80,000 irinotecan molecules packed into a nano-size capsule made of liposome.  Irinotecan is thought to disrupt proper working of DNA in tumour cells.  

The current NAPOLI-1 trial​ is a global randomised Phase III trial that compares standard treatment with 5-fluorouracil (5FU)-leucovorin, MM-398 alone and MM-398 with 5FU/leucovirin in patients with diseases that have progressed on gemcitabine-based therapy.  

Packing the irinotecan into the nano-capsule helped with the pharmacodynamics and pharmacokinetic features of the drug, explains Wang-Gillam.  “It helps with better drug uptake at the tumour site, as well as sustaining the drug in circulation longer, which are favourable features for a drug delivery in pancreatic cancer and cancer in general​.” It also converted into more of the active metabolic SN38 at the tumour site. 

Overall survival was significantly improved with the combination of MM-398 plus 5FU-leucovorin compared with 5FU-leucovorin alone in the new study.  The average overall survival was 6.1 months with the combination regimen compared with 4.2 months in the group receiving standard treatment with 5FU-leucovorin alone. Progression-free survival was boosted significantly, from 1.5 months with the standard therapy to 3.1 months in patients receiving MM-398 plus 5FU-leucovorin. 

Limited Options​ 

Patients with metastatic pancreatic cancer or pancreatic cancer in general have very limited options, Wang-Gillam notes: “These patients just simply don’t do well.” Now there is another viable option. 

Community organisations for pancreatic cancer are very interested in this drug​,” says Wang-Gillam, who hopes MM-398, developed my Merrimack Pharmaceuticals, can be submitted for FDA approval soon. 

In her own practice, presently 30% of patients receive a Folfirinox-like regime, with the remainder receiving gemcitabine-based therapy. Gemcitabine was approved the front-line treatment pancreatic cancer in 1997.  Approximately only half of patients who progress on first-line therapy could receive the second-line therapy.

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