Helping Pancreatic Cancer Surgeons Make Tiebreaker Decisions
Main Category: Pancreatic Cancer
Also Included In: Cancer / Oncology
Article Date: 15 Apr 2011 - 3:00 PDT
Australian researchers have identified two 'biomarkers' that appear to have the ability to predict patient survival after surgery for pancreatic cancer before the operation takes place. It is the first predictive tool of its kind for this most deadly of cancers.
The biomarkers are the proteins S100A2 and S100A4. Absence of both proteins results in average post-operative survival of nearly 3 years. Presence of both proteins results in survival of less than a year.
We now know that even though cancers look the same under the microscope, their genetic makeup may be vastly different, making them responsive to different therapies. Biomarkers help ensure that the right treatment is given to the right patient without delay and unnecessary side-effects avoided by not using ineffective therapies.
The American Society of Clinical Oncology (ASCO) highlights the finding in its current newsletter (ASCO Post) - distributed globally to a broad audience of cancer professionals.
Professor Andrew Biankin, Dr David Chang and members of the Pancreatic Cancer Research Team from Sydney's Garvan Institute of Medical Research presented their study at the 2011 ASCO Gastrointestinal Cancers Symposium, held 20-22 January in San Francisco. They associated the expression of the biomarkers, along with tumour size, with survival in a cohort of 372 patients who had undergone pancreatic surgery.
Biankin and Chang are both pancreatic cancer surgeons who regularly advise patients whether or not to undergo surgery, a challenging task especially if patient fitness for surgery is borderline.
The Whipple's procedure is a major operation involving the removal of half of the pancreas, which is wrapped around major blood vessels. Around 3-5% of patients die from complications of surgery, and another 20% die within 6 months from early cancer recurrence. Surgery also involves at least 3 months recovery time. So the stakes are high and deciding who will and who won't benefit ahead of time is important.
"We know that the operation benefits about 20% of people particularly well, and obviously we would like to be able to predict who they are likely to be," said Biankin.
"At the moment, we make decisions about when to operate based on very indirect measures, such as CT scans, which aren't really sensitive enough."
"This information will allow us to be more aggressive, even when a tumour is big, if it has a benign biology - that is, when neither biomarker is present. Conversely, if both biomarkers were present, you probably wouldn't operate."
"We need something to help us when we're making a tiebreaker decision. Something to help us decide whether or not surgery is worth the risk."
"Ultimately, each patient has to decide "is this operation going to benefit me?" and if it's not, why put yourself through the operation?"
Source:
Garvan Institute of Medical Research
