Newswise — SCOTTSDALE, Ariz. — April 7, 2023 — A trio of premier Southwest biomedical research centers — HonorHealth Research Institute, City of Hope and the Translational Genomics Research Institute (TGen), part of City of Hope — have developed a more precise method that may help determine when it is best to surgically remove of pancreatic cancer tumors.

Surgical removal of the tumor can be a key step in helping extend the survival of patients with pancreatic cancer, one of the most aggressive and deadly of all malignancies and the nation’s third leading cause of cancer-related death. Currently, surgery — or surgery plus  chemotherapy — are the only curative treatments for pancreatic cancer.

Because of the intricate web of critical organs and major arteries and veins surrounding the pancreas, located just below the stomach, surgery involving the pancreas is very challenging.

To take some of the guess work out of when it is safer, and more effective, to surgically remove pancreas tumors, the three research centers developed a precision method of scoring tumors based on an innovative 3D imaging technology developed by City of Hope, according to the findings of a clinical trial study published March 29 in the scientific journal Frontiers in Imaging.

“The major problem with pancreatic cancer, even what looks like localized cancer that has not spread to other parts of the body, is that you are dealing with a systemic disease right from the beginning,” said Dr. Erkut Borazanci, director of the Cancer Research Division at HonorHealth Research Institute and the senior author of the study.

“In each case, we must consider if we are making the right decision to proceed with surgery,” said Dr. Borazanci, who supervised the care of the 22 HonorHealth pancreatic cancer patients in the clinical trial.

Ranking patients for surgical candidacy

Using the 3D technology, each patient was scanned initially and scored on a range of R1-R10 to see if they qualified for surgery. Those ranked R1-R5 were eligible for surgery, and those ranked R6-R10 were not.

Patients were placed on a four-drug therapy of paricalcitol, paclitaxel, cisplatin and gemcitabine, a treatment regimen for pancreatic cancer pioneered by TGen and HonorHealth. Each patient was scanned again at 2-month intervals to see if the therapy caused their tumors to lose blood supply and shrink.

“After administration of the neoadjuvant (before surgery) therapy, 81% of patients (18 of 22) received an R score of 5 or less, deeming all of them eligible for surgery,” the study said.

Dr. Syed Rahmanuddin, who heads the 3D Oncologic Imaging Center at the Department of Radiology, City of Hope National Medical Center, one of the nation’s largest cancer research and treatment organizations, led the development of the 3D scanning analysis and the new scoring method for assessing candidacy for pancreatic cancer surgery.

His innovative 3D scanning method can determine the volume of the tumor and the number of blood vessels feeding the tumor.

Larger study needed to validate scoring system

Because of the limited number of patients analyzed in this initial study, Dr. Rahmanuddin said, the research team is already planning a larger study to validate the scoring system, establish a unique protocol for its practice, and perhaps have it adopted by the FDA.

“We are moving forward with plans to recruit 200 patients to validate this scoring process and establish it as the standard of care for treatment of patients with pancreatic cancer treatment,” said Dr. Rahmanuddin, the study’s lead author.

Dr. Daniel Von Hoff, a Distinguished Professor at TGen and the Virginia G. Piper Chair for Innovative Cancer Research at HonorHealth Research Institute, is one of the nation’s leading experts in treating pancreatic cancer patients. Dr. Von Hoff brought together Drs. Borazanci and Rahmanuddin to merge their expertise and run the study.

“Pancreatic cancer is such a difficult disease. It is incumbent on us to search for every possible advantage to benefit these patients. Progress is often dependent on bringing together the best researchers to collaborate on the most promising and innovative research,” said Dr. Von Hoff, who also authored the study. “The next, larger study we have planned will provide a unique approach for surgeons and medical oncologists to assess disease status and surgical candidacy.”

More than 64,000 Americans will be diagnosed this year with pancreatic cancer, resulting in more than 50,000 deaths. Because of the aggressive nature of this cancer, the 5-year survival rate is less than 12%.

This study was funded by The Kemper and Ethel Marley Foundation.

Journal Link: Frontiers in Imaging