Malignancies and other conditions of the pancreas, liver and biliary system are highly complex and often challenging to manage. While formidable, these diseases are treatable and survivable with prompt, specialized care.
“These are highly complex issues, and having a dedicated team of experts that specialize in the care of these conditions is important in order to make the right treatment decisions to ensure positive outcomes,” says UVA surgical oncologist Todd Bauer, MD. “This includes having radiologists specialized in reading MRI of the liver and pancreas, HPB (hepato-pancreato-biliary) surgeons and medical oncologists evaluating patients and endoscopists trained to perform complex diagnostic procedures — at UVA, patients are getting the collective experience of this entire group of specialists. It is because we have been able to put together this highly skilled team that our outcomes are among the best in the nation, specifically for the Whipple procedure, the most common operation for pancreatic cancer.”
To respond to the needs of this patient population, UVA has established a comprehensive program offering early detection measures, advanced treatment options and coordinated care for patients with HPB disorders. Services include:
HPB Next-Day Clinic
Offering consultation and care within 24 to 48 hours of receiving a call to the HPB Next-Day Clinic, this is a streamlined approach to cross-disciplinary care that aims to make referrals easy for both patients and healthcare providers. Patients are evaluated prior to arrival to ensure all imaging, consultations and treatments are coordinated during a single visit.
“The HPB Next-Day Clinic allows us to provide a more expeditious diagnostic workup, alleviate anxiety and, in some cases, expedite therapeutic intervention,” says Bauer.
High-Risk Pancreatic Cancer Clinic
As you know, early detection of pancreatic cancer can mean a greater chance of survival. UVA has made great strides in pancreatic cancer screening, establishing evidence-based screening protocols and developing a biomarker for pancreatic cancer. The High-Risk Clinic utilizes these novel tools and more to identify sooner those patients who are at an increased risk, to actively screen for early signs of disease, implement prevention strategies and treat aggressively.
“When a patient is evaluated at our High-Risk Clinic, we send a letter to the referring physician and/or primary care doctor with our assessment of the patient and information on whether any abnormality was revealed in the pancreas,” says Bauer. “We provide our estimated risk for cancer and our plan for the patient’s continued surveillance, as well as instruction on prevention measures.”
Listen to a podcast with Dr. Bauer about identifying patients at increased risk for pancreatic cancer.
Pancreatic Cyst Clinic
The UVA Pancreatic Cyst Clinic is one of the first programs in the country dedicated to the detection and treatment of pancreatic cysts. Though most of these cysts are benign, their presence can increase a patient’s risk for developing cancer. “These patients represent one of the main groups within the high-risk category for pancreatic cancer,” says Bauer.
Once referred to the clinic, patients will be evaluated by a team of specialists who can determine whether the cyst is benign or is potentially cancer-causing. “We follow international consensus guidelines to determine which cysts we monitor closely and which are high enough risk to remove,” says Bauer.
Pancreatic Cancer Clinical Trials
Because of our ongoing participation in clinical trials, pancreatic cancer patients at UVA have access to novel investigational treatments sooner, before they become widely available. “We are currently offering new, promising treatments patients are unable to get outside of research centers like ours,” says Bauer.
Oncologist Osama Rahma, MD, who joined UVA in October 2013 with the goal of developing an active translational research program in GI oncology, spent five years at the National Cancer Institute participating in GI oncology and immunotherapy research training. “The five-year survival rate for pancreatic cancer is poor — it remains at 5 percent,” says Rahma. “We’ve been treating pancreatic cancer patients with chemotherapy for the past few decades and this survival rate hasn’t changed, so it’s time to take a new approach.
“Immunotherapy is a novel modality that has shown promising outcomes in other malignancies and we are currently testing this approach in pancreatic cancer,” he adds. “These immunotherapy trials are making their way to UVA given the unique available resources and the outstanding basic scientists and expertise here.”
Some of the trials for pancreatic cancer utilizing immunotherapy that are currently available at UVA include:
Combination of Listeria/GVAX Pancreas Vaccine (ECLIPSE Study)
A Phase 2B, Randomized, Controlled, Multicenter, Open-Label Study of the Efficacy and Immune Response of GVAX Pancreas Vaccine (With Cyclophosphamide) and CRS 207 Compared to Chemotherapy or to CRS-207 Alone in Adults With Previously-Treated Metastatic Pancreatic Adenocarcinoma
Eligibility: Adults with previously treated metastatic pancreatic adenocarcinoma. See complete inclusion/exclusion criteria.
Purpose: Test the safety, immune response and efficacy of GVAX pancreas vaccine (with cyclophosphamide) and CRS-207 compared to chemotherapy or CRS-207 alone
“The result of a previous study that combined both of these vaccines was released at the Gastrointestinal Cancers Symposium in January 2014 and showed a median overall survival of 9.7 months in patients who received three or more doses of the vaccines,” says Rahma. “These results are encouraging because this population of patients with advanced pancreatic cancer are heavily pretreated with chemotherapy and do not usually survive beyond six months.”
Algenpantucel-L (HyperAcute®-Pancreas) Cancer Vaccine (PILLAR Study)
A Phase III Study of Chemotherapy With or Without Algenpantucel-L (HyperAcute®-Pancreas) Immunotherapy in Subjects With Borderline Resectable or Locally Advanced Unresectable Pancreatic Cancer
Eligibility: Adults with unresectable locally advanced (ULA) and borderline resectable (BR) pancreatic cancer. See complete inclusion/exclusion criteria.
Purpose: To assess the efficacy of chemotherapy in combination with a vaccine made of human pancreatic cancer cells that contain a mouse gene, which marks the cancer cells as foreign to a patient’s immune system
“This study targets a unique population of pancreatic cancer patients: those for which a surgeon cannot resect the tumor due to its location, either because it is too close to the vessels or because it would be detrimental to the patient,” says Rahma. “If we can offer this subset of patients an opportunity to receive immunotherapy in combination with the current standard of care chemotherapy, we may be able to increase the time until the tumor progresses or increase the patient’s survival time.”
Additional studies for pancreatic cancer enrolling at UVA include:
Nab-Paclitaxel and Gemcitabine After Surgical Resection (APACT Study)
A Phase III, International, Multicenter, Open-Label, Randomized Study
Eligibility: Patients with surgically removed pancreatic cancer. See complete list of inclusion criteria.
Purpose: To compare whether there is a delay or prevention of recurrence or death in subjects with surgically removed pancreatic cancer who then take nab-paclitaxel in combination with gemcitabine compared to those who take gemcitabine alone
“In a previous study in the metastatic setting, the addition of Abraxane (nab-paclitaxel) to gemcitabine was shown to prolong survival compared to gemcitabine alone, so it makes sense to try this approach in early disease as well. If this study is a positive study, it will change the landscape of pancreatic cancer treatment after surgical resection,” says Rahma.
Future Studies at UVA
According to Rahma, UVA is in the process of developing clinical trials using novel agents in pancreatic cancer based on encouraging preclinical data. In addition, UVA has established a strong collaboration with other major cancer centers to launch multicenter studies in the near future that would offer hope for HBP cancer patients at UVA and nationwide.