Cancer COVER STORY More Treatment Options Emerging to Address Pancreatic Cancer (continued from cover) there is greater likelihood of removing all the cancer, with a lower risk of postoperative complications, at a large-volume center with more experience,” Dr. Wainberg explains. The definition of which pancreatic tumors are resectable has broadened, and the ability of large centers, like UCLA, to perform more aggressive surgeries than in the past is being facilitated by advances in preoperative treatments. “It’s very important that these patients be treated in a multidisciplinary setting, where we can use chemotherapy and radiation therapy to improve the odds of getting them to resectability and successful surgery,” Dr. Wainberg says. STORY HIGHLIGHTS Pancreatic-cancer surgery is technically challenging and outcomes are better at higher-volume centers, with a greater likelihood of removing all the cancer with fewer complications. Preoperative treatment has expanded beyond chemotherapy, with increasing focus on immunotherapy-chemotherapy combinations and nanotechnology to improve drug delivery. UCLAHEALTH.ORG UCLA has been a leader in changing traditional thinking about when to get pancreatic-cancer patients to the operating room. “We now know that for patients who are poor surgical candidates, it is important to use preoperative therapy to treat microscopic disease that may have spread elsewhere so that we get the best results at the time of surgery,” Dr. Wainberg says. He notes that this approach has the added benefit of identifying patients who stand no chance of benefiting from surgery and sparing them the morbidity of an operation. UCLA also is a leader in efforts to expand preoperative treatment beyond chemotherapy. Perhaps the greatest hope lies in drugs that manipulate the immune system to attack the cancer. Immunotherapy drugs have recently shown great success in the treatment of melanoma and lung cancer, among others. While the drugs have not proven effective in pancreatic cancer as single agents, Dr. Wainberg says, there is optimism about strategies that combine immunotherapy with chemotherapy, as UCLA currently is doing in a large clinical trial. Dr. Wainberg and colleagues also are involved in a major effort to capitalize on advances in nanotechnology to improve on mechanisms of drug delivery to pancreatic tumors. 1-844-4UCLADR (1-844-482-5237) “It’s very important that these patients be treated in a multidisciplinary setting, where we can use chemotherapy and radiation therapy to improve the odds of getting them to resectability and successful surgery” The major challenge in pancreatic cancer is early detection. Endoscopic ultrasound has emerged as the single best way to detect small pancreatic tumors — in some cases finding lesions where CT and MRI, the more widely available imaging tests, are negative. “I always tell physicians that if you have a strong clinical suspicion of pancreas cancer and negative imaging, you aren’t finished until you get an endoscopic ultrasound,” says V. Raman Muthusamy, MD, director of interventional and general endoscopy and GI endoscopy at UCLA. Beyond its value for detection, endoscopic ultrasound now is increasingly used to obtain core biopsies. “As we move toward more personalized medicine, we are now able to make an accurate diagnosis on biopsy more than 90 percent of the time, providing important molecular information to guide the treatment,” Dr. Muthusamy explains. His team also is working to identify molecular markers that can better predict the behavior of pancreatic cysts — lesions that can turn into cancer. It is estimated that 10-to-25 percent of people older than 70 have a pancreatic cyst detectable on imaging. “Most of those will never turn into cancer, so we are trying to come up with ways to predict which ones are cause for concern,”