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Study shows differences in pancreatic cancer treatments
May 11th, 2011
05:00 PM ET

Study shows differences in pancreatic cancer treatments

Researchers comparing pancreatic cancer treatments found notable differences in patient survival rates and quality of life.

French investigators from a private company known as BioMed randomly selected 342 patients with pancreatic cancer. Part of the group was given gemcitabine, the most favored treatment according to oncologists.  The other patients were given a combination of four chemotherapy drugs, (oxaliplatin, irinotecan, fluorouracil and leucovorin) known as FOLFIRINOX. The treatments lasted for six months. The purpose of the study was to record the overall survival rates of each group.

Researchers found that even though people on the FOLFIRINOX had a longer average survival rate of 11.1 months, versus the gemcitabine group with 6.8 months, the quality of life for patients on FOLFIRINOX was not as good. At least 5% of patients on the drug combination suffered from low white blood cell counts, fatigue, serious diarrhea, a loss of feeling in their feet and hands, as well as hair loss. After six months, only 31% of patients on FOLFIRINOX reported a decent quality of life, compared with 66% of those on gemcitabine.

Investigators concluded that although the FOLFIRINOX did improve survival rates over gemcitabine, the toxicity of the drug combination caused numerous negative side effects.  Therefore investigators recommended that only patients who are younger than 76 years old, and who do not suffer from other health problems use FOLFIRINOX.

Pancreatic cancer is the fourth leading cause of death from cancer in the United States. For most patients, the prognosis is grim. Only about 6 percent of those with the diagnosis live longer than five years.

The study is published in this week’s issue of the New England Journal of Medicine. It was funded by the government of France.


soundoff (58 Responses)
  1. charles s

    What was unique about the 6% survivors? Was it luck or did the drugs only work for them? Maybe someone can focus on the survivors and determine why they lived. It sure seems like almost every treatment is a failure.

    May 11, 2011 at 19:10 | Report abuse | Reply
    • Linda Atchinson

      Early diagnosis, usually made on an accidental finding, is the favorable factor. This allows surgical removal of the tumor and follow-up treatment. Generally, symptoms of pancreatic cancer only appear when the tumor has spead beyond surgical possiblity, making most patients incurable upon diagnosis. The multidrug treatment is very tough on the patient, but 4 months more life allows the person to tie up loose ends, get his affairs in order, and kiss those grandchildren many times. It's worth it to some, not to others. It's a personal choice I hope none of us have to make.

      May 11, 2011 at 21:54 | Report abuse |
    • greenbuddy55

      Won't make sense to most, but if you KNOW the SOLUTION to Euclid's 47th Proposition, and you know just a tiny bit about this piece of anatomy and the way it's major ductwork is positioned, the answer becomes quite apparent. It's so very difficult to explain, though, so one must seek the answers that will lead to the ultimate solution, and remission.

      May 12, 2011 at 07:25 | Report abuse |
    • TRH

      greenbuddy55,

      There's no real solution to Euclid's Proposition 47. It's really more of a statement of fact. And it's just a variant of probably most commonly known mathematical equation, namely a^2 + b^2 = c^2.

      My guess is (unless that bit about the anotomy in question is substantially unknown) that this line of reasoning would not account for the relatively low 6% survival rate.

      To Tim further down...

      It may seem logical to "get the most bang for your buck" by determining that 2 months is not worth expensive treatments. But history has shown countless times that what is expensive and yields small gains in survivability and quality of life one day is OFTEN a massively successful and commonly used practice in years to come.

      If a treatment costs millions/billions to develop and for 20 years it does nothing more than extend someone's live for a couple month it SEEMS on the surface to be a bad deal. But what about after those 20 years when it's refined through experience and advancing technology and it becomes a full cure? Would the expense have been worth it then?

      Medical research is rarely a "pay $5 – get this pill that does x,y, and z" type of solition. It's better to view it as a pyramid of blocks some costing more, some less, some stacking straight up towards progress, some creating a wider base to provide for higher peaks in the future.

      May 12, 2011 at 11:02 | Report abuse |
    • J-Mo

      The term really for their sorcery should be called trickment instead of treatment. The "OiL" would be a true treatment. But nope, we don't want that...

      May 12, 2011 at 14:17 | Report abuse |
    • Tol Trunks

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      May 17, 2011 at 15:03 | Report abuse |
  2. Jim Welters

    How 'bout acknowledging that neither of them really worked, but cost a lot of money. It doesn't matter if one is better than the other, survival is less than 1 year in either case.

    May 11, 2011 at 19:51 | Report abuse | Reply
    • oaksavanna

      good point. I wonder what the survival in months is with no treatment at all.

      May 11, 2011 at 20:30 | Report abuse |
    • HatesCancer

      My mother was misdiagnosed originally and therefor was unable to receive treatment. From the time she should have been diagnosed until the time she lost her battle, she lived 7 months. Its just one case, but I think that is about the norm for non-treatment patients.

      May 11, 2011 at 22:01 | Report abuse |
  3. Michael D.

    My dad lasted 3 weeks after he was diagnosed with pancreatic cancer. The doctor failed to catch it even when his urine was black as oil. He placed him on antibiotic drugs and said he has a kidney infection. So much for our trust in doctors. This all took place in Ontario, Canada and the Dr. is still practicing medicine. Even my mother still goes to him. I can't believe it and never could......sad but true. It was the Grace of God that spared him the pain and suffering. We were devastated. Dad was too far gone for treatment.. He lived his last 2 weeks in the hospital pumped full of morphine. There was nothing they could do. He been gone 8 years now and never saw his 75th birthday.

    May 11, 2011 at 20:10 | Report abuse | Reply
    • DrPete

      Unfortunately, even when the diagnosis IS made early, the course can be just as rapid and painful. There's a long, long way to go in treating this disease. Both surgery and chemo for pancreatic cancer are such a big hit to the body that many feel like they want to die after starting treatment. My condolences, though, for your loss, and you're right–awareness of pancreatic cancer is lacking even among some physicians.

      May 12, 2011 at 05:46 | Report abuse |
  4. mikael fata

    unfortunately pancreatice cancer is almost always diagnose too late, the 5 percent most of the time has tumor in the head where it blocks the bile duct and you turn yellow, than they can do surgery. the organ is so hidden behind everything it doesnt give symptoms until its too late. pray for a cure.

    May 11, 2011 at 20:42 | Report abuse | Reply
    • brian

      Prayer won't produce a cure. Only more medical research can have a chance of accomplishing that.

      May 12, 2011 at 11:17 | Report abuse |
  5. Crazy Concept

    Why would you ever do chemotherapy with only a 5% survival rate. The best results for pancreatic cancer are actually done through diet and lifestyle changes.

    May 11, 2011 at 22:43 | Report abuse | Reply
    • DrPete

      I'd love to see some data to support that statement.

      May 12, 2011 at 05:43 | Report abuse |
    • Crazy Concept

      Here's one of the doctor's getting the best results with pancreatic cancer. I know it is a crazy concept, actually letting your body heal itself instead of getting in the way with chemo and messing everything up.

      http://www.dr-gonzalez.com/pancreatic.htm

      May 12, 2011 at 13:55 | Report abuse |
    • Patrick

      That isn't data. He simply given anecdotal evidence and case reports. How many patients did he treat that later died? Were they on any other treatment. etc. Modern medicine is all about science, not unsupported claims.

      May 12, 2011 at 17:29 | Report abuse |
    • Nurse Lisa

      that concept is crazy. Maybe still a long way from a cure, but the virulence of this cancer (often due to the absence of clear symptoms until it is far beyond the point of intervention) means that trials of new drugs and treatments will continue and hopefully each patient makes the informed choice that best suits their desires. Longer life or better quality – to each their own.

      May 12, 2011 at 18:22 | Report abuse |
  6. jpo

    Those last 4.3 months were the toughest for the gemcitabine patients.

    May 12, 2011 at 05:31 | Report abuse | Reply
  7. DrPete

    The numbers are still dismal, but I was pleased to see pancreatic cancer get a headline. There's such a long way to go in treatment of this absolutely devastating disease, but since there's no big lobby, no fundraising walks, and no ribbon, most people have no idea about it. Awareness is a good thing.

    May 12, 2011 at 05:39 | Report abuse | Reply
    • survivor

      I'm a 29-month pancreatic survivor (PTL!) and Pancreatic Cancer Action Network (pancan.org) is an organization that is increasing awareness and research funding - the website has first-rate accurate information. They sponsor walks that have increased and are now all across the country. This organization also sponsors an Advocacy Day on Capitol Hill, this year on June 14 that I'm also able to take part in - so help us get the word out, check out the website!! There is hope!

      May 12, 2011 at 11:44 | Report abuse |
    • Nurse Lisa

      walks and ribbons (Purple) are out there. Some Dr.

      May 12, 2011 at 18:24 | Report abuse |
  8. Garry

    My mother was diagnosed with pancreatic cancer by accident. She was caught early and had a whipple surgery. They treated her very aggressively and the marker cell tests showed she was doing very well for two years. The cancer came back and she passed away within a couple months. Please donate to pancan.org. The folks there are working on finding a cure.

    May 12, 2011 at 06:23 | Report abuse | Reply
    • PK

      My father, too, had a Whipple procedure. Fortunately, his tumor blocked the bile duct, and he was jaundiced in the early stages (i.e., his body was displaying late-stage symptoms). He was a 17-year survivor (yes, that is the word YEAR), and he died of something entirely different.

      May 12, 2011 at 14:43 | Report abuse |
  9. Dave

    I lost my mother to pancreatic cancer, too. She was one of the "lucky" ones – she lived over 18 months after diagnosis, and enjoyed a decent quality of life (including some travel) until the last 3 weeks. She was diagnosed very early because she was under the care of a good oncologist due to having had breast cancer a year earlier, but it was still inoperable due to it being wrapped around the artery that feeds the liver (pretty common, from what I understand). It's a horrible disease.

    May 12, 2011 at 07:28 | Report abuse | Reply
  10. LC6624

    My father was diagnosed the week after Thanksgiving and died a week before Christmas so he only lasted about 3 weeks.

    May 12, 2011 at 08:13 | Report abuse | Reply
    • Paige

      My dad also lived only three weeks post diagnosis, and died the week after Easter. Holidays and pancreatic cancer suck!!

      May 12, 2011 at 23:47 | Report abuse |
  11. Tim, San Diego CA

    What is the cost for these treatments? How long would the person live with no chemotherapy, just drugs for pain management? If a person wants to pay for these treatments on their own dime that's one thing. But as a society that shares limited resources for health care can we really afford to spend inordinate amounts to prolong a person's life a couple months? Not heartless, just pragmatic.

    May 12, 2011 at 08:21 | Report abuse | Reply
    • Beth

      Tim,

      Your question regarding spending "inordinate amounts to prolong a person's life" floors me. If YOU were diagnosed with only a few months to maybe a year to live wouldn't you want to find a way to live a bit longer to spend time with your family or to be able to do things in your life that you have yet to do? I did. I was one who was fortunate enough to be on Gemcitabine (at $2,000 per prescription for 6 weeks) after a whipple and radiation. That was almost 7 years ago. I have been able to further my education, re-marry, and watch my young son grow into a young adult.

      May 12, 2011 at 09:11 | Report abuse |
    • Glenn Henshaw

      Wow. Let me guess,...,you are a tea party-er.

      May 12, 2011 at 09:37 | Report abuse |
    • Tim, San Diego CA

      Not a Tea Partier.

      We spend about $2.5 trillion a year on health care in this country, around 17% of GDP. At some point we'll get to where the citizens in this country are unwilling or unable to spend any more. When that happens society will make the tough decision that given this limited amount of money to spend we need to get the most bang for the buck. Extending a life a couple months might not fit into that criteria. Of course if a person wants to purchase a health care policy that puts zero limits on coverage that is their option but it will be pricey.

      May 12, 2011 at 10:14 | Report abuse |
    • John

      Your reply displays the naivety of never having experienced an immediate or young family member battle cancer. I agree resources are finite, and that there is a time when a patient may recognize treatments no longer make sense, but many chemotherapies are not necessarily over the top expensive compared to other end of life medical care costs. If you find yourself fighting this disease or caring for someone that is, you'll recognize the issue is much more complex than how you stated it, especially if you are in a setting where the patient is young and their life is being cut short.

      May 12, 2011 at 10:54 | Report abuse |
    • NPS

      Beth, I do understand Tim's point. Yours is not the typical pancreatic cancer story, yet, obviously, given your experience I see your point. You were very, very lucky indeed to fall into the 5% of people who live past 5 years. Medicine is not an exact science and that's why it's so hard to make fiscal decisions based on uncertainty.

      May 12, 2011 at 11:10 | Report abuse |
    • JL

      What's the point of even developing drugs if you don't expect people to use them? My father was diagnosed in September and started Folfirinox in October. Fortunately his results have been good so far, but living with a family member who has this disease is an exercise in living one day at a time. He has experienced many of the side effects mentioned in the article above, but has also spent a good deal of time doing what he wants and visiting with family and friends. The statistics are terrifying, but I'm so grateful that we have the option to try drugs to try to prolong or save his life. I'm glad my Dad has made the decision to fight. And what would you say to those people who live a few years after diagnosis, or even 5 years past? That they should've chosen a different path? That their life wasn't worth the cost? When someone tells you that you have a 6% chance of survival past 5 years, you can make that decision for yourself.

      May 12, 2011 at 13:05 | Report abuse |
    • ER Laura

      Tim as far as I am concerned the money doesn't matter. If we can pay our Senate, Congress, and so on what they are paid and to do nothing, then we can pay for that. I pray that your words do not come back to bite you in the booty. If it were you I am relatively sure you would change you mind.

      May 12, 2011 at 19:43 | Report abuse |
    • Paige

      Just wait until someone YOU love has this disease. Then we'll see if you're still as heartless!

      May 12, 2011 at 23:46 | Report abuse |
    • CUZ in SC

      Dr. Tim ., Is that you Buddy. I'm surprised you have that feeling???

      May 24, 2011 at 00:41 | Report abuse |
    • cynthia

      it is exceedingly MEAN to even discuss cost ans what we can afford, in the face of such an agony and punishing course to death. Shame on you. FYI all cance rcells die at a palty 105.2 degrees–yes, quite close to the overall and often fatal to brain cells temperature of 106. This has been in medical literature for a bout 20 years. The problem is getting all of you the same temp wihout hot spots. There is a belly wash procedure being used now, since all metastatic cancers make their way to the mighty liver, lungs, brain, where the abdominal cavity is filled with chemo at that temp and uner anesthesia, rocked from side to side for 6 hours, leaving up to 90% less mass of the previously inoperable tumors left behind. This is particularly effective in a post colonostomy surgery, where the walls of the organ have been breached, proximal lymph-nodes full and no distal tumors found yet.

      October 6, 2013 at 18:11 | Report abuse |
  12. Jmrdel

    Part of the problem is that there are only about 300 active pancreatic cancer researchers around the world, while there are thousands for the more "treatable" cancers such as breast, lung, and prostate. A major cancer research organization is planning a summer 2012 conference which will bring together the world leaders in pancreatic cancer research to share the latest information on research and treatment, and to brainstorm new ideas to move the field forward in attacking this horrible disease. The conference is being supported by PanCAN, which is the leading and most effective voice in pancreatic cancer research.

    May 12, 2011 at 10:16 | Report abuse | Reply
  13. nina786

    what a horrible disease......:(...hope the doc or scientist find a better new medicine for this disease

    http://www.seemeagain.com

    http://www.seemeagain.com

    May 12, 2011 at 10:20 | Report abuse | Reply
  14. Orange Pekoe

    Insurance companies already make these decisions without any care for people who need treatment. I'd leave it up to the individual and their families but more time is more time. That decision should NOT be made by insurance companies who care for nothing but their own bottom line. IN a few more months of life other treatments might become available-there is always that hope and sometimes it does happen.

    May 12, 2011 at 10:50 | Report abuse | Reply
  15. JohnB

    My father died from this about 15 years ago. He also was not diagnosed until way too late for them to do any effective treatment, and he'd had various symptoms for many years before (hernia, was one, which he didn't have). He lasted about 6 weeks after the final diagnosis and they operated on him to try and let him feed, since he'd been unable to keep any food down for over a month beforehand, and that surgery only accelerated his death. Three weeks on morphine, and poof. I don't blame the doctors for not diagnosing it since its known to be hard to do so, but you have to wonder if the doctors don't put this much higher on their lists of things to consider since it doesn't get enough press/support. It's almost like its a last option when they've ruled out everything else. I think this explains the statistics. If caught early, it might be more treatable.

    May 12, 2011 at 11:02 | Report abuse | Reply
  16. Sarah

    I have a friend who has had pancreatic cancer which has spread to his liver. He has also had 2 other types of cancer. He has survived for 10 yrs. with essentially no treatment. The treatments for pancreatic cancer almost kill him. Recently they gave him an antibody to him cell type. It caused an ulcer which nearly killed him. He needed 9 units of blood. But no one has studied why he has survived this for so long. What makes him different?

    May 12, 2011 at 12:45 | Report abuse | Reply
    • Paige

      My dad's cancer didn't start growing until after he discontinued the monoclonal antibody he was taking for lymphoma. It really took off after they biopsied it. I think once you let it out, it spreads like crazy!

      May 12, 2011 at 23:44 | Report abuse |
  17. Lorin

    A friend of mine just passed away 2 days ago from this horrid disease. I hope a cure is found I just wish they had one already, than she'd still be here. :(

    May 12, 2011 at 13:11 | Report abuse | Reply
  18. healthnut999

    As a lot of viewers already commented, it is a very serious malady with quite a grave prognosis. Despite recent advances in chemotherapy, radiotherapy and immunotherapy, surgery still remains one of the potentially helpful remedy.

    http://pancreaticadenocarcinoma.info

    May 12, 2011 at 13:30 | Report abuse | Reply
  19. Michael W. Michelsen, Jr.

    My father lived with pancreatic cancer for 17 months after diagnosis. We all knew his prognosis wasn't good, but thanks to an aggressive treatment program and a lot of courage on his part, we enjoyed 17 additional months with the most wonderful person on the earth. Those 17 months translated into one more birthday, one more Christmas, one more Father's Day, etc. We are all grateful to medical science and all of those medical professionals, especially my wife, who was his case manager (not to mention a world class wife).

    May 12, 2011 at 15:15 | Report abuse | Reply
  20. LDBinAZ

    My lady of 60 years marriage has pancreatic cancer. It was diagnosed last September (8 months ago). After learning that surgery was not recommended and chemtherapy would "only add a few weeks," she elected to not undergo any more treatment. We live day-to-day and are grateful for the good days. She believes she has had a good life and that underlies her decision. I don't believe that anyone except the person involved should be making decisions regarding treatment or who pays for the cost. I would cheerfully pay every penny we have (we are not poor) for a cure, but that is not an option. Beware of those who want to make decisions for you.

    May 12, 2011 at 15:21 | Report abuse | Reply
  21. SE

    My 42 year old aunt didn't have any risk factors (alcohol, smoking, over 65, overweight) for pancreatic cancer and didn't display any symptoms until a month before her death when she started experiencing pain and had trouble keeping food down. She was miss-diagnosed as having an ovarian cyst, the flu, and a kidney infection before she suddenly died. . . we didn't find out that she had pancreatic cancer until it was revealed in her autopsy. I really wish more people knew about this horrible, deadly disease and that more resources would be devoted to researching potential treatments and a cure.

    May 12, 2011 at 19:00 | Report abuse | Reply
  22. Sue

    Last Fall, while visiting my aunt and uncle, I brought to their attention that his color had a distinct yellow hue and he had to get to a specialist as soon as possible. I demanded that he use his MD only to get into a specialist... not for a diagnosis. He was sent to a Urologist within a week for consultation and tests. He was then scheduled with a wonderful Surgeon who specializes in Pancreatic cancer surgery, within another week. By the Grace of God his tumor was blocking the bile duct, hence the jaundicing early, and he was a candidate for the Whipple Procedure. Without hesitation, he had his surgery on November 29, 2010, three days after his 83rd birthday! He came home in 12 days, not needing pain meds, and is in the last month of chemo treatments. He has not been ill, lost his hair or lost more weight. He's had a remarkable surgical recovery, and we pray that his luck holds. His surgeon said that he expects him to be one of his patients to live beyond 5 years after viewing all tissues in surrounding areas, but suggested the chemo as a safe-guard. The doctor says that with his luck and general condition prior to illness, he wants him to come for a visit on his 93rd birthday! Early or accidental diagnosis is critical in the survival of all cancers, but it is imperative in Pancreatic cancer! Do not rely on your family MD, however well-intended he might be ... you know your body better than anyone, so INSIST on an appointment with whatever Specialist might be related to your current issue. Time is of utmost importance!

    May 12, 2011 at 21:17 | Report abuse | Reply
  23. Sue

    I want to extend my thoughts and prayers to everyone here who has dealt with Pancreatic cancer or lost a loved one. I pray every day that my uncle will continue to be one of the "lucky ones"... but realize that only time will tell! Pay heed to physical problems that are not "normal" for you and take each day as a gift! Its really all we have!

    May 12, 2011 at 21:23 | Report abuse | Reply
  24. Guest

    For the survivors and loved ones of survivors posting comments on here, I pray for you just like I prayed for my mother who did not survive. Pancreatic survivors are pretty few and far between, so I hope you all GIVE IT HELL!!!

    May 12, 2011 at 23:39 | Report abuse | Reply
  25. Paige

    My dad had pancreatice adenocarcinoma and we didn't know it. He was being treated with Rituxan for lymphoma, and the tumor didn't grow during that time. It was there – showed up in the CT scan, but the doctor dismissed it as lymphoma because it was just one of many tumors. As soon as my dad finished the Rituxan, the pancan started growing. So, my question to the doctors out there is this: Do you think that perhaps Rituxan could possibly provide a longer survival rate for pancreatic cancer patients? My dad lived over a year from the time we found the original tumor. That's much longer than most people do.

    May 12, 2011 at 23:40 | Report abuse | Reply
  26. LLJ

    Such a harsh reality. My dad was diagnosed at 43. Dead at 46. It was my youngest brother who pointed out how lucky we were to have dad with us for 2.5 years after his diagnoses. That's a relatively long time. His cousin was diagnosed the day he died – she only lived a couple of months.

    May 13, 2011 at 16:48 | Report abuse | Reply
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    Marijuana: The Forbidden Cure for Cancer
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  29. Jennifer

    From the original study:
    "At 6 months, 31% of the patients in the FOLFIRINOX group had a definitive degradation of the quality of life versus 66% in the gemcitabine group (hazard ratio, 0.47; 95% CI, 0.30 to 0.70; P<0.001)."

    Doesn't this seem to contradict the summary presented in this article about quality of life?

    July 2, 2012 at 02:29 | Report abuse | Reply
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