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Medical News & Perspectives
November 18, 2020

Looking to Long-term Survivors for Improved Pancreatic Cancer Treatment

JAMA. 2020;324(22):2242-2244. doi:10.1001/jama.2020.21717
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Not only was US Supreme Court Justice Ruth Bader Ginsburg the second woman to serve on the nation’s highest court, she was also a member of another very exclusive club: long-term pancreatic cancer survivors. Justice Ginsburg lived 11 years after her initial diagnosis with early-stage disease discovered in 2009 during a routine checkup, according to the Pancreatic Cancer Action Network (PanCAN).

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    2 Comments for this article
    EXPAND ALL
    Very Interesting Research
    Nkese Antoine, MBBS | Scarborough General Hospital, Republic of Trinidad and Tobago
    This research provides a small glimmer of hope in fighting the beast that is Pancreatic Cancer.
    CONFLICT OF INTEREST: None Reported
    Ductal Adenocarcinoma of the Pancreas: Early Diagnosis is Still a Challenge
    Giuliano Ramadori, Professor of Medicine | University Clinic, Internal Medicine,Goettingen,Germany
    This news report stresses the possible role of genetics and immune reactions in determining long-term survival in a malignancy with a poor prognosis (1). In a pivotal study published almost 30 years ago Alanen and Joensuu demonstrated that long-term survival after pancreatic adenocarcinoma could be explained by the fact that the long-term survivor never had pancreatic adenocarcinoma (2).In a previous comprehensive review about 5-year survival after resection of a pancreatic cancer Gudjonsson (3) concluded that "it was not possible to identify a subset of patients with a favorable prognosis." The major problem is that an early diagnosis is not yet possible. Therefore, due to the retroperitoneal localisation of most of the pancreas at the time of the diagnosis, a ductal adenocarcinoma is already a "systemic" disease with local (retroperitoneal) metastasis and metastasis in regional lymph nodes.This is the explanation for the fact that surgery can not be curative (4) in spite of additional neoadjuvant and/or adjuvant chemotherapy. A major achievement has been reached by the use of an old drug, 5-FU at high dose, in addition to irinotecan and oxaliplatin in younger patients (5).

    LITERATURE
    1.Kuehn BM: Looking to long-term survivors for impruved pancreatic cancer tretment. JAMANews&Analysis. Published online November 18, 2020
    2.Alanen KA,Joensuu H: Long-term survival after pancreatic adenocarcinoma-often a misdiagnosis? Br J Cancer 1993:68:1004-1005
    3.Gudjonsson B: Cancer of the pancreas. 50 Years of surgery.Cancer 1987;60:2284-2303
    4.Verbeke CS,Gladhaug IP: Resection margin involvement and tumor origin in pancreatic head cancer. Br J Surgery 2012;DOI:10.1002/bjs.8734
    5.Conroy T et.al: FOLFORINOX versus gemcetabine for metastatic pancreatic cancer. New Engl J Med.2011;364:1817-1825
    CONFLICT OF INTEREST: None Reported
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