The Food and Drug Administration (FDA) has recently approved the use of Abraxane in those patients suffering from end-stage pancreatic cancer. Based upon clinical trials, the novel drug should help to extend life expectancy and, hopefully, provide a better quality of life.
Treatment of pancreatic cancer depends upon its stage, type and location. Generally, however, treatment involves different combinations of surgical intervention, chemotherapy and radiotherapy.
The early stages of pancreatic cancer might provide a window of opportunity where successful remission can be achieved, through removal of the cancerous tissue, and subsequent chemotherapy. Unfortunately, pancreatic cancer is very rarely picked up in the early stages of disease progression, as symptoms often do not present until much later on.
In other cases, however, treatment strategies may be based around slowing the spread of cancer to help circumvent some of the unpleasant symptoms.
Due to the disruption of the pancreas’ digestive function, nutritional supplements are often required. Analgesics are also commonly prescribed to limit the pain experienced.
The FDA has recently approved the novel drug Abraxane, as part of the arsenal of agents used to combat pancreatic cancer. Abraxane is actually based upon a preexisting drug, called paclitaxel, modified to improve its efficacy.
Paclitaxel (branded as taxol) is a mitotic inhibitor, and its initial discovery was made by the U.S. National Cancer Institute program. The method by which paclitaxel inhibits cell division is through interference of the cell’s microtubules, during mitotic cell division.
Abraxane, which is currently owned by Celgene, takes paclitaxel and binds it to a globular protein, named albumin. The albumin serves as a delivery vehicle, improving the transportation of the drug to the target cancer sites.
Studies have demonstrated that Abraxane can offer a modest improvement to patient life expectancy, during late-stage pancreatic cancer. Experts say that the drug can extend a sufferer’s life by as little as two months, for those patients who are unable to undergo surgical treatment.
The drug was originally approved for treatment of breast cancer, under the circumstances that a patient’s response to conventional chemotherapy had failed, or following a relapse. Its use was later extended to included patients with a type of lung cancer, called non-small-cell lung cancer (NSCLC).
The pancreas is an organ of the digestive system, capable of both endocrine and exocrine function. Its endocrine function involves secretion of a number of hormones directly into the bloodstream, including glucagon, insulin, pancreatic polypeptide and somatostatin. Glucagon and insulin release are vital for maintenance of appropriate blood-glucose levels, whilst somatostatin is capable of hormone suppression.
In terms of endocrine function, which involves the release of pancreatic juice into ducts for transportation to the first section of the small intestines (duodenum), the pancreas is critical to ensuring digestion of carbohydrates, proteins and lipids that arrive from the stomach. This is achieved on an enzyme-specific basis, which aids in the breakdown of food, which is absorbed by tiny structures (villi) lining the small intestines.
Pancreatic cancer is a relatively uncommon, but often serious, type of cancer. Despite its rarity, pancreatic cancer is the fourth biggest cause of cancer-related death, and is expected to kill 38,000 people this year alone.
The most common type of pancreatic cancer is called ductal adenocarcinoma, seen in approximately 9 out of 10 cases.
Ductal adenocarcinomas manifest when a cell of the pancreatic duct becomes cancerous and begins to divide uncontrollably. This proliferation spawns a tumor, which grows in and around the ducts, leading to a myriad of unfortunate complications, including:
- Blockage of the bile or pancreatic ducts, preventing bile or pancreatic fluid from accessing the duodenum of the small intestine
- Cancerous tissue may begin to invade the surrounding organs, including the duodenum, liver and stomach
- The cancer may metastasize, breaking off to enter the bloodstream or lymphatic system, where it can reach distant tissues around the entire body. This results in secondary, cancerous growths
Adding to Existing Drug-Based Treatments
The average life expectancy is incredibly low for patients with pancreatic cancer, particularly those who have the metastatic form, usually only surviving a six month period. Researchers have desperately tried to improve this life expectancy by adding new treatments to the “go-to” drug, gemcitabine, which targets cancer cells and inhibits their replication.
Folfirinox is another drug currently on the market, which Abraxane is to be pitted against. However, Folfirinox has been known to cause intolerable side-effects in a great many patients. One of the contraindications for Abraxane, however, is its use in patients with low white blood cell counts. Abraxane can lead to reduction in white blood cell levels, which can increase a patient’s susceptibility to bacterial infections and inflammation of the lung tissue.
Risk Factors and Genetics
There are a number of risk factors that can make individuals susceptible to pancreatic cancer. This includes age, smoking, obesity and exposure to certain chemical (pesticides, dyes etc). In addition to this, heavy drinking can cause a condition known as chronic pancreatitis, which can also increase the likelihood of developing pancreatic cancer. Diet may also play a part, with studies suggesting that consuming high quantities of fat might be a contributory factor.
Pancreatic cancer only has a small genetic component, with 1 in 10 cases caused by transmission of an aberrant gene from parents to their children.
Astronomical Profits & Costs
Celgene, the company peddling the drug in question, has already made enormous profits from Abraxane’s use as a staple medical treatment in breast and lung cancer patients. Last year’s revenue was $427 million, whilst their overall profits were in excess of $5 billion.
According to The New York Times, a biotechnology analyst for J.P. Morgan, Geoffrey Meacham, considered Abraxane’s take-up would be relatively rapid, and its use would soon become standard practice. He estimates that sales could ultimately surpass $750 million, yearly.
However, Celgene has revealed that the drug will cost between six to eight thousand dollars every month.
The FDA approving Abraxane, as a novel drug in the war against pancreatic cancer, seems like another step in the right direction. Let’s hope they can continue to make improvements to existing drugs, in a bid to combat this terrible cancer.
By: James Fenner