Mapping Progress in Pancreatic Cancer Surgery: Looking to the Future

In this fourth episode of OncChats: Mapping Progress Made in Pancreatic Cancer Surgery, Horacio J. Asbun, MD, and Domenech Asbun, MD, project where the pancreatic cancer treatment paradigm is headed, from a surgical perspective and beyond.

HA: Before we close, Domenech, we have been talking about what has happened in the past, and maybe even gloating a little bit. The reason for that is because, at least in my case, I have to say that [with the advances made these] past few years, I feel very optimistic that [we are] finally [seeing] a change in the survival of [patients with] pancreatic cancer; it’s happening.We’re still far from saying that this is the case [for everyone], scientifically, but we have observed [advances] that [have left us in awe].

We’re now able to give hope to those patients. In the past, it was very difficult to give hope. Now, we have tangible [progress]. For [example,] we have the type of radiation that we do on the MRI-LINAC, or percutaneous irreversible electroporation, new chemotherapeutic agents, and some of the trials that we have [are examining administering] chemotherapy intraarterially, directly into the area of the tumor. All those things have helped us give some hope to the patients.

That said, what do you foresee for the future? What is going to be coming [down the pike]? I’m not talking about [what you expect] in 20 years from now; we don’t need to [emanate] Star Trek here. But what do you think is going to happen next 5 years? Are we going to continue at this pace [in terms] of improvement? What are your thoughts on this?

DA: It’s a good question. I think that first, we will see the continued importance of therapies that are not surgical, so systemic therapies and particularly immunotherapy. This is a huge field right now and the advances are very exciting. I hate to say this, and I say it somewhat quietly, but I think we’re going to get to a point where we’re operating less because our other therapies are going to be more useful and more effective in the long term. Obviously, we’re not there yet and I don’t see a world in which surgery is completely out of the picture at all. However, we are seeing very big advances [beyond that area].

From a surgical standpoint, we’re always looking to see how we can improve things, how we can make the operations better and faster, and [easier] for the patients. That’s one of the joys of surgery; you get a little bit of creative freedom to see what you can do that will make an established surgery even better, even these very complex operations. I see the changes [on] that [front] continuing. Through the minimally invasive approaches, we’re now seeing an ongoing revolution that continues to pick up momentum. I think that’s what we have to look forward to. Maybe it’ll take a little more [time beyond 5 years] to see really significant changes, but that’s where we're going.

One other area that is also starting to get a lot more attention are the modalities for screening for some of these very aggressive cancers, such as pancreatic cancer, cholangiocarcinoma, [and others]. These [efforts are] still in [their] infancy, but we are looking for ways to be able to screen patients that will not be a massive burden on the overall healthcare system. [We want] something that is feasible to do in patients on a yearly basis that is, ideally, not very invasive, maybe [in the form of] a blood test, urine analysis, or salivary analysis, etc. That’s another field that we’re going to see continue to blossom, and that will help us help patients.

HA: [I think] you're right, [for the most part]. I am not sure that we’re going to be operating less. In fact, maybe we’ll operate less from the point of view that we [will] learn [more about] the biology of the disease and realize that for some patients it is not even worth it to try to attempt surgery. However, I think that with all these other therapies, at least up to now—the neoadjuvant [approaches], the new chemotherapies, and radiation—we’re operating more. We’re operating on patients who, in the past, we wouldn’t operate on. Hopefully, that trend is going to continue, or really, whatever trend [that will allow us] to cure more patients.

DA: I might have been looking at the Star Trek future. You’re right.

HA: Yeah, you were looking at the Star Trek future. That’s why I prompted you to that.

Check back on Wednesday for the final episode in the series.