Thursday, May 24, 2018
Health

New treatment takes aim at pancreatic cancer with a targeted assault on the tumor

TAMPA — David Allison knew better than most his chances of surviving pancreatic cancer.

His brother and sister had died from the disease.

"I figured it was the beginning of the end," said the 75-year-old retired milk truck driver, who spends his winters in Oldsmar.

Allison tried fighting the cancer with conventional chemotherapy and radiation in April. But the treatment made him weak. His appetite disappeared. He lost nearly 30 pounds.

He had resigned to let the disease run its notoriously deadly course — until a doctor told him about something that sounded promising: a novel approach to chemotherapy that could deliver high doses directly to his tumor, while sparing him some of the side effects.

"All of a sudden, I had hope," Allison said.

So do the doctors at Florida Hospital Tampa, one of two hospitals nationally conducting clinical trials on the procedure. Dr. Alex Rose­murgy, the lead investigator, said the treatment has the potential to shrink pancreatic tumors more effectively than conventional chemotherapy. That, he added, could make more patients eligible to have their tumors surgically removed.

"The key is the really high dose," said Rosemurgy, describing the level of medication as "industrial."

The research is still in the early stages. But Rosemurgy believes it could have wide-reaching applications.

"If you can make a difference with pancreatic cancer," he said, "you can make a real difference in a lot of cancers."

• • •

Even among cancers, pancreatic cancer has a nasty reputation.

Although the disease is relatively rare, it is almost always fatal. About 50,000 people will be diagnosed this year, according to the American Cancer Society. The five-year survival rate hovers around 6 percent.

The high mortality rate is partly because pancreatic cancer is difficult to diagnose. The pancreas is hidden behind the stomach. Tumors often go unnoticed until they are large enough to interfere with the digestive system or the cancer has spread elsewhere in the body. At that point, few are operable.

Further complicating treatment, pancreatic tumors tend to be gristly and fibrous, making them resistant to chemotherapy.

Radiation and chemo "can prolong survival by a few months," said Dr. Richard Kim, a medical oncologist in the Gastrointestinal Oncology Department at Moffitt Cancer Center in Tampa. "But it's not a home run."

David Allison was diagnosed with the disease on March 26.

He had survived prostate cancer two decades ago. But this time felt different.

"It was like a death sentence," his wife, Rosemarie, said.

Rather than returning to his summertime home in suburban Illinois, Allison underwent a traditional course of chemotherapy and radiation in Pinellas County. The treatment shrank his tumor more than the doctors expected. But he was told he would need another round of chemotherapy before surgery was possible.

He considered giving up.

"I was not going to go through the normal channels again," he said, recalling how he spent most of the spring in the hospital, and was often too weak to enjoy his time at home.

That's when his oncologist suggested he meet with Rosemurgy, a surgeon at Florida Hospital Tampa with a national reputation for treating pancreatic cancer patients. Allison had wanted to discuss surgical options. But his new doctor had another idea.

• • •

Rosemurgy had long been searching for a procedure that would enable him to treat pancreatic cancer.

Traditional chemotherapy — drugs pumped into a patient's bloodstream through a vein in the arm or a port in the chest — had lackluster results on pancreatic tumors. And because the drugs would circulate throughout the body, patients often experienced painful side effects.

Rosemurgy had led dozens of trials in hopes of finding a better approach. One involved injecting pancreatic tumors with radioactive phosphate. Another treated them with viruses meant to introduce genetic material into the cancer cells. But nothing got the results he wanted.

A few months ago, he got a call from a medical device company in California. The company, RenovoRx, had developed a catheter that could treat pancreatic tumors at the site. The technology had already been cleared by the U.S. Food and Drug Administration, but not yet widely studied.

Rosemurgy was intrigued. He agreed to lead a clinical trial at Florida Hospital Tampa.

The procedure goes straight at the problem. Doctors insert the catheter into the patient's body through an incision in the groin or arm. They snake it through the vascular system until it reaches the artery that feeds the tumor.

Once the device is in place, doctors can inflate two tiny balloons that briefly block the flow of blood into and out of the artery. The catheter then releases a high dose of chemotherapy directly into the cancer.

The balloons ensure all of the drugs reach the tumor. They also prevent high levels of chemotherapy from traveling throughout the patient's body and destroying other cells such as hair follicles and digestive cells.

Patients experience fewer side effects than with conventional chemo.

The procedure takes about two hours, Rosemurgy said, and is repeated every two weeks for a period of two months.

So far, more than a dozen patients have signed up to participate in the study at Florida Hospital Tampa, said Rosemurgy, who hopes to enroll another dozen over the next few weeks.

He acknowledged the risk in trying a new procedure, but said patients recognize the benefits.

"They get the therapy of tomorrow today," he said.

• • •

Rosemurgy isn't the first doctor to try treating a tumor directly. Dr. Bruce Zwiebel, Tampa General Hospital's director of vascular and interventional radiology, said so-called regional therapies have become "the new strategy for treating cancers."

At Tampa General, for example, physicians are treating liver cancer by injecting small beads into the arteries around the organ. The beads get lodged in the tumor — and release chemotherapy drugs for 30 days.

What makes Rosemurgy's work unique is that he is among the first to use a targeted strategy on the pancreas. The two-balloon catheter is also the first of its kind, he said.

Will it work? That's hard to predict.

Kim, the medical oncologist at Moffitt, said he is "cautiously optimistic" about the trial.

But Zwiebel, from Tampa General, expressed some doubts.

"Pancreatic tumors don't have a ton of blood supply like some other tumors do," he said, explaining that even with the device, it would be difficult to get chemotherapy to the cancerous cells.

Rosemurgy won't be able to determine what effect, if any, the treatment has had on Allison's tumor for another few weeks.

So far, the patient has been tolerating the infusions. He needs the occasional nap, but hasn't felt the exhaustion that brought his life to a halt during the initial round of chemo. He has gained some of the weight back, too. He asks to go to restaurants again, and devoured a fist-sized sticky bun on a recent afternoon.

"We're leading normal lives," Rosemarie said. "We go out to dinner. The kids come over."

Allison is hopeful he will soon be a candidate for surgery.

He likes the idea of pioneering a new treatment that could someday be used to help patients with other types of cancers. But one thing still baffles him.

"I can't understand why they didn't do it years ago," he said.

Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.

   
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