Two-thirds of patients with pancreatic cancer without metastases cannot have surgery to remove the tumor because of local ingrowth in important blood vessels. However, some international centers of expertise prescribe longer pre-treatment with chemotherapy (and radiation) and then operate more often than in the Netherlands. This practice is associated with a higher chance of long-term survival. Therefore, the Dutch Pancreatic Cancer Group initiated the PREOPANC-4 project, aiming to improve survival rates for Dutch patients with locally advanced pancreatic cancer. The project is supported by the Delta Plan for Pancreatic Cancer.
Thomas Stoop: “In the past decades, we in the Netherlands have been somewhat more reserved and cautious about operating on locally advanced pancreatic cancer. After all, these are complex operations with a risk of complications that - at the time - did not outweigh the benefits of possible survival gain. However, with the recent introduction of better multi-agent chemotherapies, such as FOLFIRINOX, the tumor can be controlled for a longer period of time in some patients. This makes removal of the tumor with surgery useful and safe in highly selected patients. Now that the international centers of expertise have shown these positive results, it is time to take a step forward in the Netherlands.”
Survival gains
The PREOPANC-4 implementation project is looking at which patients in the Netherlands could benefit from surgery after pre-treatment with chemotherapy. Doctors choose a treatment supported by improved selection criteria, such as determining tumor markers and making scans. Selecting the right patients for surgery is complex and requires a lot of experience. Patients who may now be eligible for surgery will be nominated for consideration by an expert panel.
“The international experts are also looking into this. Together, we decide what treatment could best increase the chance of a survival,” says Thomas.
Training for a tailor-made treatment
Thomas is now working on the implementation of the best treatment method. “We have researched the four different best international practices and combined them into one 'best treatment method' that we want to use. We have set up a training program for surgeons, oncologists, radiotherapists, gastroenterologists, liver specialists, radiologists and pathologists, among others.”
The training program was organized by the four international centers of expertise, involving medical centers in Heidelberg, New York, Denver, and Houston. “We learn to better pre-treat with chemotherapy and radiotherapy, and we learn to select patients better for the optimal therapy. When is surgery useful? Do we need to pre-treat longer? Should we switch to a different chemotherapy? In this way, we tailor the treatment much more and we can operate on more patients.”
The wishes of the patient
In addition to optimizing the medical side, the research also focuses on optimizing patient-oriented care. “Of course, we select patients based on a scan, blood results, or a response to chemotherapy. But we also map out: what does a patient - and his or her loved ones - want for themselves? As doctors, we must provide patients and their families with good insight into what a treatment process looks like, what the possible advantages and disadvantages of a treatment are, and what these can mean for the quality of life. To improve this process, the PREOPANC-4 project is developing tools that can support doctors, patients, and their families in making such complex decisions. The patient is therefore central. Of course, the doctor will indicate which treatment he or she considers useful, but we really decide together.”
Additional operations
The implementation project will run until 2024 and has already started in Amsterdam, Rotterdam, Utrecht, and Eindhoven. Thomas hopes to be able to start as soon as possible in the other Dutch hospitals of the Dutch Pancreatic Cancer Group. All in all, he expects to be able to include between 200 and 250 patients in the PREOPANC-4 project over the next three years.
This project was made possible by the Dutch Cancer Society and Deltaplan Alvleesklierkanker. “Thanks to the Delta Plan and the Dutch Cancer Society, we can carry out the entire implementation project and that is just amazing. We can really improve the care we give to patients.”
For more information contact Thomas Stoop
This article was adapted from ‘Vaker opereren bij lokaal gevorderde alvleesklierkanker: landelijk trainingsprogramma’ originally published by Deltaplan Alvleesklierkanker , with permission.