Video: | Tarceva has also been approved and some physicians will also add Tarceva to Gemzar. Some physicians use a combination of other medications but its always Gemzar-based. However, the data to support adding that second drug is pretty limited so thats still a controversial area. It doesnt appear to add significantly to survival and so many medical oncologists try to look at the efficacy, they look at the cost, they look at the side effects and they usually come back to just Gemzar as a single agent or perhaps with Tarceva. That varies from office to office.
But we do know that Gemzar is better than nothing for some patients; but however, its not made a huge impact upon survival. I think there are certainly some patients whose life is prolonged with single agent Gemzar. It does appear to improve quality of life as well, which is why it was approved. But yet, we certainly need new options for therapy for this devastating disease.
How long does Gemzar help a patient? It varies from person to person. Some it doesnt help at all. Some perhaps the benefit might be there for a few months. But again, if you look at the overall record of these patients, less than ten percent of people are alive two years after the diagnosis. The majority of people have died within a year.
Two patients that we have treated thus far with PAM4 both entered with a good performance status, which is part of the entry criteria. Both had very easily measured disease, which again we wanted to be certain that we could measure whether or not were doing the patient any good. And both were enthusiastic in participating in some type of trial because theyd done their homework. Theyd gotten on the internet. They had seen physicians at other institutions and they all knew the prognosis was grim. And so they were just very enthusiastic about being on something that might offer additional benefit.
We began with our first two patients that we treated that we have had time to follow with what I would consider to be ideal candidates, folks who are still feeling good, theyre eating well, the nutritional status is good. We have seen in a short period of time following treatment what I would consider to be dramatic responses to treatment.
One gentleman had an extremely elevated C19. That was dropped almost to normal. His PET scan resolved the hypermetabolic activity. That was quite encouraging and the other patient did not have an elevated marker but did have very solid radiographic evidence of reduction in the amount of tumor present.
The thing that I was quite pleased with was the fact that we did not see any subjective toxicity while the patients were undergoing treatment. I was concerned that we might see significant myelosuppression. I was concerned that we might have gastrointestinal complaints. Both patients just literally breezed through therapy and had absolutely no complaints at all.
We had very minor thrombocytopenia, didnt have any significant neutropenia. So we were just thrilled with the fact that they tolerated therapy and as far as we know with the follow up, which is limited, that we have now, were not seeing any delayed toxicity. So were quite interested in continuing this study and were trying to accrue as many patients as we can to further examine the duration of remission that will be obtained and just to get more data available because weve just seen with a very low dose of Gemzar extremely impressive results.
The significance of a response on a PET scan is a bit hard to say at this point in time when it comes to cancer of the pancreas. Now if we can extrapolate from other diseases for which weve had quite a bit of experience, actually years of experience for lymphoma patients, we know that those people with just tumors, those people with lymphomas who do respond dramatically with a normal PET scan after two to three cycles of therapy, those patients do very well and we know that in lymphomas theres a higher cure rate. We also have some evidence that PET scan negativity, a PET scan going from extremely hypermetabolic to negative is also predictive of a good response to chemotherapy in patients with gastrointestinal malignancies. We know that the prognosis is much better.
Were hoping the same thing is true with patients who have cancer of the pancreas. We really dont have any reason to believe that the mechanism of the PET scan going from positive to negative would be different although that theoretically is possible. But its encouraging to me because its very hard to measure a benefit with chemotherapy in cancer patients whose primary is a pancreatic malignancy because we know theres not often a good correlation between resist criteria and the benefit with treatment for metastatic cancer of the pancreas. Its a bit of a unique disease in that regard and so were hoping that the PET scans will give us a better indicator of how effective a treatment is than just relying upon CT scans which are notoriously difficult to interpret.
The question that comes up next is what happens to patients who have a very good response. Lets say they have an excellent remission, theyre doing well, theyre asymptomatic. Were not certain that were going to cure these people and in fact anybody who talks about cure at this point in time I think would be risking their credibility.
So the question comes up: Should you continue a person on Gemzar, perhaps full dose Gemzar. Another alternative which weve chosen would simply be to follow these patients and then at signs of disease occurrence, evidence of disease recurrence resume treatment. And then the question comes up: What treatment? Would you simply go to traditional single agent Gemzar at the usual dose of 800 to 1,000 mg/m2? I personally would be in favor of reinstituting treatment with PAM4 as long as we dont have problems with the dosimetry and neurotoxicity. Again, as a farm boy, this is on an unplowed field and were interested in approaching that. My personal preference at this time is to simply follow these folks, see how well they do and then at the time of disease recurrence if neurotoxicity is not excessive from prior treatments, if we think weve got a window of opportunity here, resume treatment with the same combination of Yttrium and Gemzar as before. |