Drug may delay cancer's return after pancreas surgery

CHICAGO - Offering a glint of hope for treating a notorious killer, researchers found that a common chemotherapy drug can help pancreatic cancer patients who have undergone surgery stave off a return of the disease longer.

In the German study, the group receiving Gemzar, or gemcitabine, lived on average of 13.4 months without their cancer coming back. A comparison group that did not receive the drug lived without disease for 6.9 months.

The 6 1/2-month gain may look modest. And scientists said they have seen no difference so far in the overall survival rates between the two groups. But pancreatic cancer is such a rapid and efficient killer that the findings were still highly encouraging.

Pancreatic cancer has one of the worst chances of recovery of all types of cancer. Most patients are not diagnosed until the cancer has spread, and fewer than one in 10 patients are alive five years after diagnosis.

Only 20 percent of newly diagnosed patients are good candidates for surgery, the best hope for a cure. And even then, the disease returns in the vast majority of cases.

The new findings, when considered along with preliminary results from a large U.S. trial reported last year, suggest that chemotherapy after pancreatic cancer surgery should at least include gemcitabine.

The study appears in today's Journal of the American Medical Association.

''This study says to me that gemcitabine can keep the disease at bay for a period of time after surgery,'' said Dr. Sunil Hingorani of the Fred Hutchinson Cancer Research Center in Seattle. But it also ''underscores the essential incurability of the disease,'' he said. ''If you wait long enough, the beast comes back.''

The findings apply only to those patients who can have surgery - just 6,000 to 6,500 patients a year in the United States. Those are the patients whose cancer was diagnosed before it spread beyond the pancreas.

Gemcitabine already is used to fight breast, lung and ovarian cancer. It is also used to treat inoperable pancreatic cancer. It costs about $2,800 a month and has relatively mild side effects such as fatigue and hair thinning.

Doctors disagree about the best treatment following surgery for pancreatic cancer. Some watch for the disease to recur before starting other therapies. Others recommend chemotherapy right away, or a combination of chemotherapy and radiation.

Unlike other cancers, pancreatic cancer appears to spread almost as soon as it appears, possibly because the pancreas is not as self-contained as other organs. Pancreatic cancer cells are also usually tougher to kill in a petri dish than other types of cancer cells.

The pancreas, located between the stomach and the spine, secretes enzymes that help digest food and hormones that maintain blood sugar levels.

Smoking and a family history of pancreatic cancer raise the risk of the disease. Eating more fruits and vegetables may reduce the risk.