What Can We Offer Patients With Pancreatic Cancer?

Recently, I received a call from a previous patient for whom I was not the treating oncologist.  Originally, she had heard about our work on a radio interview and asked her physician in Ohio to send a sample to our laboratory. The results of her assay concluded that a three-drug combination (cisplatin plus Taxol plus gemcitabine) — not commonly used in a pancreatic cancer — was her best option.

Unbeknownst to me, after beginning therapy, the patient had a prompt and dramatic response. When the patient recently contacted me, I cursorily examined the chart prior to our discussion and noted the date of June 24. At first, I thought the patient was showing evidence of progression barely two months after our analysis. Recognizing that no test is perfect and that even our best recommendations may not work, I contacted the patient to discuss her case. It was only then that I realized that indeed the assay data was from 14 months ago and that her response had been excellent for more than a year.

After congratulating the patient on her good outcome and discussing modifications in her therapy (predicated on some x-ray findings of early progression) I asked what her physician’s reaction to the good result had been. The response was muted. Indeed, the physician, having witnessed a rather remarkably good response, only commented that she knew the patient wouldn’t be cured. Recognizing that metastatic pancreatic cancer has an objective response rate measured in single digits and a median overall survival of 4-6 months, I was disappointed to realize that a patient who was well 14 months after diagnosis didn’t seem to impress the treating oncologist.

We are now engaged in reviewing the patient’s diagnostic studies to determine if the EVA-PCD findings will provide information to further guide therapy. While I was very realistic with the patient — explaining that there is no certainty that further benefit can be obtained — there are, in fact, a number of drugs that could hold benefit for the patient. These including: erlotinib, irinotecan and a number of novel combinations. We will be interested to see if further good results can be obtained and are gratified by the patient’s good outcome to date.

About Dr. Robert A. Nagourney
Dr. Nagourney received his undergraduate degree in chemistry from Boston University and his doctor of medicine at McGill University in Montreal, where he was a University Scholar. After a residency in internal medicine at the University of California, Irvine, he went on to complete fellowship training in medical oncology at Georgetown University, as well as in hematology at the Scripps Institute in La Jolla. During his fellowship at Georgetown University, Dr. Nagourney confronted aggressive malignancies for which the standard therapies remained mostly ineffective. No matter what he did, all of his patients died. While he found this “standard of care” to be unacceptable, it inspired him to return to the laboratory where he eventually developed “personalized cancer therapy.” In 1986, Dr. Nagourney, along with colleague Larry Weisenthal, MD, PhD, received a Phase I grant from a federally funded program and launched Oncotech, Inc. They began conducting experiments to prove that human tumors resistant to chemotherapeutics could be re-sensitized by pre-incubation with calcium channel blockers, glutathione depletors and protein kinase C inhibitors. The original research was a success. Oncotech grew with financial backing from investors who ultimately changed the direction of the company’s research. The changes proved untenable to Dr. Nagourney and in 1991, he left the company he co-founded. He then returned to the laboratory, and developed the Ex-vivo Analysis - Programmed Cell Death ® (EVA-PCD) test to identify the treatments that would induce programmed cell death, or “apoptosis.” He soon took a position as Director of Experimental Therapeutics at the Cancer Institute of Long Beach Memorial Medical Center. His primary research project during this time was chronic lymphocytic leukemia. He remained in this position until the basic research program funding was cut, at which time he founded Rational Therapeutics in 1995. It is here where the EVA-PCD test is used to identity the drug, combinations of drugs or targeted therapies that will kill a patient's tumor - thus providing patients with truly personalized cancer treatment plans. With the desire to change how cancer care is delivered, he became Medical Director of the Todd Cancer Institute at Long Beach Memorial in 2003. In 2008, he returned to Rational Therapeutics full time to rededicate his time and expertise to expand the research opportunities available through the laboratory. He is a frequently invited lecturer for numerous professional organizations and universities, and has served as a reviewer and on the editorial boards of several journals including Clinical Cancer Research, British Journal of Cancer, Gynecologic Oncology, Cancer Research and the Journal of Medicinal Food.

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