A Madrid hospital launches an innovative therapy against pancreatic cancer

A multidisciplinary team from the University Hospital of Fuenlabrada, in Madrid, has applied an innovative treatment for locally advanced

cancer that offers fewer side effects compared to other therapies and whose objective is

so that, in the medium term, it is possible perform

.

This is a strategy that combines

: internal radiation in which, through ultrasound-guided endoscopy, the active ingredient is injected into the tumor with

, so that large doses are administered with

.

The treatment is approved by the Spanish Agency for Medicines and Health Products (AEMPS) and is available to the National Health System.

One patient -who is now continuing with the usual chemotherapy- has already undergone this process and has tolerated the administration of this radioactive isotope without complications, an initiative

within the Osprey international registry, a database that collects people diagnosed with this type of disease and where selected centers from different countries participate.

Fernando Pereira

, head of the General Surgery and Digestive System Service at the University Hospital of Fuenlabrada, and

health center, explains to DM that this is the first time that the procedure has been performed in Spain, although not at the international level. international.

"Treatment with the

was approved in Europe for clinical use in May 2020, following a lengthy preclinical phase and the presentation of the results of the pivotal PanCO study at the European Society for Medical Oncology (ESMO) World Congress 2020. The PanCO study, conducted in Australia, Belgium and the United Kingdom between 2017 and 2018, included 50 patients from 10 centers, with

compared to standard treatment regimens with chemotherapy or chemo-radiotherapy in these patients with locally pancreatic cancer. advanced".

Urgent need

In his opinion, in these patients there is "an urgent need to develop

that help us improve results."

Thus, the next step proposed to confirm these data has been the international prospective, observational, and multicenter registry Osprey (OncoSil Pancreatic cancer post-marketing clinical REgistrY), in which the data of patients undergoing implantation of the OncoSil device

.

Several international centers and a few Spanish ones from which the Fuenlabrada Hospital has carried out the first treatments will participate in this registry.

Pancreatic cancer is one of the tumors with the worst prognosis.

It is estimated that half of the cases are

and, therefore, only amenable to palliative treatment.

"20% of the cases detected are susceptible to surgery, the ideal and only curative option, while 30% correspond to those that are called

and in which there are currently several lines of

them and be able to apply treatment surgery", like the one developed by this Madrid hospital.

Regarding the

that is expected to be achieved with this strategy in locally advanced lesions, Pereira explains that in the PanCO study a median reduction in

It is, therefore, "the one we hope to achieve", although he emphasizes that, although the reduction in tumor volume is an important parameter to access surgery afterward, there are

.

"The

of the tumor itself - which is controlled by PET images - and the

of these locally advanced tumors; that is, with the arteries and veins adjacent to the pancreas, which are the main responsible for these cancers not being able to be operated on. In the PanCO study, the

, which is also what would be expected now."

In this sense, the fact that the

- specifically

- emits beta radiation is very important because the side effects are minor and the tumor lesion will be receiving this

.

"It is important to emphasize that the

are going to be small based on what has been described in the first studies and remember that this therapy is carried out in the Day Hospital, so that the patient

and can go to home afterwards", added

, Associate Nuclear Medicine Physician at the University Hospital of Fuenlabrada.

Complementary Strategies

Subsequently,

-up is carried out on a regular basis by the Medical Oncology Service.

People who have undergone this new technique must

, since both are complementary.

This is the case of the first person treated in Fuenlabrada, who has tolerated the radiopharmaceutical approach without complications and continues with the usual chemotherapy.

Peiró explains that the choice of this specific isotope lies in the fact that the phosphorus-32 microparticles used in this treatment (OncosilTM) are a pure beta-emitting radioactive isotope.

"This means that the

, specifically the average range in the tissue is 2.76 mm, which allows

, around 100Gy, as well as good preservation of

The clinic results in that the side effects are less and the tumor lesion will be receiving this

.

The OncosilTM suspension is prepared on the day of treatment in the Department of Nuclear Medicine and the amount of phosphorus-32 suspension to be implanted is calculated based on the

in the imaging tests performed days before.

Iván Guerra

, an endoscopist at the Digestive System Service at Fuenlabrada Hospital, explains to DM that the procedure is an

procedure and the patient must prepare in the same way as for any digestive endoscopy procedure: fasting, with sedation and analgesia.

It basically consists of performing an

where the lesion in the pancreas is identified, and through the endoscope channel, a fine needle is inserted that passes through the gastric or duodenal wall

It is also important to have an

, since, according to Peiró, "the tumor usually has a capricious disposition, and for a correct placement of the implant, it is necessary to avoid blood vessels and, often, also biliary prostheses".

Once the needle is in position inside the tumor, the Nuclear doctor manually implants

.

The procedure

, and when it is finished, the patient is accompanied to the Day Hospital for observation until they fully recover from the sedation, "which usually happens an hour after finishing the treatment," says Guerra.

He peiró clarifies that "before the patient is discharged, a

to confirm that the radiation has been administered in the correct location."

Role of chemotherapy

Subsequent

-up is carried out as usual in Medical Oncology, since after the application of the technique it is necessary to continue with the previously indicated chemotherapy treatment.

It is a

in which, according to Pereira,

, especially with the new schemes used in recent years, which have shown

to traditional schemes, although in order to use the patients should be in acceptable general condition. In fact, the

that patients we select for Oncosil treatment receive is chemotherapy."

The implantation of the radioisotope in the tumor is carried out after the first or second cycle of chemotherapy, and later "chemotherapy is continued until the response control tests are carried out, proceeding with the

says the head of Digestive system.

Peiró recalls that microparticles are a permanent implant and in their therapeutic use,

will be released in a controlled manner for about 81 days after implantation.

"All of this, together with the usual pattern of chemotherapy treatment that the patient does not abandon, probably allows a

The analysis of the data offered by the Osprey registry will be able to specify who would be the

to receive this therapy.

Peiró notes that approximately 50% of pancreatic cancer patients are diagnosed with

.

"In these, this strategy

; today they are only susceptible to palliative treatment with chemotherapy. Another 20% are considered operable from the outset, and in these, at least for now, this strategy is not considered either because they are candidates for surgery. It is in the other

, where this strategy would make sense today".

The professionals want to underline that the application of this innovative procedure requires significant

, including the services of Medical Oncology, Radiophysics, Digestive System, Nursing, Nuclear Medicine and Radiology.

In the specific case of the Fuenlabrada Hospital, Alfonso López, head of the Radiophysics Service;

oncologists Ignacio Juez and David Gutiérrez;

the endoscopists Andrea Bermejo, Antonio Guardiola and Iván Guerra;

Nuclear Medicine doctors Virginia Peiró, Pilar Boya and Esther Llorente;

and radiologists Teresa Martín and Covadonga del Riego.

"We have been the first in the world within the Osprey registry to apply it and it is very important for the entire team due to the

highlights Peiró.

Other attempts against pancreatic cancer

Pancreatic cancer has been, precisely, the object of study of new

published in the latest issue of

, which highlights the worldwide scientific interest in this complex tumor that still does not benefit from highly effective treatments. effective.

A study, coordinated by

, of the University of Leiden, in the Netherlands, refers specifically to the treatment for

in a patient with progressive

pancreatic cancer who was treated with a single infusion of

that had been genetically manipulated to clonally express two allogeneic HLA-C*08:02 restricted T cell receptors (TCRs) targeting the

expressed by tumors.

The patient had

- 72% overall partial response - based on Response Evaluation Criteria in Solid Tumors;

response that was maintained at 6 months.

Engineered T cells constituted more than 2% of all circulating peripheral blood T cells

.

In this patient, according to the authors, TCR gene therapy targeting the KRAS G12D driver mutation mediated

of metastatic pancreatic cancer.

An accompanying editorial praises the work of Leidner's team focused on the application of T-cell immunotherapy against mutant KRAS in

, the deadliest of all common cancers.

The advanced stage of cancer when symptoms become evident and the hidden presence of

and other organs at the time of initial surgical treatment are the variables associated with this high mortality.

In addition,

systemic disease, and immunotherapy with T-cell checkpoint inhibitors is notoriously ineffective, the editorial notes.

Therefore, the study reported by the Dutch team in this issue

in that it shows profound and long-lasting tumor shrinkage in a heavily pre-treated patient who received an

, directed against the mutant molecule KRAS G12D expressed by cancer cells, a key feature of the immune system.

The data, adds the editorial, justify

to determine the therapeutic potential of this therapy in pancreatic cancer and

.

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