Continuing the Conversation: Pancreatic Cancer Clinical Trials

PanCAN recently hosted a webinar titled “Spotlight on Clinical Trials: A PanCAN Conversation.” Hundreds of patients, caregivers and loved ones tuned in to hear our expert panel address a range of topics related to this critical treatment option. PanCAN recommends clinical trials at diagnosis and during every treatment decision, as patients who participate in clinical research have better outcomes.

So many great questions came in from the PanCAN community that we weren’t able to get to all of them during the webinar! Here, we follow up and dive more deeply into areas of interest.

Do all clinical trials include a control group that receives a placebo?

A placebo, sometimes referred to as a “sugar pill,” does not contain active medication. However, in cancer treatment clinical trials, placebos are never used in place of treatment. All trial participants will receive either the experimental treatment or the best-known standard treatment. In some clinical trials, a placebo may be added to the standard treatment for comparison reasons. Read more about five clinical trial myths (including the use of placebos). 

Do all clinical trials involve travel to the hosting site? Are there options for my local oncologist to administer treatment?

Most of the time, clinical trials involve some travel, although there may be options close to your home. Clinical trials are carried out by doctors and institutions across the country, including hospitals, academic medical centers, cancer centers and community hospitals. Depending on the trial, it may be conducted in one, two, or several different cities. So even if your local oncologist is not administering the treatment, you may be able to find a clinical trial site near your home. PanCAN Patient Services Case Managers can help you decide on the geographic range that works for you, and search for trials that meet your needs.

If you join a trial and it does not work, are you able to easily pivot to another one? How does that work?

It depends on the study. Everyone who enrolls in a clinical trial has the right to leave at any point, whether the treatment isn’t right for you or for other reasons. Pivoting to another study may be difficult, however, because clinical trials have very specific requirements to enroll. For example, you may have to wait a few weeks for the previous treatment to flush out of your body. This is called a wash-out period. Additionally, the trial site might require extra tests to confirm your eligibility, which will take time. It’s crucial to communicate early and regularly with the trial sites you’re interested in to ensure a smooth transition to a new trial.

Are there any trials available for stage IV patients?

Although every clinical trial has unique eligibility criteria, and some may not be open to patients who are stage IV, trials are available for patients in this group. Usually, all clinical trials require an adequate level of physical functioning (known as performance status) and good major organ (liver, kidney, heart, etc.) function. In addition, some trials require that participants be off treatment for a specified length of time before participating in the trial. Other trials, like post-surgery trials, may require participants to enroll in the trial within a certain amount of time after surgery. 

It’s important to talk to your healthcare team about your goals moving forward so that you can seek out trials that meet your needs and your situation. Download our “Three Steps to Navigate Clinical Trials” to help start the conversation.  

What is the difference between genetic testing and biomarker testing? Why are they important? 

All cancers, including cancers of the pancreas, begin with a mutation in the DNA of one cell causing the cell to grow and divide unchecked. Sometimes, the mutated DNA is passed from generation to generation; these mutations may lead to hereditary pancreatic cancer. Genetic testing is done to identify inherited mutations.

Mutations also may be acquired during a person’s lifetime (known as somatic mutations). Most cancers happen because of somatic mutations, caused by exposure to cancer causing agents that people may encounter in their environment, or from random errors that occur during normal cell growth and division. Therefore, these mutations can spontaneously occur in most cells in the body, including in the pancreas. These are known as tumor-specific mutations. Tumor-specific mutations contribute to the growth and survival of cancer cells. Biomarker testing of a tumor, also referred to as molecular profiling, identifies these mutations.

The goal in identifying specific mutations – both inherited and somatic – is to find a treatment that targets the mutation leading to the cancer, an approach known as precision medicine. Research in this area is ongoing with many clinical trials focused on finding and testing potential targeted treatments. PanCAN strongly recommends that all pancreatic cancer patients get genetic testing for inherited mutations as soon as possible after diagnosis and biomarker testing of their tumor tissue to help determine the best treatment options.

What types of clinical trials are available – are they all focused on new treatments or drugs?

In addition to new treatments, clinical trials study other ways to improve quality of life for patients with pancreatic cancer. Types of clinical trials include:

• Maintenance trials look for ways to prevent cancer from coming back (recurrence) in patients who were successfully treated.
• Diagnostic trials look for better tests or procedures for diagnosing cancer.
• Screening or surveillance trials test for the best way to detect cancer in a large population.
• Supportive care trials look for different ways to improve comfort and quality of life for individuals with cancer.
• Prevention trials look for ways to prevent cancer in healthy people. These trials are not common in pancreatic cancer.

Are clinical trials a last hope for when all standard treatment has failed?

Not at all. PanCAN recommends that patients consider clinical trials each time they need to make a treatment decision, including at diagnosis, for many reasons. Patients in clinical trials receive high quality care and are closely monitored by a study team. They are treated by experts in the pancreatic cancer field who are using leading-edge technology. Clinical trials also contribute to research to help advance new treatments. We want to empower patients to talk with their healthcare team about clinical trials and to get as much information as possible on all their options. PanCAN Patient Services is ready to help!