George P. Kim, MD: Diagnosing Patients With Pancreatic Cancer at an Earlier Stage

What can be done to help diagnose patients like Larry at an earlier stage?

This is an area where we have not done very well, and a lot of work has to be performed, and funding has to be provided. This patient presented with diabetes. Many patients with pancreatic cancer will present with diabetes. The problem is, as people get older, as baby-boomers get older, they will also encounter diabetes. The majority of them will not have pancreas cancer as the cause of their diabetes, but a percentage of these folks will have pancreas cancer underlying non-insulin dependent diabetes. The Holy Grail is to figure out who those people are. We tried to do a lot of proteomic analyses, and, unfortunately we just came up short. We are trying to use tumor markers, but we’ve come up short. But this is very clearly an area where a lot of work needs to be done. The majority of patients with pancreas cancer present with metastatic disease.

Metastatic Pancreatic Cancer: Case 1

Larry D, a 62-year-old, presented to his primary care physician with persistent pain in his epigastric region, which persists throughout the night. Within the past 2 years, he has developed diabetes and experienced considerable weight loss with signs of depression.

• During his visit, jaundice was observed along with periumbilical subcutaneous metastases.
• Testing revealed an elevated CA19-9 level (2293 U/ml).
• CT scan showed a large mass on the head of the pancreas, and a subsequent biopsy showed the mass to be adenocarcinoma. Liver and local lymph note metastases were identified.

Larry went on to receive the combination of nab-paclitaxel and gemcitabine as frontline therapy for 5 months:

• Upon progression, Larry was switched to the combination of liposomal irinotecan, fluorouracil, and folinic acid. Treatment failure occurred after 2.5 months.
• Larry received FOLFOX as a third-line treatment.