Two cancer drugs keep rare pancreatic tumors in check

9:00 AM, Feb 11, 2011   |    comments
Steve Jobs as seen in an Oct. 2010 news conference (AP)
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Two new drugs offer promise in treating the rare type of pancreatic tumor afflicting a small number of Americans - including Apple CEO Steve Jobs.

The drugs are the first in decades to improve outcomes for patients with pancreatic neuroendocrine tumors, a cancer of the hormone-producing cells of the pancreas that's diagnosed in about 550 Americans a year.

Jobs, who has been grappling with this type of tumor since 2003, last month announced he would be taking his third medical leave. Neuroendocrine tumors tend to grow far more slowly than most pancreatic cancers, which can kill within months of diagnosis.

Neither pill cures cancer.

But both Sutent, made by Pfizer, and Afinitor, made by Novartis, double the amount of time that cancers remain in check, compared with placebos, according to two studies in today's New England Journal of Medicine.

That's significant, because patients with advanced disease live a median of only about two years, says James Yao, lead author of the Afinitor study.

The only known drug for this cancer, approved decades ago, is very toxic and doesn't work very well; many doctors don't even try it, says Yao of Houston's M.D. Anderson Cancer Center.

"This is very good news for patients," he says. "It's very encouraging to have two drugs come along at the same time."

Both drugs, already on the market for kidney cancer, controlled tumors for about 11 months. Patients taking placebos saw their tumors begin growing again in 4½ to 5½ months, according to the studies, paid for by the drugs' manufacturers.

Still, the two drugs did cause some serious side effects. Sutent increased the risk of high blood pressure and a loss of infection-fighting blood cells. Afinitor increased the risk of anemia, diarrhea, mouth sores and high blood sugar, the studies say.

Doctors don't know how long patients can live on the drugs, Yao says. The Afinitor trial, involving 410 patients from 18 countries, hasn't gone on long enough to tell, he says.

The Sutent study, with 171 patients from 11 countries, ended early because Sutent patients were doing so much better than those on placebos that an ethics committee decided to offer the drug to everyone. By that time, 10% of the Sutent patients had died, compared with 25% of those on placebo, the study says.

The new drugs are a big step forward for patients, who haven't had many options until now, says Richard Goldberg, a professor at the University of North Carolina-Chapel Hill and an expert on neuroendocrine tumors.

The study results offer patients hope that other new drugs might work in this disease, as well, Goldberg says, or that patients might do even better if they combine them.

But the findings leave many questions unanswered, write researchers Robert Jensen and Gianfranco Delle Fave in an accompanying editorial. For example, since the drugs appear to stabilize the disease rather than cure it, will patients have to take the drugs indefinitely? If so, will patients, who are often symptom-free, even with advanced disease, agree to accept side effects for years?



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