In this study, researchers performed the first comprehensive analysis of the current landscape of clinical trials for pancreatic cancer to better understand the near future of potential new therapies.
The vast scope of studies currently underway around the world sometimes makes it difficult to determine the current state of research in a particular field. Researchers based out of Cleveland, Ohio, and Charlotte, North Carolina, found this to be especially true when it comes to pancreatic cancer research. Published in Oncotarget, these researchers authored a paper meticulously detailing the current state of research in pancreatic ductal adenocarcinoma (PDAC).
Pancreatic Cancer Research Funding
The National Institutes of Health (NIH) allocates somewhere around $6 billion annually to fund cancer research and, of these funds, more than $100 million is dedicated solely to the study of pancreatic cancer. Other agency, organization, and industry sponsors have contributed millions of additional dollars in funding to PDAC research over the years.
Given these figures, one would expect not only a heap of research studies but also numerous treatment options and advancements in the disease. However, authors of this paper dutifully sorted through the data to uncover a disparate reality and, more positively, opportunities for new therapies and approaches. The authors carefully divided their analysis by current phase of the study, clinical stage of the study population, type of intervention under investigation, and the biological mechanism targeted.
“Unlike many other common cancers, there have been no new paradigm-changing therapies in the past 40 years beyond multi-agent chemotherapy. In this study, we perform the first comprehensive analysis of the current clinical trial landscape in pancreatic cancer to better understand the pipeline of new therapies.”
The Study Results
Despite a plethora of funding over the last 23 years, progress in PDAC has consisted of “incremental advances” with chemotherapy and today, targeted drugs and immunotherapies still “do not consistently impact PDAC patients.” Using the database archived by the NIH, researchers in this study concluded that there were a total of 430 therapeutic interventional trials active and registered – with 590 interventions in testing (as of May 18, 2019). The distribution of phases among these PDAC trials are:
- 31% in phase I
- 22% in phase I/II
- 38% in phase II
- 1% in phase II/III
- 8% in phase III
This uneven distribution clearly illustrates a lapse in studies allocated to test interventions focussing on patients in phase II/III and phase III of PDAC. The researchers found that only 14 trials are testing new interventions in these later stages. Of the 430 total active trials, they found that the 590 different therapeutic interventions being investigated are among a wide range of categories, including:
- 52% new drugs or pharmacologic agents
- 14% conventional therapies with new drug combinations or methods
- 8% FDA-approved therapies already in use for other cancer types
- 9% radiation-based interventions
- 4% gene therapy
- 6% cellular therapy
- 3% nutraceutical therapy
- 2% technique- or procedure-focused interventions
- 2% pain management- or quality of life-focused therapy
The authors note that many of the trials using interventions listed above are similar or even identical, which reflects potential redundancy and duplication of work. Among these therapeutic interventions being investigated, 31% of the studies were considered to be using conventional or existing drug therapies. Of the new drug interventions in trial, the researchers collected the mechanisms being targeted and categorized them below:
- Immune system: 37%
- DNA and cell cycle: 30%
- Cell signaling: 13%
- Metabolism: 7%
- Angiogenesis: 3%
- Hormone receptors: 3%
- Apoptosis specific: 3%
- Target symptoms: 2%
- Metastasis/Invasion: 1%
- Unknown mechanism: < 1%
Conclusion
The authors stress that by continuing to study PDAC while using the same familiar methods as previous decades, historical success rates show that results will continue to be disappointing for patients in the upcoming years. They also point out that their analysis shows current research focuses on therapeutic studies – not early detection.
“It is possible that the greatest advance in the future could be the discovery of an effective PDAC biomarker.”
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Click here to read the full scientific paper, published in Oncotarget.
