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25 april 2008: Bron: BSD

Hyperthermie naast chemo en bestraling bij alvleesklierkanker geeft beter effect. Dit laten de resultaten zien van drie onafhankelijk van elkaar uitgevoerde studies.

In de Veronastudie bestond groep A uit 25 patienten die chemotherapie en hyperthermie plus bestraling (of alleen chemotherapie in het geval van 5 patienten met uitzaaiingen op afstand waarvoor bestraling was uitgesloten).

Groep B bestond uit 21 patienten (geen van hen had uitzaaiingen) die chemotherapie en bestraling zonder hyperthermie kregen. Na 24 maanden, nog 9 patienten (36%) waren in leven in groep A, vergeleken met 4 patienten (19%) die nog in leven waren in groep B. Chemotherapie werd goed getolereerd in beide groepen, met niet meer toxiciteit in groep A. Dus ondanks dat in groep A 5 patienten zaten met al uitgezaaide alvleesklierkanker waren daar bijna twee keer zoveel patienten nog in leven na twee jaar dan in de controlegroep. Het is een kleine groep maar wel opvallend positief verhoudingsgewijs. Bijna verdubbeling.

In de studie in Munchen waarin 22 alvleesklierkankerpatienten met vergevorderde alvleesklierkanker worden geen getallen genoemd maar volgens BSD leiden de resultaten ertoe dat er een fase III studie wordt opgezet. In een studie in Japan werd een hyperthermie  studiegroep historisch vergeleken en ook daaruit kwamen goede resultaten naar voren. Patienten in de studiegroep ontvingen gemcitabine plus hyperthermie therapie. De ziektecontrole was 57.1% voor de hyperthermie studiegroep en 14.3% voor patienten behandeld met gemcitabine alleen (historische controle). De 1-jaars overleving voor de controle groep was 30%, vergeleken met 49% voor de hyperthermiegroep. De studie concludeert dat deze combinatie therapie potentie heeft om als eerste lijns behandeling te worden ingezet voor patienten met vergevorderde alvleesklierkanker (patienten met uitzaaiingen)  

Multiple Studies Demonstrate the Use of Hyperthermia Therapy in Treating Pancreatic Cancer


The Verona Study

Fifty-seven pancreatic cancer patients were accrued between 2000 and 2006 in a study conducted by the Department of Radiotherapy of the University of Verona in Italy. Eleven patients were lost at follow up, leaving 46 evaluable patients. Patients were divided into groups A and B. Group A consisted of 25 patients who received chemotherapy and hyperthermia plus radiation (or chemotherapy alone in the case of 5 patients affected by distant metastases wherein radiation was excluded). Group B consisted of 21 patients (none of whom had metastatic disease) who received chemotherapy and radiation without hyperthermia. At 24 months, 9 patients (36%) were alive in group A, compared to 4 patients (19%) who were alive in group B. Chemotherapy was well tolerated in both groups, with no more toxicity in group A. The study concluded that hyperthermia is a promising therapeutic modality in the treatment of locally advanced pancreatic cancer, that it does not increase acute or late toxicity of combined treatment, and that it seems to enhance the efficacy of both chemotherapy plus radiation and chemotherapy alone with metastatic disease, as 5 patients with distant metastases were included in group A.

The Munich Study

Researchers associated with the University of Munich, Germany, reported results after treating 22 pancreatic patients in a very difficult stage of the disease (19 metastatic and 3 with locally advanced pancreatic cancer). Using a combination of gemcitabine plus cisplatin as their chemotherapy drugs combined with hyperthermia therapy, the treatment reached their target for improvement, and based on these data a randomized first-line phase III clinical trial has been initiated. A number of cancer research institutions with BSD-2000 systems have agreed to participate in this government sponsored phase III study.

Kyoto Studies

This study conducted at the Kyoto Prefectural University of Medicine in Japan was a retrospective analysis of patients with advanced inoperable pancreatic cancer who were treated with the sequential combination of chemotherapy (gemcitabine) plus hyperthermia therapy between 2004 and 2007. Patients treated with gemcitabine alone between December 2003 and April 2005 were allocated as a control group (historical control). Patients in the experimental group received gemcitabine plus hyperthermia therapy. The disease control rate was 57.1% for the experimental group and 14.3% for patients treated with gemcitabine alone (historical control). The one-year overall survival for the control group was 30%, compared to 49% for the experimental group that received hyperthermia therapy. The study concluded that this combination therapy could be a potential first-line treatment for patients with advanced pancreatic cancer.

A second Kyoto study was also presented, designed to identify some of the mechanisms whereby hyperthermia therapy works in combination with chemotherapy to improve results in killing cancer cells. When cells are attacked by chemotherapy they release a protective protein complex called NF-kB, and this protein induces tumors to become resistant to chemotherapy. To explore the effects of hyperthermia therapy in the formation of NF-kB, the group treated cultured human pancreatic cancer cells with gemcitabine, inducing the formation of NF-kB. They discovered that hyperthermia inhibited the chemotherapy-induced activation of NF-kB, and thus enhanced cancer cell death through gemcitabine. The study concluded that hyperthermia inhibited gemcitabine-induced activation of NF-kB and decreased the expression of anti-apoptosis proteins, resulting in the enhancement of the cytotoxicity of gemcitabine.
 

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