Multidisciplinary Therapy for Pancreatic Cancer

Abstract

Multidisciplinary therapy for pancreatic cancer, including surgery, chemotherapy and radiotherapy, has been performed. However, the prognosis remains poor. Extended pancreatectomy frequently impairs the patient's quality of life due to malnutrition. We performed lymphatic and neural tissue dissection around the superior mesenteric artery, partially preserving the nerve plexus, for pancreatic cancer. This procedure decreased the frequency of diarrhea and prevented malnutrition after surgery. Intraoperative radiotherapy (IOR) improved the survival rate in patinets with curative resection. We performed adoptive immunotherapy (AIT) using lymphokine-activated killer (LAK) cells or cytotoxic T-cells (CTLs) in patients with unresectable pancreatic cancer. AIT using CTLs was more effective than AIT using LAK cells. This result suggests the efficacy of specific immunotherapy for pancreatic cancer. Recently, it has been reported that MUC1 specific CTL, which recognize the mucin core protein MUC1, killed pancreatic tumor cells in an MHC-unrestricted fashion. We also demonstrated that pancreatic tumor cells expressed MUC1 while normal pancreatic cells did not. We treated three patients with unresectable pancreatic cancer by AIT using MUC1 specific CTLs. One patient who received a total of 3×10¹⁰ MUC1 specific CTLs showed neither tumor progression nor increases in levels of tumor markers, such as CA19-9, CA125 and Span-1, during therapy. These results suggest that AIT using MUC1 specific CTLs may be a useful therapy for patients with pancreatic cancer.