Pushing the boundaries of pancreatic cancer treatment

Pancreatic cancer is one of the most aggressive and challenging malignancies, with a prognosis that remains devastatingly poor. Our organisation is dedicated to funding innovative research that offers new treatment options to patients.

Introducing the STEREOPAC-trial

This trial is testing a novel treatment strategy for patients with pancreatic cancer, more specifically for patients with borderline resectable pancreatic adenocarcinoma.

Meet the investigator: Prof. Dr. Christelle Bouchart

To get a deeper understanding of this complex trial, we sat down with Prof. Dr. Christelle Bouchart (ULB, Department of Radiation-Oncology at H.U.B. Institut Jules Bordet). As the Investigator and member of the steering committee of the STEREOPAC-trial, she is at the forefront of designing and implementing this novel strategy.

1.

The STEREOPAC trial is an effort to improve outcomes for patients with pancreatic cancer. Could you give us a brief overview of the trial and its main goal?

"We plan to enroll 256 patients with borderline resectable pancreatic cancer who will receive what we call neoadjuvant treatment, meaning treatment before surgery. The current standard is to start with chemotherapy. If the disease doesn't progress, patients are then randomizsed into two arms: one continues with chemotherapy alone, and the other adds a targeted treatment—isotoxic high-dose stereotactic radiation therapy—to the chemotherapy. We’re doing all of this before the surgery to see if we can significantly improve long-term outcomes for the patients."

2.

Can you explain what "borderline resectable" pancreatic cancer means and why it's so difficult to treat?

“Borderline resectable means the disease is still localised and there are no distant metastases. The issue is that the tumour is in contact with the major abdominal vessels. This makes the surgery much more difficult and complicates our ability to achieve an R0 resection, or a surgery with clear margins, where no tumour cells are left behind. It's really complex because there’s no real consensus on the best approach here. We know that immediate surgery isn't the best option, so we are investigating if adding radiation therapy can be a crucial step.”

3.

So, the trial is testing a new strategy. How is this different from what doctors usually use?

"It's certainly different. Doctors don't typically propose this kind of intensive radiation. Traditionally, they used conventional radio-chemotherapy, but those were long treatments, and unfortunately, the clinical trials failed. We are investigating a new option: we try, in just five sessions, to give a highly focused, almost ablative dose of radiation. This is radiation therapy with a curative aim: we are trying to eliminate the tumour locally."

4.

For a patient who joins the study, what does the treatment journey look like? How long does this take, and what are the possible advantages of participating?

"We try to stick as closely as possible to the classical pathway to keep the burden light for the patient. The only differences are a questionnaire to assess their quality of life, and optional blood samples. The radiation component involves just five treatment sessions, and it’s entirely ambulatory, so, there is no hospitalisation. The total pathway is kept short, adding perhaps only two weeks before surgery. The clear advantage is the close follow-up you receive in a clinical study. Dedicated teams and coordinators are there for you every step of the way."

5.

What is the one message of urgency you want to share with the public about pancreatic cancer research right now?

"At least two things stand out. First, we must improve public awareness. People must know this research exists. We are working on it and things are moving. Second, and vitally important, is raising awareness among funders. Pancreatic cancer carries a huge and growing burden, yet securing funding for research is extremely difficult. We have to perform research to improve things for the patients, but to do that, we absolutely need financial support."

6.

This is a trial running across many hospitals in Belgium. How crucial is the collaboration for its success?

"Collaboration is absolutely crucial. Because pancreatic cancer is not as frequent as breast or prostate cancer, patient recruitment is our main issue. While we have many hospitals in Belgium, we can't afford the cost and complexity of opening the study in every single one. We need to work in strong networks to ensure every eligible patient is aware of the study and has the chance to participate and help us move the field forward."

7.

What inspires you to tackle one of the toughest cancers, and what gives you the energy to keep pushing?

"Its sheer complexity, and the fact that there is so much potential for change. It is a challenging disease, but it’s critical that we study it to understand how it works. We know there are different tumour subtypes, and we need to identify them so we can move toward more personalised treatments. What keeps me going is tackling the core problem: the tumour’s resistance to all current treatments. When we introduce new strategies and see them work, even in a subset of patients, well, it’s incredibly rewarding. It shows us that things are moving, even if it is slow."