Pancreatic Cancer

Pancreatic Cancer

Pancreatic cancer can develop from two kinds of cells in the pancreas:
exocrine cells and neuroendocrine cells, such as islet cells. The exocrine type is more common and is usually found at an advanced stage. Pancreatic neuroendocrine tumors (islet cell tumors) are less common but have a better prognosis. – National Cancer Institute.


General Information About Pancreatic Cancer

  • Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.
  • Certain factors affect prognosis (chance of recovery) and treatment options.
    Read the full article on the National Cancer Institute website.

Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)

  • Pancreatic neuroendocrine tumors form in hormone-making cells (islet cells) of the pancreas.
  • Certain factors affect prognosis (chance of recovery) and treatment options.
    Read the full article on the National Cancer Institute website.

Marisa is 20-year Stage IV Pancreatic Cancer Survivor

Read full story on LetsWinPancreaticCancer website

See Terminal Cancer Patient Says Vegan Diet Is Reason She’s Still Alive Five Years Later

More long-term survivor stories below.


Additional Treatment Options for Pancreatic Cancer

Caution:  Always seek medical advice before you undertake any treatment.

New

New pancreatic cancer treatment may add years to the lives of those facing death

Phase III Clinical Trials are currently underway to test a new chemo delivery system for use in pancreatic cancer treatment.

Here’s an excerpt from an online report in the Miami Herald:
Coined RenovoCath — Latin for revive, restore and repair — the new device is a sleek catheter that’s inserted through an artery in the groin, into the pancreas and through a tumor. Then, two silicone balloons on either end of the device inflate, trapping the sponge-like mass and delivering a high-dose of an existing chemotherapy called gemcitabine directly into it.

The new technique minimizes drug leakage into the rest of the body, which means little to no side effects…

EARLY TRIAL RESULTS ARE “UNHEARD OF”
Phase 1 and Phase 2 trials, which began in 2015, show the new technique nearly doubled the median survival rate of the traditional treatment from about 14 months to 28 months. The results were published in the Journal of Pancreatic Cancer in 2017.

*****

The Study Concluded: The results demonstrate feasibility of localized and selective intra-arterial chemotherapy delivery to the pancreas utilizing the RenovoCath. With gemcitabine, this approach is safe, with the sole prerequisite of perioperative antibiotics for patients with prior biliary drainage/stent. Efficacy results suggest a survival benefit when compared to historical control, especially in patients with prior radiation therapy.


 

1. Non-conventional treatments

Gonzalez Protocol
A successful alternative therapy that is being studied as a treatment for pancreatic cancer. It includes a special diet, nutritional supplements, pancreatic enzymes, and coffee enema’s. The Gonzalez Protocol is available online at The Nicholas Gonzalez Foundation website.

Pancreatic enzymes
Pancreatic enzymes help break down fats, proteins and carbohydrates. Pancreatic insufficiency is the inability of the pancreas to secrete the enzymes needed for digestion. Having an insufficient amount of pancreatic enzymes is very common among people with pancreatic cancer.

See Gonzalez Protocol page
See Case Reports of long-term (including 15-year) survivors
See Pancreatic Enzymes page

You can buy Pancreatic Enzymes in a health shop or here

Metabolic Treatment (CISA protocol)
A metabolic treatment based on the nutri-pharmacological blockade of aerobic glycolysis (Warburg effect), and glutaminolysis.

(Note: The studies below were carried out in the University of Buenos Aires, Argentina and the treatment doesn’t yet appear to be available anywhere else).

This 2018 research article says: Twenty two patients were evaluated -9 women and 13 men, mean age 58, 5 years (30-75) – out of which 11 had not undergone any previous treatment (naïve), and 13 presented metastasis at the time of diagnosis. Our Metabolic Therapy of pancreatic cancer has shown an overall one-year survival rate of 72% for the group of patients included in the CISA protocol. Remarkably, patients without metastasis at the time of diagnosis had a one-year survival rate of 100%, a two year survival rate of 100%, and an impressive three-year survival rate of 55.6%. The magnitude of the effects observed suggests that the treatment program allows for a substantial increase in the one-year survival rate. It should be considered that for the treated group as a whole overall survival reached an average of 26 months, a significantly longer period than that reported worldwide, which stands at 4,5 (3-6) months. 

This 2019 study of 27 patients from the same institution found:

Results: Following up on a previous Randomized Controlled Clinical Trial on the metabolic therapy of exocrine pancreatic cancer, these authors have found that the one-Year Survival rate (YS) of our study (N=27) has remained above 70%, while overall survival (OS) increased to 27,82 (4-76) months. The YS of the subset of patients with no metastasis at the time of diagnosis stayed at 100%. It has become apparent that OS of the treated group has come to be 5.6 times the OS reported worldwide, which stands at 4,5 (3-6) months.

Conclusion: The magnitude of the observed effects suggests that the metabolic therapy of pancreatic cancer allows for a substantial increase in both parameters of survival, particularly in patients with no metastatic lesions at T0.

SEF Chemo: New treatment with no side-effects?

Berkeley Institute International are treating patients with SEF Chemo – a new treatment that is reportedly side-effects free. Here is some info from its website:

For decades, doctors and researchers have been trying to figure a way—without success—to deliver chemo agents directly to cancerous cells without harming healthy tissue. Dr. Matsumura, and his team of dedicated scientists at the ALIN Foundation, tried a different approach: protect the body by using antidotes to neutralize the damage to normal cells and negate the toxic side effects commonly associated with chemotherapy. Dr. Matsumura developed a novel method in their use that produced a powerful new therapy without the dosage-limiting side effects of cancer drugs. While normal cells are protected, cancer drugs can be employed in higher doses to eradicate the dividing cancer cells not protected by the antidote.
See SEF Chemo page


2. Anti-Cancer Drugs

Ukrain
Ukrain is a drug based on the extract of the plant Chelidonium majus L (greater chelandine). It is claimed to be effective against a range of cancers.
Available from a pharmacy in Vienna, Austria.

The Ukrainian Anti Cancer Institute has this on it’s website:
Incredible results of the treatment of pancreatic cancer were achieved during clinical research studies with NSC-631570 (UKRAIN) carried out by Associate Professor Gansauge and Professor Hans Beger in Germany. They showed that 30% of pancreatic cancer patients lived more than 5 years after treatment with NSC 631570, while medical statistics show that after conventional treatment methods patients with the same diagnosis live only 4-6 months and only 2.2% of them reach the 5-year-survival rate.

This study concluded: We could show that in unresectable advanced pancreatic cancer, NSC-631570 [ukrain] alone and in combination with gemcitabine nearly doubled the median survival times in patients suffering from advanced pancreatic cancer.

This study says its results suggest that Ukrain can exert some effects on pancreatic tumor progression.

“Ukrain is capable of improving the general conditions and prolonging the lives of terminal cancer patients by boosting their immune systems and inhibiting tumour growth.”
Douglas Brodie, M.D.

See UKRAIN page

Drug combination – Metformin and Aspirin
Combination of metformin with aspirin significantly inhibit the growth of pancreatic cancer cells, according to this 2017 study

Metformin is a medicine used to treat type 2 diabetes.
Aspirin is an everyday painkiller for aches and pains such as headache, toothache and period pain.

Drug combination – Trametinib plus Hydroxychloroquine
Trametinib (trade name Mekinist) is a cancer drug. 
Hydroxychloroquine is an anti-rheumatic drug.

This 2019 study found: treatment of a PDA [Pancreatic ductal adenocarcinoma] patient with the combination of trametinib plus hydroxychloroquine resulted in a partial, but nonetheless striking disease response. These data suggest that this combination therapy may represent a novel strategy to target RAS-driven cancers.

Olaparib (Lynparza)
A drug used to treat adults with certain types of prostate cancer, pancreatic cancer, or breast cancer. Lynparza blocks an enzyme involved in many cell functions, including the repair of DNA damage. Blocking this enzyme may help keep cancer cells from repairing their damaged DNA, causing them to die. Lynparza is a type of poly (ADP-ribose) polymerase inhibitor. Also called AZD2281, olaparib, and PARP inhibitor AZD2281. – National Cancer Institute.

The Pancreatic Cancer Action Network website says: The Food and Drug Administration (FDA) recently approved the treatment Lynparza® (olaparib) for use in a group of pancreatic cancer patients: those with stage IV pancreatic adenocarcinoma who have germline (inherited) BRCA mutations and whose tumors did not progress after treatment with a first-line platinum-based chemotherapy.
More info at lynparza.com


3. Off-label Drugs

When a doctor prescribes a drug to treat one condition with a drug that is approved to treat a different condition, it is said to be off-label use. It is a common practice.

Care Oncology Clinics
The Care Oncology Clinic is a London based cancer clinic offering metabolic and immune stimulating medical treatment using existing licensed safe medicines that aim to fight patients’ disease while preserving an acceptable quality of life. Here is the Pancreatic Cancer page on the clinic’s website.

Metformin (anti diabetes drug)
In human cancer cells of different origin, metformin has been shown to induce cell cycle arrest, growth inhibition and apoptosis…As demonstrated in a number of recent studies,
metformin is able to selectively target Cancer Stem Cells in different types of human cancers, including breast, pancreatic and thyroid cancer. In particular, metformin has been shown to selectively kill Cancer Stem Cells in four genetically different types of human breast cancer, according to this study

Diabetes drug slows down growth of pancreatic cancer
Source: The Indian Express

Metformin — a commonly used generic medication for type 2 diabetes — decreases the inflammation and fibrosis characteristic of the most common form of pancreatic cancer, the researchers said.

Researchers are likely to have uncovered a novel mechanism behind the ability of the common diabetes drug metformin to inhibit the progression of pancreatic cancer.

Diabetic patients taking metformin have a reduced risk of developing pancreatic cancer. Among patients who develop the tumour, those taking the drug may have a reduced risk of death, the study revealed.

See Metformin page

Statins
A group of drugs which act to reduce levels of cholesterol in the blood.

This study found: A total of 797 patients were assessed in the current study; of which 156 patients received statins and 641 did not receive statins. Using Kaplan–Meier survival estimates, patients who received statins seem to have better overall and progression-free survival compared to patients who did not.

This study found: In summary, this meta-analysis provided preliminary evidence that statin or metformin use may improve the survival time among pancreatic cancer patients. These two drugs have been prescribed for other purposes for many years but should be further investigated, both individually and in combination for therapeutic repurposing for pancreatic cancer patient survival.

This study notes: The efficacy of statins as anticancer agents has been evaluated both in monotherapy and in combination therapy with currently used chemotherapeutic drugs. To a varying degree of success, studies have shown the potential mortality benefits of statin consumption in patients with different types of cancers, which include esophageal, breast, lung, liver, pancreatic, endometrial, and colorectal cancer.

Beta Blockers (BBs)
Beta blockers are widely prescribed for angina, heart failure and some heart rhythm disorders, and to control blood pressure.

This Review found: Several studies indicate that BBs, particularly the nonselective ones such as propranolol, may inhibit the damage induced by catecholamines stimulation of the adrenoreceptors in pancreatic cancer patients…Authors concluded that BBs may inhibit progression of pancreatic adenocarcinoma and may be a complement for current therapies in order to prevent cell damage in pancreatic cancer patients…the use of BBs was associated with a reduction of cancer-specific mortality rate.

This review says: To investigate the association between administration of beta-blocker and cancer prognosis, we performed a meta-analysis…Thirty-six studies involving 319,006 patients were included…Among the cancer types, positive associations between beta-blocker use and cancer prognosis were observed in breast cancer, pancreatic cancer, and melanoma…

This study of 457 patients who were taking beta-blockers at the time of diagnosis found non-selective β-blocker use in patients with resected Pancreatic ductal adenocarcinoma was associated with longer overall survival.

This study of 2,394 pancreatic cancer patients found: In conclusion, our results support the hypothesis that inhibition of β-adrenergic receptor signaling pathways may impede progression of pancreatic adenocarcinoma and suggest that β-blockers may complement existing treatment modalities for these patients. 

Itraconazole
 Itraconazole is a prescription medication used to treat fungal infections of the toenails and fingernails

According to Repurposing Drugs in Oncology (ReDO), Clinical trials have shown that patients with prostate, lung, and basal cell carcinoma have benefited from treatment with itraconazole, and there are additional reports of activity in leukaemia, ovarian, breast, and pancreatic cancers…There is evidence that that it may also be applicable to a number of other cancers, including glioblastoma, breast, pancreatic, and ovarian. 

Jane McLelland – How to starve cancer
Jane McLelland was first diagnosed with cervical cancer and then  developed leukemia after chemotherapy treatment and was deemed Stage 4, Grade 4 in 1999. She beat her cancer by using a mixture of diet, exercise, supplements, herbs and off-label drugs to block the metabolic pathways that fuelled her cancer. Many others are now following her example. The protocols she used can be found in her book How to Starve Cancer.
Learn more at her website howtostarvecancer.com and Facebook page


4. GP administered treatments

Intravenous Vitamin C
In Dr Linus Pauling (winner of 2 Nobel Prizes) and Dr Ewan Cameron’s paper “Ascorbic Acid and Cancer: A Review” – published with Brian Leibovitz in Cancer Research in March 1979, they state:
Our own clinical studies, discussed in several publications, strongly indicate that supplemental ascorbate not only increases well-being but also produces a statistically significant increase in the survival times of advanced cancer patients. Present evidence suggests to us that supplemental ascorbate can offer some degree of benefit to all advanced cancer patients and quite remarkable benefit to a fortunate few and that it has even greater potential value in the supportive treatment of earlier and more favorable patients…

This study says: In small phase I clinical studies, intravenously administered ascorbate was safe. Survival was doubled in patients with metastatic pancreatic cancer

This study says: Recent studies have demonstrated that high-dose, intravenous pharmacological ascorbate (ascorbic acid, vitamin C) induces cytotoxicity and oxidative stress selectively in pancreatic cancer cells vs. normal cells, suggesting a promising new role of ascorbate as a therapeutic agent.

This study says: Here, we report the use of PAA [Pancreatic ductal adenocarcinoma ] in a patient with poorly differentiated stage IV PDA as an exclusive chemotherapeutic regimen. The patient survived nearly 4 years after diagnosis, with PAA as his sole treatment, and he achieved objective regression of his disease.

Eicosapentaenoic acid
Patients with pancreas cancer treated with supplements of fish oil capsules (EPA and docosahexaenoic acid) showed body weight gain accompanied by significant reduction in acute-phase protein production and by stabilization of resting energy expenditure. While nutritional supplement alone did not attenuate the development of weight loss in cachectic patients, nutritional supplement enriched with EPA resulted in significant weight gain. A randomized controlled study was carried out to investigate the effects of dietary EPA plus vitamin E on the immune systems and survival of well-nourished and of malnourished cancer patients… EPA prolonged the survival of both groups of patients. 

Vitamin C and Doxycycline
Doxycycline is an antibiotic.
This study found that antibiotics, such as Doxycycline, could eradicate Cancer Stem Cells in multiple cancer types. These include: DCIS, breast (ER(+) and ER(-)), ovarian, prostate, lung, and pancreatic carcinomas, as well as melanoma and glioblastoma. The study authors propose the combined use of Doxycycline and Vitamin C as a new strategy for eradicating CSCs.

See Vitamin C therapy page


5. Dietary therapies

Radically change your Diet

Radical Remission: Surviving Cancer Against All Odds
Kelly Turner, PhD, a researcher who specializes in integrative oncology, studied one hundred cancer survivors and analysed over one thousand cases of people who experienced a “radical remission” from “incurable” cancer. She found that radically changing their diet was one of 10 factors common among all of them. Other factors were: being physically active, increasing positive emotions…See more at www.RadicalRemission.com

Adopt a plant-based diet
According to the Physicians Committee for Responsible Medicine (an organisation of 30,000 GPs in the US), a plant-based diet is an important way to improve survival in people with cancer.

A plant-based diet consists of exclusively plant foods, including fruit, vegetables, grains, and legumes, and avoids meat, dairy, and eggs.

The American Institute for Cancer Research website advises:
Strive for a plant-based diet as much as possible. This will take time as your body heals from treatment. Begin by adding easy-to-digest plant-based foods like oats, barley, bananas, applesauce, pears, peaches, turnips, sweet potatoes, carrots and asparagus. Over time, increase your intake of different plant-based foods and test your tolerance.   
See Radically Change Your Diet

Ketogenic Diet
According to keto diet proponents, normal cells can burn ketones to stay alive, cancer cells cannot – they use both glucose and glutamine for fuel.

Calorie-restricted / ketogenic diets can transition normal cells to use ketones for fuel while also keeping them hungry for glucose – this will force normal cells to compete with cancer cells for glucose, thus depriving cancer cells of their fuel.
This is based on the understanding that cancer is a Metabolic Disease

This study (including 4 pancreatic patients) says: We performed a case series study of a new ketogenic diet regimen in patients with different types of stage IV cancer. Carbohydrates were restricted to 10 g/day during week one, 20 g/day from week two for three months, and 30 g/day thereafter. A total of 55 patients participated in the study, and data from 37 patients administered the ketogenic diet for three months were analyzed. No severe adverse events associated with the diet were observed. Total ketone bodies increased significantly, and both fasting blood sugar and insulin levels were suppressed significantly for three months after completion of the study. Five patients showed a partial response on Positron emission tomography-computed tomography (PET-CT) at three months. Three and seven patients showed complete and partial responses, respectively at one year. Median survival was 32.2 (maximum: 80.1) months, and the three-year survival rate was 44.5%…Our ketogenic diet regimen is considered to be a promising support therapy for patients with different types of advanced cancer.


6. Natural Plants

Cannabis (Cannabinoids)
Cannabis refers to a group of three plants with psychoactive properties, known as Cannabis sativa, Cannabis indica, and Cannabis ruderalis.

Cannabinoids may cause antitumor effects by various mechanisms, including induction of cell death, inhibition of cell growth, and inhibition of tumor angiogenesis invasion and metastasis. – National Cancer Institute.

Study (laboratory): Herein, we investigated the in vitro antitumor activity of CBs [cannabinoids] and the potential role of their receptors in human pancreatic cancer cells MIA PaCa‐2.Our results demonstrate that CBs produce a significant cytotoxic [anticancer] effect via a receptor‐independent mechanism. 

Study: In conclusion, results presented here show that cannabinoids exert a remarkable antitumoral effect on pancreatic cancer cells in vitro and in vivo due to their ability to selectively induce apoptosis [programmed cell death] of these cells via activation of the p8-ATF-4-TRB3 proapoptotic pathway. 

Study: Endogenous cannabinoids, synthetic or cannabis extracted from plants, can reduce tumor invasion and growth, induce tumor cell death, and inhibit tumor angiogenesis via cannabinoid receptor or receptor-independent pathways. Cannabinoid receptors appear to be highly expressed in pancreatic cancer compared with normal pancreatic tissue. CBD and THC appear to have antiproliferative and proapoptotic effects. CBD in a clinically relevant pancreatic cancer model improved survival outcomes when combined with gemcitabine. 

A study published in The American Journal of Cancer showed that cannabinoid administration induced apoptosis. They also reduced the growth of tumour cells, and inhibited the spreading of pancreatic tumour cells.

Rick Simpson Cannabis Oil 
RSO is a concentrated form of cannabis oil known to have medical benefits, particularly for cancer. RSO differs from a lot of other cannabis oils because it contains higher levels of THC.

Other therapeutic cannabis oils tend to contain a cannabinoid called cannabidiol (CBD) and little or no THC. You can find full information about RSO on Rick Simpson’s website.

See Man Treats Stage 4 Pancreatic Cancer Using Cannabis Oil

See Cannabinoids page

Chinese Herbal Medicine (CHM)
Chinese herbal medicine is part of a larger healing system called Traditional Chinese Medicine. Herbs are prescribed to restore energy balance to the opposing forces of energy – Yin and Yang – that run through invisible channels in the body.

This study says: Our study is the first nationwide study investigating the benefits of complementary CHM among patients with pancreatic cancer. This matched-cohort study was based on a database, RCIPD, which enrolled all the pancreatic cancer patients during the years 1997-2010 to compare the differences between 386 CHM users and 386  non-CHM users in Taiwan. We found that patients who used CHM for more than 90 days had lower mortality risk than those in the non-CHM group. Our study is in accordance with a previous study published by Tianjin Medical University Cancer Hospital, China. In that study, the hazard ratio of mortality risk was 0.419 and the median overall survival was 19 months for patients with TCM treatment versus 8 months for those without TCM treatment.

In summary, adjunctive Chinese herbal medicine may have benefits in reducing mortality rate in pancreatic cancer patients. Bai-hua-she-she-cao and Xiang-sha-liu-jun-zi-tang appeared to be the most commonly used single herb and Chinese herbal formula for the treatment of pancreatic cancer patients.

This study says: We retrospectively studied 107 pancreatic cancer patients between January 2009 and October 2013 in Tianjin Medical University Cancer Hospital.

We conclude, from this small retrospective study, that TCM [ traditional Chinese medicine] treatment was associated with a survival benefit in patients with pancreatic cancer. In addition, TCM in combination with WM [western medicine] would be a better optimal treatment for patients with pancreatic cancer to improve survival time. More importantly, we provide TCM practitioners with a proposal that heat-clearing, diuresis-promoting and detoxification TCM treatment may improve the efficacy of TCM in patients with pancreatic cancer.


7. Over-the-counter Supplements

Curcumin
Curcumin is the principal curcuminoid of turmeric.
It is available as a supplement.

Twenty-five patients were enrolled in this study, with 21 evaluable for response. The authors concluded: “our current study shows that oral curcumin is tolerated without toxicity at doses of 8 g/d for up to 18 months…Preclinical data suggest that curcumin has potent activity against pancreatic cancer, but higher levels of exposure need to be achieved.

This study says: In conclusion, results of the present study have demonstrated that curcumin has synergistic effects with either gemcitabine or docetaxel on PC cells. Combination of chemotherapeutic drugs with curcumin may be an alternative choice for the treatment of clinical PC patients.

This review says: Li et al were the first to report the anticancer effects of curcumin against pancreatic cancer cells. They demonstrated that curcumin can suppress tumor growth in pancreatic cancer cell lines.
Dhillon et al were the first to report a phase II clinical trial of the effects of curcumin against pancreatic cancer. Twenty-five patients, including 3 chemo-naive patients, were enrolled in this study. Of the 22 patients that could be evaluated for responses, one patient showed a stable disease course for over 18 mo and another patient showed a partial response in a liver metastasis (73% decrease in size), although this effects lasted for only 1 month. Furthermore, curcumin treatment was found to be safe in patients with pancreatic cancer, and no toxicity was associated with curcumin intake.

However, the poor bioavailability of curcumin has been the major challenge to its clinical application. This problem has now been solved by the development of highly bioavailable forms of curcumin (THERACURMIN®), which can induce higher plasma curcumin levels without increased toxicity.

Berberine
Berberine is a alkaloid extracted from a variety of herbs.
It is available as a supplement.

This study says: In conclusion, the present analysis provides in vitro evidence for the therapeutic utility of berberine for the treatment of pancreatic cancer. After twenty-four hours, berberine has shown preferential growth inhibitory effect on cancer cells compared to normal ones. In addition to apoptosis, other signalling pathways were triggered by berberine, which constitutes a comparative advantage regarding the multiplicity of apoptosis-resistance mechanisms of cancer cells.

This study says: A recent study reported that berberine efficiently suppresses cancer stem cells. In particular, the current results indicated that berberine had a greater apoptotic effect in PANC-1 cells than did gemcitabine, which is considered the standard treatment for pancreatic cancer.

Nimbolide (Neem Tree extract)
Nimbolide is a bioactive constituent of neem leaves.
Available as a supplement.

This study found: This study assessed the anticancer properties of nimbolide against pancreatic cancer. Our data reveal that nimbolide induces excessive generation of reactive oxygen
species (ROS), thereby regulating both apoptosis and autophagy in pancreatic cancer cells. Experiments…demonstrated that nimbolide-mediated ROS generation inhibited proliferation and metastasis. In vivo experiments also demonstrated that nimbolide was effective in inhibiting pancreatic cancer growth and metastasis. Overall, our data suggest that nimbolide can serve as a potential chemo–therapeutic agent for pancreatic cancer.

Triptolide
Triptolide (TPL), a natural compound isolated from the Chinese herb Tripterygium wilfordii (Thunder God vine)
Available as a supplement.


This study says: In conclusion, this study shows that triptolide induces autophagy in pancreatic cancer cells. Our study sheds light on the fundamental question of whether autophagy is protective or causes cell death, proving convincingly that triptolide-mediated induction of autophagy causes cell death of pancreatic cancer cells.

This study says: In conclusion, triptolide causes pancreatic cancer cell death in vitro and in vivo by the induction of apoptosis, and its mechanism of action is mediated via the inhibition of HSP70. In addition, we have provided further support that HSP70 confers resistance to apoptosis in pancreatic cancer cells. Therefore, triptolide is a potential therapeutic agent that can be used to prevent the progression and metastases of pancreatic cancer.

Ginger extract (a spice)
It is available as a supplement.

This study says: In conclusion, the present study demonstrated that ginger extract inhibited cell proliferation and subsequently induced the autotic death of pancreatic cancer Panc-1 cells. The extract suppressed tumor growth without serious adverse effects in a Panc02 peritoneal dissemination mouse model and Panc-1 xenografted mice when administered intraperitoneally. Our results suggest that whole ginger extract or its constituents may have clinical implications for therapeutic intervention against pancreatic cancer.

This study says: In summary, it was uncovered in our study that zerumbone induced apoptosis in pancreatic carcinoma cells through p53 signal pathway. This finding indicates zerumbone, a sesquiterpene in subtropical ginger, as a new therapeutic candidate for pancreatic cancer.

Zyflamend
Zyflamend is an herbal supplement consisting of Holy basil, turmeric, ginger, green tea, rosemary, hu zhang, Chinese goldthread, barberry, oregano, and skullcap.

This study says: In summary, our study shows that, through a unique combination of 10 herbs, the therapeutic potential for targeting PNETs [pancreatic neuroendocrine tumors ] (and possibly other types of cancer) could be enhanced in an additive or synergistic manner. It is our hope, the findings from this study may pave the way towards pre-clinical validation of the beneficial effects of Zyflamend as a potential adjuvant for the treatment for PNETs. It is also our hope that finding from this study could be soon translated into clinical trials aimed at developing safer and more potent therapeutic approaches capable of improving pancreatic cancer patient outcomes and quality of life.

Dandelion Root Extract (DRE)
Available as a supplement

This study found: We demonstrate that DRE has the potential to induce apoptosis [cell death] and autophagy [cells eating themselves] in human pancreatic cancer cells with no significant effect on noncancerous cells.

Feverfew extract (parthenolide)
Feverfew leaves contain many different chemicals, including one called parthenolide.
Available as a supplement.


This study says: Activation of the transcription factor nuclear factor-κB (NF-κB) has been implicated in pancreatic tumorigenesis. We evaluated the effect of a novel NF-κB inhibitor, parthenolide, a sesquiterpene lactone isolated from the herb feverfew, in three human pancreatic tumor cell lines (BxPC-3, PANC-1, and MIA PaCa-2). Parthenolide inhibited pancreatic cancer cell growth in a dose-dependent manner with substantial growth inhibition observed between 5 and 10 μmol/L parthenolide in all three cell lines.

This study says: This study is in agreement with the published studies demonstrating that autophagy induction leads to suppression of cancer growth. These findings strongly support the idea that the parthenolide-induced autophagic cell death is probably an effective therapeutic strategy against pancreatic cancer. Overall, our studies established autophagy-mediated antitumor effects of parthenolide in pancreatic cancer. This is the first report of antitumor activity of parthenolide through the induction of autophagy-mediated apoptosis in pancreatic cancer cells.

This study says: NF-kB inhibitor PTL may be an agent which can effective against pancreatic cancer, because they can effectively inhibit cell proliferation, induce cell apoptosis and suppress metastatic activity.

Holy Basil (an herb)
Available as a supplement.

This study says: In conclusion, we report that ethanolic extract and the essential oil of O. sanctum inhibit the proliferation, motility and invasive ability of PC [pancreatic cancer] cells. Intraperitonally injected aqueous extracts decreased the tumorigenicity of orthotopically implanted AsPC-1 cells significantly. This was associated with significant increase in the expression of pro-apoptotic genes with a concomitant decrease in the level of genes that inhibit apoptosis or promote PC cell proliferation or metastasis. Taken together, these results suggest that the extract or essential oil of basil leaves and the components present in them could be potentially useful as novel agents for the therapy and/or prevention of human PC [pancreatic cancer].

This study says: Here, we show that extracts of O. sanctum leaves inhibit the proliferation, migration, invasion, and induce apoptosis of PC cells in vitro. The expression of genes that promote the proliferation, migration and invasion of PC cells …was downregulated in PC cells after O. sanctum treatment.

Yams (Dioscoreaceae)
Potato-like roots from a tropical climbing plant that can be eaten.
Available as a supplement

This study says: Methyl protodioscin (MPD) is one of the main bioactive components in the plant of Dioscoreaceae. MPD has been demonstrated to possess antitumor activities…In the present study, we demonstrated that MPD inhibited proliferation and promoted apoptosis of pancreatic cancer.

Anvirzel (Oleander extract)
Anvirzel™ is an extract of Nerium oleander, a shrub or tree of Apocynaceae family.
Available as a supplement

This 2014 study presented case reports of 9 metastatic cancer patients who received the extract Nerium oleander. Cases included 4 colon cancer patients, 3 pancreatic cancer patients (1 neuroendocrine and 2 adenocarcinoma), 1 renal cell carcinoma and 1 lung cancer patient…The renal cell patient experienced tumor regression for 12 months with the extract alone; the 3 pancreatic cancer patients and a colon cancer patient experienced disease stabilization. Survival times were extended for all patients with survival times ranging from 32 months to 11 years for these patients with metastatic disease.

Thymoquinone (Tq) (a plant extract)
Thymoquinone is a chief bioactive constituent of black seed oil (Nigella sativa). 
Available as a supplement

This study says: Chehl et al. (2009) showed that TQ, the major constituent of N. sativa oil extract, induced apoptosis and inhibited proliferation in PDA (pancreatic ductal adenocarcinoma) cells…TQ also can abrogate gemcitabine- or oxaliplatin-induced activation of NF-kappa B, resulting in the chemosensitization of pancreatic tumors to conventional therapeutics (Banerjee et al., 2009). The high molecular weight glycoprotein mucin 4 (MUC4) is aberrantly expressed in pancreatic cancer and contributes to the regulation of differentiation, proliferation, metastasis, and the chemoresistance of pancreatic cancer cells.

This study says: In vivo, Tq significantly reduced tumor size in 67% of established tumor xenografts….These molecular targets demonstrate rationale for using Tq as a promising antineoplastic agent to prevent postoperative cancer recurrence and to prolong survival of PDAC [Pancreatic ductal adenocarcinoma] patients after surgical resection.

This study says: The results of our present study indicate that TQ downregulates MUC4 expression in pancreatic cancer cells…These results agree with previous work done by our group, where it was documented that the overexpression of MUC4 is related to an increased invasiveness, migration, and motility of malignant cells. TQ induced apoptosis of pancreatic cancer cells by means of different pathways…

Bitter Melon Juice (BMJ)
Available as a supplement

This study says: In conclusion, we have demonstrated that BMJ possess strong efficacy against human pancreatic carcinoma cells without any noticeable side effects. Molecular studies revealed that BMJ activates AMPK in pancreatic carcinoma cells both in vitro and in vivo and induced strong apoptotic death. Considering the short survival and high mortality due to pancreatic cancer, BMJ that is widely consumed as vegetable and for health benefits could have significant translational relevance in managing this deadly malignancy.

This study says BMJ interferes with the survival and multiplication of Cancer Stem Cells leading to effective anti-cancer efficacy against Pancreatic Cancer cells and their resistant phenotypes.

The National Cancer Institute says: Our published and preliminary studies show that bitter melon (Momordica charantia) juice (BMJ) significantly decreases the viability and induces strong apoptotic death of human PanC [pancreatic cancer] cell lines…
See Bitter melon page

Shikonin
An herbal plant extract.Shikonin is the Asian version of aspirin. It has almost the same profile of efficacy as aspirin.
Available as a supplement

This study says: Pancreatic ductal adenocarcinoma (PDAC) has poor survival and treatment options…The PKM2 inhibitor (shikonin) reduced PDAC cell proliferation, cell migration and induced cell death…   Shikonin is also relatively free from cancer drug resistance, suggesting that it may be translated clinically to treat PDAC patients.

This study concluded: …our current findings demonstrate that shikonin can suppress the growth of human pancreatic cancer and further enhance the antitumor effects of gemcitabine, which are partly due to inactivation of…gene products that regulate proliferation ,angiogenesis, invasion and resistance to apoptosis.

This study found shikonin induces death in cancer cells and enhances the anti-cancer effect of the chemo drug, gemcitabine in pancreatic cancer in laboratory and animal studies. These data indicate that the combination of SK and GEM may be a promising chemotherapy regimen for the treatment of pancreatic cancer.

The The University of Manchester has the following on its website:
Pulling the plug on calcium pumps – potential new treatment strategy for pancreatic cancer

UK scientists have identified a new way to kill pancreatic cancer cells by ‘pulling the plug’ on the energy generator that fuels calcium pumps on their cell surface. The study, published in the British Journal of Cancer, reports how switching off the cancer’s energy supply causes the pancreatic cancer cells to become ‘poisoned’ by an irreversible build-up of calcium…

Shikonin was very effective at killing pancreatic cancer cells within just a few hours of treatment. Treated cells had depleted energy levels, which in turn led to the failure of their calcium pumps and a toxic rise in calcium. Shikonin also prevented the cells from growing and migrating, which implies an impact on cancer spread.
Continue reading article at The University of Manchester

Pao Pereira
Pao pereira is a tree. The bark is used to make medicine. 
Available as a supplement

This 2018 study found: Previous studies on the extract of Pao showed the inhibitory effect on proliferation on pancreatic, ovarian and prostate cancers. Our animal data here showed promising effects of Pao in inhibiting tumorigenicity and tumor growth, at a dose and administration route that can be easily translated into clinical use. No toxic side effects were observed in mice at this dosage. The inhibition in tumorigenicity implies a possible role of Pao in the prevention of cancer, in addition to data indicating a treatment role. Given that the extracts of Pao Pereira are consumed by the American public as a health supplement, the safety, toxicity, and effects of Pao as an anticancer agent should be further investigated clinically.

This study found: In the present study, we investigated a natural product, the extract of Pao Pereira (Pao), for its anti-pancreatic cancer effect in vitro and in vivo, either alone or in combination with the first-line chemotherapeutic drug gemcitabine (Gem). Pao induced dose-dependent apoptosis to all five tested pancreatic cancer cell lines. The combination of Pao and Gem had a synergistic effect in the inhibition of cell growth, with combination indices (CIs) <1 by Chou-Talalay’s median effect analysis based on the isobologram principle. Adding Pao to Gem treatment reduced the concentration of Gem to produce an equitoxic effect on pancreatic cancer cells. In an orthotopic pancreatic xenograft mouse model, mice bearing PACN-1 tumors were treated with Pao and Gem, either alone or in combination. The progression of tumors was monitored longitudinally by imaging of live animals. While Gem did not provide significant inhibition, Pao treatment significantly suppressed tumor growth by 70-72%. Combined Pao and Gem treatment further enhanced the tumor inhibitory effect compared to Gem alone, and markedly reduced metastatic lesions in the peritoneum. Collectively, these data suggest that the extract of Pao possesses anti-pancreatic cancer activity and can enhance the effects of Gem in vitro and in vivo.

L-Carnitine (LC)
L-carnitine is a chemical similar to an amino acid that is produced in the body. Lcarnitine helps the body turn fat into energy. 
Available as a supplement

This study says: Cancer cachexia and malnutrition are associated with an increased risk of surgical complications and higher toxicity levels of chemotherapy… L-Carnitine is critical for energy generation by mitochondrial ß-oxidation and was found depleted under chemotherapy. Its oral supplementation can normalize nutritional L-Carnitine deficiency and reduce chemotherapy related side effects. We therefore tested whether oral L-Carnitine supplementation has a clinical benefit in patients with advanced pancreatic cancer and found that L-Carnitine can reduce malnutrition, increase bodyweight and improve body composition.

Combinations of Natural Products 
(All available as supplements)

This 2017 study reported:
Combination of (−)-gossypol with genistein significantly inhibited the growth of pancreatic cancer cells.

Combination of sulforaphane with quercetin significantly eliminated the growth of pancreatic cancer stem cells.

Combination of wogonin with apigenin and chrysin enhanced TRAIL-mediated apoptosis [cell death] of CaPan-1 human pancreatic carcinoma cells.
*****
Gossypol is a polyphenol isolated from the seed, roots, and stem of the cotton plant. Genistein is a plant extract. 
Sulforaphane is a sulfur-rich compound found in cruciferous vegetables like broccoli, bok choy, and cabbage. Quercetin is a flavonoid present in many fruits and vegetables.
Wogonin, a compound extracted from the plant Scutellaria baicalensis (colloquially known as skullcap). Apigenin is a common dietary flavonoid that is abundantly present in many fruits, vegetables and Chinese medicinal herbs. Chrysin belongs to a class of chemicals called flavonoids. It occurs naturally in various plants and substances, such as the passionflower.


8. Integrated cancer treatments

Chemo with Natural Remedies, Extracts, and Hyperthermia
This 2018 study says: Here, we describe 2 cases of metastatic PC. The first case concerns the integrated treatment of a patient with cancer of the pancreas tail with metastatic involvement ab initio of peripancreatic lymph nodes and liver parenchyma, with numerous secondary lesions greater than 9.5 cm.

The second case concerns the integrated treatment of a patient with cancer of the pancreatic body with metastatic involvement of the liver parenchyma, with a small secondary lesion. In both cases, an integrated cancer treatment approach, combining chemotherapy with natural remedies, extracts, and hyperthermia, induced a notable remission of primary and metastatic lesions…

Co-administration of chemotherapy, natural substances, and hyperthermia led in both cases to a complete remission of primary and metastatic lesions with a follow-up at 2 years.

Biological intra‑control cancer treatment (BICT)
Systemic therapy involving palliative care and herbal extract combinations.

This study says: Biological intra‑control cancer treatment (BICT) is a novel systemic therapy involving palliative care and herbal extract combinations [including ginseng (Panax ginseng C.A. Mey.), Herba Agrimonia (Agrimonia pilosa Ledeb.), White Flower Patrinia Herb (Thlaspi arvense Linn.) and arginine – All available as supplements], which has been approved by the State Food and Drug Association.

The treatment is intended to regulate and inhibit blood vessel generation and tumor growth by inhibiting epidermal growth factor receptor and vascular endothelial growth factor receptor expression, and to manage symptoms to improve the quality of the treatment. The present study discusses the case of a 75‑year‑old female diagnosed with pancreatic cancer with multiple metastases in the liver and lymph nodes. The patient was administered BICT and achieved survival for 11 months without side‑effects of a severity greater than grade 1 according to the Common Terminology Criteria for Adverse Events.

Chemo, Radiation and Chinese Herbal Medicine
Study: Multivariate analysis showed that chemotherapy and Chinese herbal medicine were protective factors. Multimodality treatment is well tolerated by patients with PCLM [pancreatic cancer with liver metastasis] and may be effective in prolonging their survival.

Other

Silver Nanoparticles (AgNPs)

Silver nanoparticles of different sizes induce a mixed type of programmed cell death in human pancreatic ductal adenocarcinoma. This study concluded: …we identified programmed cell death: apoptosis and necroptosis, associated with autophagy and mitotic catastrophe induced in PANC-1 cells by AgNPs in a concentration- and size-dependent manner. Our results lead us to assume that AgNPs could bypass drug resistance by inducing mixed type of cell death in pancreatic ductal adenocarcinoma cells.


Cases of Survival beyond 5 years

Study: A 56-yr-old Japanese man with Pleomorphic carcinoma of the pancreas – a rare tumor with an extremely poor prognosis. The mean survival time is reported to be approx 3 months. After surgery the patient did not undergo chemotherapy or radiotherapy. He has been well without recurrence for 8 years.

Study: a 53-yr-old female who presented was diagnosed with tumor in the head of the pancreas. The pancreatic tumor was 18 mm in diameter and had lymph node metastasis. Pancreaticoduodenectomy was performed with regional lymph node dissection.
Three years later, the patient was diagnosed with recurrent tumor involving lymph nodes, the residual pancreas, the splenic artery, and the left lobe of liver. These sites were resected. The patient survived 4 years after the second surgery without evidence of recurrence (total survival term of 7 yr and 5 days after the first surgery). No chemotherapy or radiation therapy was administered throughout the clinical course.

Study: 30 patients with pancreatic adenocarcinoma including 9 with carcinoma of the body and tail were treated by a multimodal approach consisting of extended pancreatectomy, intraoperative radiotherapy (IORT), and hepatic artery or portal vein infusion of mitomycin C (MMC) followed by systemic bolus injection. All surviving patients were followed for more than 8 yr and survival rates were calculated by the Kaplan-Meier method.
Results: There were no operative or hospital deaths. Eight patients survived for more than 5 yr, 3 of whom survived more than 10 yr. Conclusion: The multimodality treatment combined with IORT and MMC chemotherapy appeared to have a benefit for prognosis of advanced pancreatic adenocarcinoma.

Study (47-year-old man): We report a rare case of a long-term survivor (more than 10 years) of metastatic carcinoma of the pancreas tail controlled with subsequent surgical and chemotherapeutic strategies with an acceptable performance status and quality of life.
In conclusion, this is the fifth case reported in the literature showing that long-term survival may be achieved even in advanced pancreatic cancer. Moreover, this is the first patient with inoperable metastases at the time of diagnosis who has survived for more than 10 years.


2 cases of extended survival (3 years and 2 1/2 years)

This study reports on 2 cases:
The first case concerns the integrated treatment of a 58-year-old woman affected by PC with metastatic involvement ab initio of peripancreatic lymph nodes and liver parenchyma, with numerous secondary lesions greater than 9.5 cm in size
 in March 2014. The disease was stage IV.
At the end of March 2017, 36 months after the diagnosis, the patient is still alive.

The second case concerns the integrated treatment of a patient bearing PC with metastatic involvement of the liver parenchyma with small secondary lesions. She was a 55-year-old woman operated for pancreatic pseudocyst in 2013…Simultaneously with chemotherapy, the patient started taking some natural substances (used for their antitumor effects, as reported in case 1).
At the end of March 2017, 30 months after the diagnosis, the patient is still alive.


Supportive Care

Source: The American Journal of Managed Care
Palliative care plays a critical role in the management of patients with pancreatic cancer throughout the continuum of care and should be provided as soon as a diagnosis is confirmed. Complications associated with pancreatic cancer are due to tumor growth and infiltration of adjacent structures (biliary obstruction, duodenal obstruction, pancreatic insufficiency, pain) and systemic phenomena (cachexia, thromboembolic events). Patients should undergo a comprehensive palliative care assessment by their primary oncology team, which includes:

  • Benefits and burdens of anticancer therapy
  • Physical symptoms
  • Psychosocial or spiritual distress
  • Personal goals, values, and expectations
  • Educational and informational needs
  • Cultural factors affecting care

Unfortunately, many physicians and patients are reluctant to seek out palliative care, believing that palliative care is associated with imminent death. On the contrary, palliative care supports the patient and provides important symptom management. Patients receiving palliative care have a better QOL throughout all stages of their disease with lower cost of care.

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