Interview with Dr. Mark D'Andrea - Understanding Pancreatic Cancer

Understanding Pancreatic Cancer

Receiving a diagnosis of pancreatic cancer can be devastating, and all too often it arrives at a stage where surgical removal is no longer an option. This is because pancreatic cancer is frequently silent until it progresses; by the time symptoms appear, the disease has often spread beyond the pancreas. Yet, despite its grim reputation, there are promising advances in both detection and treatment - from refined chemotherapy to radiation innovations and participation in clinical trials.

Dr. Mark D’Andrea, a leading radiation oncologist and principal investigator of the Alpha DaRT (Diffusing Alpha emitters Radiation Therapy) pancreatic cancer trial in the U.S., recently spoke with the daily radio talk-show Hello Houston, where he shared insights about the disease and possible treatments.

The Challenges: Why Pancreatic Cancer Is So Difficult

Pancreatic cancer remains one of the most lethal malignancies. According to the American Cancer Society, fewer than 20% of patients are eligible for surgical resection because the disease has often already spread by the time it’s detected. Even among those who undergo surgery, additional treatments like chemotherapy or radiation are often needed to reduce the risk of recurrence.

Research shows that the 5-year survival rate for many pancreatic cancer patients remains very low. Adding to the concern, epidemiological studies indicate a worrying trend: in recent years, the incidence of pancreatic cancer has risen, particularly among younger adults.

Screening & Early Detection: What Can Be Done

Dr. D’Andrea emphasized how critical early detection is, especially for those with a family history of cancer. “That’s a way to get it, too,” he explained. “Mostly if you have family history … especially stomach cancer or pancreatic cancer, we would screen you.” He recommends practical and relatively accessible screening tools: “If you have a family history of pancreatic cancer, I would suggest you get it. Or even an ultrasound … and that would also show if there’s any mass in there.”

He also spoke about blood tests: “There’s a blood test that’s specific for pancreatic cancer … Now you don’t have to have an MRI. You get a PET scan. PET scan is very quick, easy, inexpensive”. He acknowledged the fact that patients refrain from gets scanned regularly: “Why doesn’t everybody just get a pancreatic scan when they go for a physical? … It’s exposure to radiation.”

But perhaps most importantly, Dr. D’Andrea addressed the fear many people feel: not wanting to face a cancer diagnosis. He explained: “Well, I always let folks know that the quicker you come in, the smaller the disease, the higher chance of your survival in any type of cancers. And also less treatment if the tumor is small.”

Treatment Options & the Role of Clinical Trials

Treatment of pancreatic cancer today typically involves a multi-pronged approach: surgery (when possible), chemotherapy, radiation therapy, and - for some patients - newer, targeted or immune-based treatments.

• Surgery: For the small fraction of patients whose cancer is detected early and is resectable, surgery offers the best chance for long-term survival. Post-operative chemotherapy and sometimes radiation can help reduce recurrence risk.

• Chemotherapy: Common regimens (e.g., FOLFIRINOX, gemcitabine-based therapies) remain the backbone of treatment for many patients, particularly those with advanced disease.

• Radiation Therapy: Radiation, often combined with chemotherapy, can help control local disease, especially when surgery isn’t an option.

• Targeted Therapy & Immunotherapy: There has been promising, but limited, progress in this area. A review in PubMed highlights that while the 5-year survival rate is low, recent advances in targeted therapies and immunotherapy offer hope, particularly for specific molecular subtypes of pancreatic cancer.

Emerging research also underscores innovations in radiation planning and delivery. For example, a deep learning–based model has been developed to accelerate radiotherapy planning in pancreatic cancer, potentially shortening treatment timelines and improving patients’ quality of life. And a new study models the use of dose-escalated proton beam therapy, which may provide more effective and safer radiation delivery for certain tumors.

In the context of these challenges, Alpha DaRT therapy represents a promising new frontier. By implanting alpha-emitting sources directly into the tumor, it's possible to deliver ultra-high doses of radiation in a very focused manner. This precision helps overcome a key limitation of standard external-beam radiation, which must travel through healthy tissue to reach the tumor, and thus is constrained by the risk of collateral damage.

This capability opens new possibilities: it may allow re-treatment of previously irradiated areas, improve local control in inoperable cases, and potentially be combined with systemic therapies. Moreover, early patient-screening strategies backed by Dr. D’Andrea’s guidance can help identify more patients at a stage where such advanced therapies may make a real difference.