PANCREAS CANCER ALICANTE | Enrique de Madaria, doctor: “We must advance in research because pancreatic cancer is increasing”

What does this recognition mean to you?

Research is a discipline in which you work very hard for a long time without obtaining results. Discoveries and publications appear over many years. It is a recognition of work that is often unpaid and at the expense of your free time to be able to advance your lines of research. Having our group awarded the “UEG Research Prize” is a very exciting feeling.

What does the essay consist of?

We study acute pancreatitis. Since at first patients cannot eat or drink due to the presence of abdominal pain and vomiting, they must be given intravenous fluids so that they do not become dehydrated. In pancreatitis, fluid is sometimes lost from the veins, so it also replaces it so that the patient is stable. There are two main types of fluids used in hospitals around the world. The best known is physiological saline, saline, which is actually water and salt; and there is another one that is widely used, called lactated ringer, which has water, salt and other components, such as lactate, potassium and calcium, and it seems that this fluid has anti-inflammatory effects. Since acute pancreatitis, which is the disease that we study the most in our Isabial group, requires fluids and is inflammatory, we want to see if lactated ringer’s has an inflammatory action that improves the evolution of the pathology, and if it causes patients to have a less serious illness, may they do better.

Serums

How are you going to do?

We have designed a randomized study, which means that it is decided by chance which patients receive saline solution and which receive ringer’s lactate. It is a very ambitious study that aims to recruit 800 patients and we have done it multicenter with hospitals around the world, breaking the record for the clinical trial in acute pancreatitis with the most countries carried out so far.

What phase is it in?

We are recruiting patients in Spain, Croatia, Czech Republic, Egypt, China, India, Pakistan, United States, Mexico, Bolivia, Argentina… There are 35 centers from 14 countries and four continents contributing patients and we have surpassed the first 500. We will finish the recruitment at the end of the year. In a few months we will analyze the data and the first publication will be published in an international effort led by Isabial (Alicante Health Research Institute). With the 50,000 euros from the European prize we will continue with the study and help increase the international presence of the studio.

Insulin

How important is the pancreas?

It is a key organ. It produces insulin, a hormone that enters the blood and controls the consumption of glucose by the cells of our body. If insulin rises in the blood, sugar passes into the cells and participates in all cellular processes such as energy generation, etc. If the pancreas fails, insulin is not produced and blood glucose cannot be used by the cells, so its level increases and increases in the blood, and that is diabetes, which causes damage to the body’s organs by being exposed to that excess glucose that we have to solve with medications or injected insulin. The pancreas also produces a fluid called pancreatic juice, which is full of enzymes and proteins whose function is to digest food. Without it we would not be able to digest its components, especially fats.

Organ

However, it is not a very well-known organ…

It is better known for diabetes but it is not a very showy organ nor does it have a group that is frequently talking to society about it and it goes quite unnoticed.

Therefore, one of its objectives is to make the pancreas visible?

It is to make visible one of the diseases of the pancreas, which is cancer, the most aggressive tumor and with the highest mortality in humans today. Most tumors are benefiting from new treatments, immunotherapy, CAR-T cells, and high-tech drugs. In pancreatic cancer, although there has been progress, mortality is still very high, and it is something that must be made visible with two objectives. The first, that society understands that the way to improve the prognosis of patients is scientific research; and the second, to obtain funds for research with events such as the Race against Pancreatic Cancer but also for society to pressure politicians so that there are more resources for the fight against this tumor in which at this time we do not have effective tools to improve. your prognosis. There are people with this cancer who are getting younger and younger. We are seeing many more patients between 50 and 60 years old than before. We must advance in research because the frequency of the tumor is increasing and in increasingly younger people.

Is pancreatitis related to cancer?

Patients with chronic pancreatitis, who have sustained inflammation for years, can develop pancreatic cancer in 5% of cases.

How to take care of the pancreas?

The prevalence of diabetes rises greatly in the presence of obesity, which is associated with insulin resistance that makes it less effective and raises blood glucose. One of the main measures to take care of the function of the pancreas is to have an adequate weight and healthy nutrition. Another is not smoking, as it is associated with chronic inflammation of the pancreas and cancer.

How does this tumor face?

We have two types of patients. In which the tumor grows near the duct through which bile is expelled, it blocks it and the patient turns yellow, which is called jaundice in medicine. They are the ones that are detected the earliest and the ones that have the best chance of being able to operate on the tumor at an early stage. In the rest, the discomfort begins with weight loss, loss of appetite, onset of diabetes and slight abdominal discomfort. My advice is that a patient who has even mild abdominal pain but who is associated with a clear weight loss of more than four kilos, should consult with their Primary Care doctor.

Diabetes

Is there a diabetes-cancer relationship?

When there is cancer, sometimes the tumor causes diabetes, but being old for many years does not predispose one to having pancreatic cancer.

What has been the most exciting thing you have discovered?

The previous study that we published in which we wanted to verify if truly giving a lot of fluids to patients with pancreatitis (Waterfall trial) improved their evolution, which was a dogma that everyone followed. We doctors thought that they had to be given a lot of fluids for the pancreatitis to improve. We considered doing an international trial with Spain, Mexico, India and Italy with more restrictive amounts, and it was very surprising because we discovered that giving a lot of fluids, as recommended, was associated with patients having heart failure and waterlogging in their lungs. It had to be stopped because it endangered the patient and was exactly the opposite of what the dogma that we all followed around the world said. This completely changed the way fluid therapy is managed for patients with acute pancreatitis around the world. It was published in the best international clinical medicine journal, the New England Journal of Medicine, and the new North American clinical guidelines have just been released, which state that the way fluids are given must be changed and recommend the most restrictive regimen indicated in our trial. For us it has been very exciting because we have changed clinical practice.

Is there anything new you are seeing in pancreas?

There are very elderly patients with gallbladder problems, complex ones, who are admitted frequently and weak enough to be removed. We are giving new treatments to prevent them from suffering as much as putting prostheses through endoscopy to empty the gallbladder of stones into the stomach as an alternative to surgery. We are one of the first centers to do this less invasive technique in Spain.