Pancreatic Cancer Advances

Pancreatic cancer has always been tricky to detect because the pancreas is hidden so far back in the abdomen that doctors cannot feel tumors during a routine examination. By the time it’s discovered, the disease is in its late stages.

What’s more, the warning signs of abdominal pain, back pain, unintended weight loss, and fatigue are easily dismissed as something else entirely, and they don’t show up until the disease has progressed into the late stages.

The good news is that recent medical advances have allowed doctors to detect the dangerous cancer in its early stages. As a result, the five-year survival rate for pancreatic cancer has more than doubled over the past two decades. The American Cancer Society reports that the survival rate of pancreatic cancer is around 44 percent if the disease is caught early and the tumor is small and confined to the pancreas, as is the case in about 16 percent of diagnoses.

The lives of people with pancreatic cancer have been prolonged due in part to improvements in conventional treatments, like chemotherapy and radiation, according to Dr. Brian Wolpin, a professor of medicine at Harvard Medical School and co-director of the Pancreas and Biliary Tumor Center at Dana-Farber Cancer Institute in Boston.

Most of all, breakthroughs in targeted therapies are generating “major excitement in the field,” Dr. Wolpin told AARP.

Targeted Therapy

Researchers are learning more about the distinct changes in pancreatic cancer cells that contribute to their growth, and are working to develop treatments to target these changes. This process is called targeted therapy.

“When you talk about targeted therapy, it’s on the assumption that there’s a specific molecular alteration—whether a gene mutation or a protein overexpression—that is an Achilles’ heel for that cancer and is something that’s very actively driving that cancer,” Dr. Michael Pishvaian, director of Gastrointestinal, Developmental Therapeutics and Clinical Research Programs for the Johns Hopkins Kimmel Cancer Center told AARP. “And by shutting down its activity, usually with a drug, then you can significantly impede or reverse the growth of the cancer.”

Researchers have pinpointed several targets, and a major one is the mutated KRAS gene, which is found in the vast majority of pancreatic cancer cases.

Although the therapies are still in clinical trials for pancreatic cancer and are in the experimental stage, they work by turning off the KRAS mutation, like a light switch, according to Dr. Shubham Pant, a professor in the gastrointestinal medical oncology department at the MD Anderson Cancer Center in Houston.

“If you have the [KRAS] mutation, the light is always turned on in your house, and you cannot turn it off because it’s stuck in the ‘on’ position,” Dr. Pant explained to AARP. “So these inhibitors bind to that switch and turn it off. So just like the light would go off in your house, this mutation leads to cancer-cell death once you turn that switch off.”

According to Dr. Pishvaian, there has been “an absolute tidal wave of new therapies” targeting the KRAS gene, and early data show promising results.
KRAS Inhibitors

Researchers have been investigating whether KRAS inhibitors can block the activity of the mutated KRAS gene. For example, scientists at the Perelman School of Medicine at the University of Pennsylvania and Penn Medicine’s Abramson Cancer Center conducted a study on mice that targeted precancerous pancreatic lesions with KRAS inhibitors.

The mice that received the therapy had fewer precancerous lesions and slower tumor development. The researchers also noticed that the mice that received treatment before developing pancreatic tumors lived nearly twice as long as those treated only after developing tumors. Now, the investigators want to discover how to apply these findings to human studies.

Dr. Robert Vonderheide, director of the Abramson Cancer Center, and a co-author of the study, is convinced that the next “frontier of cancer therapy” is “cancer interception”—the ability to catch (intercept) cancer cells when they begin to develop into pre-cancers or very early cancers, and stop or reverse that process.

“Pancreatic cancer has a stubbornly poor prognosis, limited treatment options and no proven screening or prevention strategies,” Dr. Vonderheide said in a statement. “If we can find a way to intercept it—to identify and neutralize abnormalities on their earliest steps toward malignancy—it would be a game-changer.”

Using AI To Detect Cancer

Dr. Elliot Fishman, professor of radiology and radiological science at the Johns Hopkins School of Medicine in Baltimore, said he has been using artificial intelligence (AI) to train computers to read CT scans and identify tumors at earlier, smaller stages so that they can be surgically removed.

Dr. Fishman enlisted the help of AI since imaging scans miss early pancreatic cancer 30 percent of the time. This means that nearly half of all pancreatic cancer cases are not caught until the later stages.

“We should be able to do better,” Dr. Fishman told AARP. Dr. Fishman has used AI to screen several thousand pancreatic patients, and AI has detected tumors with a high degree of accuracy.

Using Blood and Urine Tests

Scientists are exploring the possibility of detecting early-stage pancreatic cancer through blood or urine tests, since body fluids contain fragments of tumor-cell DNA. While some progress has been made, Dr. Pant said it may be several more years before a screening test for pancreatic cancer becomes available.

Exploring A Vaccine For Pancreatic Cancer

Researchers at Memorial Sloan Kettering Cancer Center are conducting a small, but ongoing clinical trial involving an mRNA vaccine. The investigators discovered that a personalized mRNA vaccine stopped the most common form of pancreatic cancer from returning in about 50 percent of the study participants. The clinical trial results were published in 2023 in the journal Nature.

How to Lower Your Risk For Pancreatic Cancer

Knowing the risk factors for pancreatic cancer “offers the opportunity for us to diagnose pancreatic cancer early and intervene, with the overall hope of improving patient outcome overall,” Dr. James Farrell, director of the Yale Center for Pancreatic Diseases at the Yale School of Medicine and Yale New Haven Hospital, told AARP.

Some of the common symptoms of pancreatic cancer include:

• New-onset diabetes or worsening blood sugar levels, especially with weight loss

• Darkening of urine and lightening of stool

• Jaundice (yellowing of the skin and whites of the eyes)

• Itching

• Nausea and vomiting

• Fatigue

• Loss of appetite and unintentional weight loss

Some of the most common risk factors for developing pancreatic cancer include:

• Having a pancreatic cyst on a CT or MRI scan

• Smoking

• Drinking alcohol

Also, the American Cancer Society reports that people who are obese (BMI of 30 or higher) are 20 percent more likely to develop pancreatic cancer.
According to Dr. Wolpin, type 2 diabetes is more common among overweight adults, and this raises the risk for pancreatic cancer, especially in people over 50 who suddenly develop type 2 diabetes without having a family history of it.

Medical experts say that early detection of pancreatic cancer increases the likelihood of effective treatment.

Source Links:

https://www.aarp.org/health/conditions-treatments/advances-in-pancreatic-cancer-treatment/