Pancreatic Cancer Update From ASCO 2017

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Topics include: Treatment and Understanding

As part of our coverage from the 2017 American Society of Clinical Oncology annual meeting, Dr. Alan Venook from the UCSF Helen Diller Family Comprehensive Cancer Center discusses pancreatic cancer.  Dr. Venook provides an update on the latest in pancreatic cancer, how researchers are working towards early detection, and his hope for the future.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Dr. Venook:

My name is Alan Venook.  I'm a medical oncologist at the University of California San Francisco.  I have a variety of roles there.  I'm a professor of medicine.  I run or am in charge of the GI, gastrointestinal oncology program, and am an Associate Director of the cancer center, the Helen Diller Family Comprehensive Cancer Center at UCSF, where I'm in charge of program development.  

What that means today is it's my responsibility with others to figure out where we need to be in three to five years and what we should be focusing on in terms of how to get the best results for patients and how to make the most progress as quickly as possible. 

Pancreatic cancer has been one of our most daunting challenges.  It's a cancer that because of where the pancreas is located and the difficulty of determining sort of what it looks like other than with special scans we really have had a lot of trouble even diagnosing the cancer for many years. 

We've made some progress in pancreas cancer in the last few years especially with new chemotherapies.  We've discovered that aggressive chemotherapy can actually help patients with pancreas cancer.  Years ago, we didn't think that was the case. 

I'd say over the last few years the greatest potential advances have been in identifying a subset of patients with pancreas cancer who may actually be curable or have their cancer removed who we didn't think that could be done before.  These are patients with what's called borderline resectable pancreas cancer.  And at centers with excellent surgical and medical care, we've learned that we can occasionally remove these cancers, whereas we couldn't do so in the past partly because of the new chemotherapies. 

The big advances that we were hoping we would see were in immunotherapy, so?called immuno?oncology, and there it's been tough sledding.  We and others have done numerous studies exploring some of these new agents that are popular and all over the mainstream media, and in fact they for reasons we're not quite clear don't work really well at all in most patients with pancreas cancer.  Our research now is focusing in on trying to figure out why that is and seeing if we can turn that around for patients. 

One advance that is perhaps coming, we're hoping will make a difference, is a strategy of using treatment, putting chemotherapy into patients and using an agent that we think will break down the stroma, the connective tissue around the pancreas cancer.  So pancreas cancer is a process whereby there may be a few cancer cells and a lot of inflammation, a lot of hard, fibrous tissue, and that damages the pancreas and we think makes it difficult for our treatments to be effective against the cancer.  It's as if it creates its own shield from the body, from the body's immune system. 

There's a treatment, for example, something called PEGPH20 from a company called Halozyme, which is in study.  That will be presented—that was presented actually yesterday, and that data suggests that you may be able to in selected patients be more effective with our treatment if we use a drug that breaks down this connective tissue.  Now, the problem is, of course, this is incremental right now, and we'll take incremental improvement if we can get it.  

Part of our future, though, will be identifying the subset of patients, as I said, who might be resectable earlier and ideally finding targets within the cancer that we can use some of our new molecular agents against. 

So right now, unfortunately, this is not a big year for big advances in pancreas cancer.  I think though as we continue to work harder, we have some therapies that are more effective that's generated new enthusiasm in terms of novel approaches, and, of course, there are lots of new ideas out there. 

Our center and others, we have a variety of consortia around the country which put together the leading centers in terms of trying to advance the field, and we really do hope that will be effective.  I think the collaboration in pancreas cancer is uniform across all academic centers because of our dissatisfaction with what we can do for patients right now. 

Early diagnosis of a disease is really, it's a challenge in many cases.  It's a matter of how easy it is to sort of surveil the disease or the organ.  So breast cancer is not so difficult to do early detection, because the breasts are out, out right in front of you, and you can do tests easily.  You can feel them, you can feel a mass.  

Pancreas is embedded deep in the back of the abdominal cavity, and so you wouldn't routinely be doing X?rays to look for that.  Even if you did X?rays, it might not be possible to find it until you knew it was a cancer, and by then it may be too late. 

The best example of sort of screening would be—Ruth Bader Ginsburg, the Supreme Court justice, had pancreas cancer that was removed some years ago.  That was a fluke.  She had had a history of breast cancer and got a routine CT scan for follow?up of her breast cancer, and, lo and behold, they found a pancreas cancer.  We don't do scanning for anybody except Supreme Court justices who have had breast cancer, so it was her good fortune.  But that's the exception that makes the rule. 

Now, there are strategies that we would hope, for example, can we find circulating cell?free DNA, tumor DNA that might be in the bloodstream.  We can, but even there is it too late, and this is really a very long process to figure out if screening is adequate.  But I'd say the future is not going to be with imaging.  It's not going to be with sort of tests other than blood tests, which at some point will allow us to find DNA that doesn't belong in the patient which may reflect the presence of a cancer.  There are a number of companies that are pursuing that, and we're working with those groups as well to see if we can find evidence of a cancer in time to do more about it. 

I think this is—there's no time like the present in terms of the trajectory of what the advances will be.  The immunotherapy advances that we now have seen over the last few years weren't even on our radar five years ago.  The challenge though, with some diseases is they will remain really tough nuts, and pancreas cancer is probably one of them.  

But as I tell patients, I've never been one who fantasizes.  I've never been one to tell patients just hold on, because there's maybe something around the corner.  Now we can say that because what we don't think—where we don't think we have options we may suddenly discover there are new options, that is finding new targets, new molecular targets as well as maybe coming up with new observations that—perhaps circulating factors that would predict who will or won't benefit from treatment.  

And there are also the genetics of cancer.  I think our real task would be to figure out what genetics, what genes predispose people to which cancers, and perhaps those are people we could do more aggressive surveillance on.  So I think this is a great time and certainly a time to be optimistic about our progress against cancer, and even that includes pancreas cancer. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on June 28, 2017