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Improved detection and treatment of pancreatic cancer provides hope

More targeted treatments now being tested could help improve survival rates, experts say.
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The statistics for pancreatic cancer are dire: Only 9 percent of all patients survive longer than five years after their diagnosis. Notoriously hard to detect and treat, it's the third-leading cause of cancer deaths in the United States.

But experts say research is being done to improve both detection and the treatment approaches — providing a potential glimmer of hope for a disease that is diagnosed in nearly 57,000 people each year in the U.S., according to the American Cancer Society.

On Wednesday, longtime "Jeopardy" host Alex Trebek, 78, announced he had been diagnosed with stage 4 pancreatic cancer — meaning the cancer has metastasized to other parts of his body. Trebek fits the profile of a pancreatic cancer patient in many ways: It's typically diagnosed in older patients, about two-thirds of whom are 65 or older; it's more common in men than in women; and it often is not diagnosed until late.

The vague early symptoms of pancreatic cancer — stomach ache, back pain — often are not taken seriously enough to make a diagnosis right away, said Dr. Anirban Maitra, scientific director of the Pancreatic Cancer Research Center at the University of Texas MD Anderson Cancer Center. Because the pancreas is deep inside the abdomen, patients do not feel a lump like they might in their breast with breast cancer or see a mole on their skin as with skin cancer, he said.

It is often not until more serious symptoms, including drastic unintended weight loss or jaundice, present that the possibility of pancreatic cancer comes up.

"These typically happen when the disease has advanced," Maitra said.

While there are currently no approved early detection tests for pancreatic cancer, researchers say there are promising possibilities — particularly in blood tests that can pick up biomarkers for it.

"We are slowly making inroads," said Gloria Petersen, a professor of epidemiology at the Mayo Clinic who has researched pancreatic cancer for 20 years. She said she thought there probably will be some biomarker tests "being offered up within the next five years for early detection for pancreatic cancer."

Because pancreatic cancer is relatively rare, experts do not believe universal screening should be done. They say it would make the most sense to test those at high risk for it, which includes people with a close family member diagnosed with it, or people over 50 who have received a new diagnosis of diabetes — which in some cases can be an early, overlooked sign of the disease.

Petersen believes the blood tests currently under development would result in a diagnosis one to three years earlier than the average diagnosis now.

"We know from a lot of research that with earlier detection, there are better treatment options, so that is our goal," she said.

The treatment options at the moment are limited.

Fewer than 20 percent of patients are candidates for an invasive surgery — called a Whipple procedure — to remove the affected portion of the pancreas, because most of the time, the cancer has spread beyond the pancreas by the time of diagnosis, Maitra said. Chemotherapy and radiation are given, but only with varying degrees of success.

"Something that makes pancreatic cancer difficult is the tumor itself is surrounded by a dense microenvironment, so it makes getting the drug delivery difficult," said Julie Fleshman, president and CEO of the patient advocacy organization Pancreatic Cancer Action Network. "It's like the rind of a watermelon."

But more targeted therapies are being experimented with. Some clinical trials have focused on an individual's genetic mutations that may have made them more susceptible to developing pancreatic cancer: Having a mutated BRCA-2 gene, the gene most commonly associated with breast cancer risk, is one risk factor. And some current trials offer targeted therapy "based on the molecular makeup of your tumor," Fleshman said.

Other novel treatment approaches are being developed. This week, the journal Nature Medicine published research that found that a combination treatment strategy that changes the way pancreatic cancer tumors receive nutrients can essentially starve the cancer cells.

"We are in desperate need for new treatment options for this disease and we feel like at the very least, the biology we have described in this paper will inform future drug efforts."

"That combination treatment is particularly good at slowing the growth of the pancreatic cancer cells and also causing them to die," said lead author Kirsten Bryant, a research assistant professor at the University of North Carolina's Lineberger Comprehensive Cancer Center in Chapel Hill. "We are in desperate need for new treatment options for this disease."

Bryant said she anticipates clinical trials using her method to start soon.

Those advocating for better detection and treatment of the disease say they are more confident than ever that the research will result in a better survival rate. Sheila Sky Kasselman, an 11-year stage 1 pancreatic cancer survivor and founder of the Sky Foundation, which raises awareness and funds for medical research into pancreatic cancer, said the disease is finally getting the attention it has desperately needed.

"There are so many more researchers working on this issue from all over the world," she said. "I think things are very hopeful."