November is pancreatic cancer awareness month—one of empowerment, education, and inspiration for communities that have been touched by pancreatic cancer. This month of awareness has come at a time when the world is mourning the loss of television personality and longtime host of “Jeopardy!,” Alex Trebek, who recently succumbed to the deadly disease.
Since his diagnosis, Trebek worked to shed light on this form of cancer that more than 57,000 people in the United States get diagnosed with each year. Although pancreatic cancer is much less common than other forms of cancer, Dr. Peter Hosein, who specializes in medical oncology at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System, explained that the fatality rate is much higher than other common cancer types and is the third leading cause of cancer death in this country.
“Pancreatic cancer is usually picked up very late because there are no early warning signs, and there aren’t any screening tests to catch this form of cancer early on,” he said. “For example, we’ve been able to reduce the mortality for other cancers because there are developed screening tools, but we don’t have any screening tests available for pancreatic cancer.”
Dr. Nipun Merchant, who leads surgical oncology at Sylvester, said that 80 percent of those diagnosed usually are in an advanced stage—similar to Trebek, who revealed in March 2019 that he had stage IV pancreatic cancer. Although the statistics seem grim, Merchant explained that there have been significant advances in the last few years.
“We now have better treatment options for patients and have seen dramatic responses in patients with advanced stages of the cancer that were unheard of even a few years ago,” he said.
Both Hosein and Merchant want to spread a message of hope through the remarkable ongoing research at Sylvester.
“One of the biggest advances at Sylvester is the improved chemotherapy drugs we can offer our patients, which are showing much better responses,” said Merchant. “We have also significantly improved the ability to get tissue from patients and genetically profile the tumors and understand the genetic drivers for each patient. It has given us the ability to use very specific targeted therapies individualized to a patient’s tumor in many circumstances.”
Part of the reason why pancreatic cancer is so complex is because it is comprised primarily of fibrotic tissue, which makes it very difficult for drugs to penetrate into the tumor. Merchant points out that the same fibrotic tissue also creates an immunosuppressive microenvironment that prevents the body’s own immune cells from penetrating into the tumor.
“Immunotherapy has not shown any efficacy in pancreatic cancer. We are doing revolutionary research here at Sylvester and finding ways the we can target the supportive tissue of the tumor and provide the opportunity for the body’s own immune cells to attack it,” said Merchant. “This is now allowing immunotherapy to be an effective way in treating pancreatic cancer, which is unique and novel here at Sylvester.”
Using MRI guidance to safely deliver a very high dose of radiation (also called ablative radiation) to a pancreatic tumor is another innovative approach being used at Sylvester to treat pancreatic cancer that cannot be surgically removed. When radiation therapy is delivered using this approach, published findings show it could trigger a response from the patient’s immune system against their own tumor.
“Treating patients with unresectable pancreatic cancer at an even higher dose of radiation guided by MRI is an ongoing clinical trial at Sylvester. The study is being done to see if survival can be improved,” said Lorraine Portelance, vice-chair of radiation oncology and the principal investigator for this trial at Sylvester.
“Defeating pancreatic cancer is our passion,” explained Hosein. “People get into medicine to help patients, and both of us have dedicated our lives to try to make a difference. We get fulfillment when we see patients do well, and we hope to further our research to advance the field and make a great impact on a wider scale.”
Merchant credits Sylvester’s dedicated multidisciplinary team of surgeons, oncologists, radiation oncologists, radiologists, and pathologists who continually work together as an entire team focused on each individual patient to ensure that the center is providing optimal therapy.
“We see so many patients from the outside who are told there is nothing that can be done for them. They come to Sylvester where we discuss potential treatment options and many times have been able to effectively treat them to where some are now living four and five years without evidence of the disease,” he said. “It’s very gratifying to see. We have both been treating pancreatic cancer patients for a long time, and with recent advances we are seeing responses that were unimaginable even a few years ago.”
