November 18, 2019
Moon Shot promotes efforts to prevent, quickly detect pancreatic cancer
BY Clayton Boldt, Ph.D.
Each year in the U.S., more than 50,000 people will be diagnosed with pancreatic cancer, which ranks around the 10th most common cancer type. However, it is the third leading cause of cancer death, behind only lung and colorectal cancers.
For Pancreatic Cancer Awareness Month, Cancer Frontline spoke with Anirban Maitra, M.B.B.S., scientific director of the Sheikh Ahmed Pancreatic Cancer Research Center, about important ongoing work in pancreatic cancer prevention and early detection.
Maitra also is co-leader of MD Anderson’s Pancreatic Cancer Moon Shot®, part of the Moon Shots Program®, a collaborative effort to accelerate the development of scientific discoveries into clinical advances that save patients’ lives.
Q: With November being Pancreatic Cancer Awareness month, what’s the one piece of information you wished more people know about the disease?
A: Obviously, pancreatic cancer is a very lethal disease. It has one of the lowest five-year survival rates among solid cancers. In terms of the greatest unmet need in this disease, early detection and prevention is of paramount importance.
As Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.” I don’t think there’s another disease where that is more applicable. The one area where we are likely to have the greatest impact on disease outcomes is in the context of early detection and cancer prevention.
Q: What’s the outlook for patients when pancreatic cancer is detected early as compared to later?
A: The difference is quite remarkable. With current neoadjuvant treatment regimens, the five-year survival rate for patients who are able to undergo surgery, meaning their cancer has not yet metastasized, is around 30-40%. Unfortunately, the majority of patients are diagnosed with advanced, Stage IV disease, and the survival rate is just 5-7%. So it’s really a four- to five-fold difference in survival rates between those disease stages.
I think this underscores the tremendous value of early detection. Currently, only about 20% of patients are able to undergo surgery, which means 80% are not. If we were able to flip those numbers, the impact we could have on survival benefits would be more than any drug that’s out there now.
Q: Are there recommended guidelines for pancreatic cancer screening?
A: Fortunately, pancreatic cancer is relatively uncommon, although its incidence rate is rising in the U.S. and worldwide. But, it’s not common enough to merit screening everyone for pancreatic cancer. There is actually a concern that screening the entire population might do more harm than good. However, there are high-risk populations where screening is warranted. That’s where we believe we have the greatest opportunity for having an impact from early detection.
Those high-risk cohorts include individuals who have inherited, or germline, mutations that can increase pancreatic cancer risk. Additionally, there are those with chronic inflammatory conditions or cystic lesions in the pancreas that can increase risk.
At MD Anderson, we have a high-risk clinic, directed by Dr. Florencia McAllister, which has been funded entirely by the Pancreatic Cancer Moon Shot. The clinic is devoted to individuals that don’t have pancreatic cancer but may be at a higher risk for the disease. We also have a cyst clinic run by Dr. Michael Kim, and these two clinics collaborate very closely. These clinics allow us to follow these individuals and intervene early if pancreatic cancer develops.
Q: What about screening tests – are there any options there?
A: We don’t currently have a good test, so this is another area that the Moon Shot is actively working on – trying to develop blood tests and imaging tools to identify early pancreatic cancer. Both of these avenues are critical for helping us to find pancreatic cancer as early as possible.
Dr. Sam Hanash and his team are developing blood tests by looking at thousands of proteins and metabolites to help us narrow down what happens when you have an early, asymptomatic pancreatic cancer. If we are able to develop a blood test, then we can use it in the high-risk clinic with the possibility of expanding more broadly in the future.
Imaging is also an important consideration for us. CT scans and MRIs that we use now are wonderful, but their resolution isn’t high enough to allow us to pick up these small, early cancers we want to find. Dr. Eugene Koay, in another Moon Shot-funded project, is working on computational algorithms that can help bypass the limits of resolution and find these very early lesions.
Q: What should physicians know about genetic risk for pancreatic cancer?
A: The first thing they should know is that approximately 10% of pancreatic cancer patients have a germline mutation, and only half of them have an obvious family history of cancer. This means that just using family history to select patients for genetic testing is going to miss a lot of patients.
In light of this, we saw a major shift in the guidelines for germline testing of patients earlier this year. It’s now recommended that everyone with pancreatic cancer be offered the opportunity for germline testing. This is much easier and more affordable now than in the past, and we also have targeted therapies now that work against certain mutations. So the benefits could extend beyond family members to the patient themselves.
Q: What options are available for those with a family history of pancreatic cancer?
A: I think it’s very important that family members who might be carrying one of these mutations be tested. If they are at increased risk of pancreatic cancer, they can have the chance to enter some of these screening programs, such as in our high-risk clinic. However, we see only a small minority of family members taking this opportunity.
Fortunately, there is an option now. We’ve received a grant from Stand Up to Cancer and the Lustgarten Foundation to launch the GENERATE (GENetic Education, Risk Assessment, and Testing) Study to offer germline testing for people with a close relative that has been diagnosed with pancreatic cancer. MD Anderson is the lead site for this multi-institutional study that includes five other sites.
We’ve really made the process very easy. You don’t even have to leave the comfort of your living room. Interested individuals can sign up online, fill out the questionnaire and, if you fit the bill, we’ll send you a genetic testing kit. It’s a simple spit test that you can send away and get the results back.
If an individual has one of these high-risk mutations, we’ll offer genetic counseling and the potential to enter a high-risk screening program near their home. Again, this is an opportunity for families that have been touched by the disease to better understand their own risk for pancreatic as well as other cancers so that we can intervene sooner, when we have a better chance of success.