Pancreatic cancer as a paradigm.
Pancreatic cancer is one of the most difficult cancers to treat. Given the location of the pancreas, tumors are often discovered at later stages when symptoms occur. But even when detected early, this cancer has a high risk of recurrence following surgery and is not very responsive to therapy.
What makes pancreatic cancer such a bad actor in the first place? We know that certain mutations, such as in the KRAS gene that is seen in more than 90 percent of cases, can lead to more aggressive growth and treatment resistance. Cigarette smoking can also contribute, in that tobacco-induced mutations in lung, head and neck and pancreatic cancers lead to “meaner cells,” sort of like growing up in a bad neighborhood. Also, the abnormal function of the pancreas increases the risk of secondary complications such as diabetes and blood clots—both of which worsen the overall prognosis.
Pancreatic cancer is, therefore, a paradigm for the notion that if we can discover and develop more successful treatment strategies for a very tough malignancy, we should be able to translate that success to other malignancies. Progress has been made but we have a long way to go. Still, early foundations for success are being laid. A team led by Arizona-based researcher and innovator Daniel Von Hoff recently published results of a phase 3 study showing improved overall survival in participants who took a new drug combination. Advocacy and awareness have increased, generating more patient resources and research support by groups, such as the Pancreatic Cancer Action Network. Newer surgical techniques and less invasive approaches allow a larger number of patients to be candidates for potentially curative resections.
While small gains are being made with newer chemotherapy agents, pancreatic cancer is ripe for more sweeping changes, such as those we have seen in the last few years in melanoma and kidney cancer. May the trend continue—and spill over to other cancer types.
Debu Tripathy, MD
Professor of Medicine, University of Southern California
Co-Leader, Women’s Cancer Program at the USC/Norris Comprehensive Cancer Center