What Patients Should Know During Pancreatic Cancer Awareness Month

In recognition of Pancreatic Cancer Awareness Month, observed annually during the month of November, Dr. Suneel Kamath sat down for an interview with CURE where he shared his insights on this aggressive disease. During the interview, he discussed emerging treatments, the potential of cancer vaccines, and the importance of collaboration among specialists in providing the best possible care.

Notably, Kamath currently works in Gastrointestinal Medical Oncology at the Cleveland Clinic, in Ohio, where he also is an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.

CURE: How has the incidence of pancreatic cancer changed over the last two decades, and what factors are driving this increase?

Kamath: That is, unfortunately, something that we have seen over the last 20 years or so. When you look at our typical American Cancer Society statistics that get quoted in the news and everything, if you looked at those numbers from the late 1990s and early 2000s, pancreatic cancer incidence was somewhere around the 45,000 to 50,000 range. In the last few years, that's increased substantially to be almost pushing 70,000 per year, which may not seem like a huge change, but for a disease as aggressive and deadly as this one is, any increase certainly has a big impact.

I would say pancreatic cancer is difficult from a prevention standpoint because, more so than really any other cancer, it's not strongly linked to any particular behavior or habits. It doesn't have that smoking gun, if you will, like smoking for lung cancer. I really think the biggest reason for this increase in the last 20 years is obesity-driven. We are realizing more and more that weight, obesity, and diet tends to trigger that, and the sedentary lifestyle that is often associated, actually have a bigger impact on cancer risk than just cardiovascular health, like we thought it used to be. I do think that's a big driver of what's happening.

Certainly, the other traditional risk factors we think of for cancer, like alcohol consumption and smoking, things like that, sort of weakly increase the risk for pancreatic cancer, but it's not a huge change. I'm not sure that any variations there are really driving the trend. And so I do really think it is weight-related obesity, our diets being much higher in processed foods, and leading a more sedentary lifestyle is probably a bigger driver of it.

In turn, due to that, I think we are really trying to push awareness about that, to educate people about this as an additional factor. I think we were all aware of the impact on risks for heart attacks and strokes and everything, but making sure people are also aware that obesity is also a cancer problem, too.

We are also increasingly recognizing that there are certain hereditary syndromes that are out there that you may not have a very obvious family history, but if you really dig into it more, you identify a lot of people that are high risk. Fortunately, we have developed a lot of these pancreas clinics across the country now, where we're able to follow people. We have much better guidelines to say when people need a CT scan or an endoscopy to check it out, and how often that's needed. Because it's gotten rolled out to more people, we're better able to detect people that are at high risk and then follow those people so we can prevent the cancer from happening in the first place.

What strategies exist to identify patients at high risk for pancreatic cancer?

We are extremely excited in gastrointestinal [GI] oncology. For all of us that treat pancreatic cancer, KRAS has been a gene we've known for a very long time is extremely important in pancreatic cancer. More than 90% of pancreatic cancers have a mutation in a gene that's called KRAS. This is one we've known for decades is a strong driver of the cancer forming in the first place, a driver of its spreading to other sites, and it leads to the overall aggressiveness of pancreatic cancer.

We've been excited about recently, there have been several drugs that have come about that can target this gene. It's been one that's been very hard to make medications and drugs for, but now we can do that. We're at the very beginnings of that, but we're starting to see some signals already of newer drugs and clinical trials that are leading to significant shrinkage of tumors that we hope will get developed further into their development, and then reach FDA approvals and everything. That is definitely one area I'm super excited about.

What recent advances in targeted therapies and vaccines show the most promise for pancreatic cancer treatment?

The cancer vaccine space has also gotten very exciting in pancreatic cancer as well. This is a disease, unlike with breast cancer or prostate cancer where surgery and chemo will cure most people, or sometimes just surgery by itself. With pancreatic cancer, even with doing all that, more than half of people, the cancer still returns in the next five years. It really leaves a big opportunity, a big need, for us to develop something to help reduce that chance that the cancer comes back.

We have a number of these vaccines that have come about. A couple of different companies (I know Moderna and BioNTech) have [helped] develop that mRNA technology into the cancer space; one of the big ones is in pancreatic cancer.

It's been exciting. We're following a number of different vaccines in development where they're adding the vaccine on top of the traditional chemo to see if we can reduce the chance that the cancer might return after surgery. It's still early for sure, but there's a very early signal that looks very promising. I hope that, with more development and more research on those, we can actually bring those into the market and start treating patients with it in the approved space.

This is a disease where you're having a strong participation collaboration amongst those of us in GI medical oncology, our surgical oncologists, and radiation oncology as well. I think having everyone involved is so important.

Why is multidisciplinary collaboration particularly critical in pancreatic cancer care, and how does it impact patient outcomes?

I would say the most important thing about that coordination in this cancer is two things. One is time is of the essence with pancreatic cancer. It's one that moves and spreads faster probably than any other cancer. Having a strong partnership from your GI colleagues, who often make the diagnosis, to then handing off to a surgical oncologist and a medical oncologist, making sure that those handoffs happen quickly, smoothly, that the plan is arrived at quickly and executed quickly, is probably more important in this cancer than really any other.

How does the aggressive nature of pancreatic cancer affect the speed and coordination of treatment decisions?

Collaboration is so important. I would say just due to the location in the body, where the pancreas is, it's very difficult from a surgeon's standpoint, from a radiation standpoint, and from a stenting standpoint. A lot of people with pancreatic cancer need stents done by our GI or gastroenterology colleagues.

Therefore, having people that have a lot of expertise and treating this cancer repeatedly at high-volume centers really is critically important; this is because these are surgeries that done in the right hands, can have great outcomes. However, if you go to a place where maybe they're only doing a few pancreas cancer surgeries a year, complication rates go up. The number of tumors where some tumor is left behind also gets increased quite a bit. And so definitely, I think collaborating across all disciplines is important, and doing so in a timely way.

Transcript has been edited for clarity and conciseness.

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