"A lot of us are not aware of our pancreas,” said Kim Reiss Binder, MD, a gastrointestinal oncologist and clinical researcher here at Penn Medicine. “It’s not an organ that gets much press."
She's not wrong. The pancreas, a glandular organ that produces hormones like insulin, isn’t exactly a household name—and neither is pancreatic cancer. Despite being one of the deadliest cancers of 2018—third only to colorectal cancer (50,630 deaths) and lung cancer (154,050 deaths)—many people aren’t aware of the facts of pancreatic cancer.
What causes it? Why are the five-year survival rates low? How effective are treatment options? Oncologists and clinical researchers at Penn Medicine’s Abramson Cancer Center are working to answers these questions—and finding new ways of treating the disease.
Why pancreatic cancer rates are on the rise
According to Dr. Reiss Binder, “There are a couple of different risk factors for pancreatic cancer that are also becoming more common on a population level.”
For one thing, pancreatic cancer is age-associated, she said: “People are typically in their 60s to 80s when they’re diagnosed with pancreatic cancer. So the fact that the population is aging will make you see a rise in any disease that’s age-associated.”
Other risk factors include “obesity, sedentary lifestyle, and diabetes—and those things are also all unfortunately on the rise,” she added. “So that explains another chunk of why pancreatic cancer is becoming more common.”
Why pancreatic cancer is so life-threatening
Pancreatic cancer has a low (roughly nine percent) five-year survival rate. One of the primary reasons for this is “that it’s very often diagnosed when it’s no longer curable,” Dr. Reiss Binder said.
For many cancers, like breast cancer or colon cancer, patients have access to regular screenings to detect whether or not they’re developing a malignancy. With pancreatic cancer, though, “There is as yet no approved standard screening test.”
Pancreatic cancer also doesn’t produce many clear symptoms in its early stages, “so, by the time a patient presents us with a symptom, the disease is—in 90 percent of cases—already inoperable,” the oncologist said.
Another major reason pancreatic cancer can be so detrimental is that the disease itself has “a very aggressive disease biology,” making it difficult to treat. The pancreas is swaddled in a thick stroma, which is a tissue that “shrink-wraps” the organ, as Dr. Reiss Binder put it. “That stroma blocks chemotherapy from getting in. It blocks immune cells from getting in. It makes the disease much harder to reach.”
But Penn researchers are developing new ways of reaching it.
Immunotherapy offers new hope to pancreatic cancer patients
For many years, chemotherapy, radiation therapy and surgery have been on the frontlines in the fight against various forms of cancer. Now, after years of research and clinical trials—much of which originated here at Penn—immunotherapy is joining them in the fight.
Immunotherapy, an intravenous drug treatment administered similarly to chemotherapy, uses medications to “enhance the effects of the immune system,” according to Mark O’Hara, MD, a gastrointestinal oncologist at Penn Medicine.
As a cancer develops in the body, it’s also developing “immune-suppressive signaling,” Reiss Binder explained. In short, this means the t-cells—the cells that act on behalf of the immune system—are not activating in the presence of cancer cells.
“The cancer essentially sends out a signal that turns the cell off, so the cell just hangs out and doesn’t do anything,” which allows the cancer free rein.
Through immunotherapy, the cancer can be “uncloaked,” she said. The t-cells recognize the cancer as a threat, and they “recruit an army, so to speak, and help to kill the cancer.”
This form of cancer treatment has proven effective in a number of malignancies. However, because of the pancreas’ difficult-to-penetrate stroma, immunotherapy for pancreatic cancer has been “relatively unsuccessful up until this point,” Reiss Binder added.
But there’s hope.
Basically, doctors are pairing immunotherapy with other forms of cancer treatment, like chemotherapy or radiation; by first attacking the pancreas with one of these treatments, the stroma may weaken, allowing immune cells to enter and do their job.
“You bust up those cells, and then give a combination of immunotherapy agents to really try to rev up the immune system so that it recognizes those antigens and then attacks,” Dr. Reiss Binder explained. “Then, once the immune system has memory for what it’s looking for, it can run around and find any place within the body where this kind of rogue cell-type may be living.”
The Abramson Cancer Center currently has numerous clinical trials employing approaches to immunotherapy. If interested, look into Penn’s many relevant clinical trials here and request an appointment to discuss them.
For even more information on pancreatic cancer treatment and pancreatic cancer survival rates, visit our Pancreatic Cancer Research Center page.