A diagnosis of pancreatic cancer is especially devastating. Survival rates are poor – at just 12%, it has the lowest rate of all major cancers – and treatment options are limited.
Part of the problem is that pancreatic cancer is rarely caught soon enough. Symptoms include fatigue, unexplained weight loss, new onset diabetes, a change in stools, stomach and/or back pain, and loss of appetite, and these can often be put down to other things.
Meanwhile, the pancreas itself, located deep in the abdomen where it quietly helps the body regulate blood sugar and digest food, is a relatively low-profile organ.
“About 80 to 85% of the time, people with pancreatic cancer are diagnosed too late for curative treatment,” says Liam Willis, executive officer at the Gut Cancer Foundation. “Most patients aren’t eligible for surgery because the tumour has spread to other organs or wrapped itself around a blood vessel.”
Shifting the dial on pancreatic cancer is a priority. The Gut Cancer Foundation has committed close to $250,000 to three different trials in New Zealand aimed at improving survival rates and potentially stopping the disease in its tracks.
“Bringing these trials to New Zealand means we can give Kiwis the opportunity to get the latest treatment options,” explains Willis.
Two of the projects are co-ordinated by the Australasian Gastro-Intestinal Trials Group. The Masterplan trial uses an advanced technique called stereotactic radiation to shrink the tumour and try to improve survival rates for those who are able to have surgery. And Ascend aims to improve life for those whose cancer is too advanced for surgery – their current survival time is around 8-11 months – by adding a new tumour-penetrating peptide to the chemotherapy regime.
“This won’t provide a cure but it may give people longer with their loved ones and a better quality of life,” says Willis. “All participants will receive a chemotherapy treatment that is available in Australia but not currently to patients here, so everyone will get a better standard of care.”
The third trial is New Zealand-driven. This one is particularly exciting as it is working to prevent pancreatic cancer from developing.
Many of us form small cysts inside the pancreas, particularly in later life. Most are benign but certain types of these cysts are far more likely to progress to cancer. Generally, people find out they have a problem only because they are suffering from another health issue, and the cysts are picked up during screening for that.
“At the moment, the only treatment option is major surgery to take out the pancreas, which instantly makes someone diabetic,” explains Willis. “If a patient is unwell already, they may not be able to have surgery. This trial is looking at a way to remove the cysts by injecting chemotherapy. This is an endoscopic procedure, so it is minimally invasive. Other studies we’ve seen suggest the cysts don’t come back again. So, you’re eliminating what may be as high as a one-in-four chance of someone getting pancreatic cancer.”
Other cancers have seen huge improvements in treatments and survival rates, particularly breast cancer. Willis hopes advances in research will help make a difference for pancreatic cancer, whether it’s getting more patients to surgery, finding preventive options or helping people live longer when they are diagnosed at a later stage.
Internationally, there are attempts to develop a blood test to screen for early pancreatic cancer. Some progress has been made at Melbourne’s Walter and Eliza Hall Institute of Medical Research, where they have identified proteins that signal the most prevalent form of the disease. Meanwhile, at New York’s Memorial Sloan Kettering Cancer Centre, researchers are trialling an mRNA vaccine to reduce the chance of pancreatic cancer returning after surgery.
“There is some exciting stuff going on out there, but the reality is, it needs to,” says Willis. “When you look at upper gastrointestinal cancers, there are some seriously poor survival rates. Pancreas cancer is the nadir, but we are very heavily invested in looking at ways to change outcomes for all of these cancers.”
