Editor’s note: In our “Let’s Talk About” series today, we’re focusing on the newly released American Cancer Society’s Cancer Facts and Figures 2022, which reports that the five-year survival rate for pancreatic cancer has increased from 10% to 11%. Here, Lynn Matrisian, PhD, MBA, PanCAN’s Chief Science Officer, talks about the importance of this increase, as well as some of the challenges for pancreatic cancer specifically, and how PanCAN drives progress.
PanCAN: While it is good news to see the five-year survival rate for pancreatic cancer increase to 11%, we know that many other cancers have higher survival rates. Why is this? What are the challenges for pancreatic cancer as compared to other cancers?
Lynn: When pancreatic cancer is diagnosed, it’s often already metastatic. With many other cancer types, we have the opportunity to find it before it spreads to distant sites – we can find a physical lump or identify it through specific symptoms. When it’s all in one place, surgery is effective. But as soon as it starts to spread, then we have to go to chemotherapy, a more systemic way to try to control cancer.
About 50% of pancreatic cancer is already metastatic when it’s diagnosed. That’s a challenge. And only about 15 to 20% of cases are eligible for surgery. So even when it’s still localized to the pancreas, sometimes it’s too close to blood vessels to be safely removed. The lack of surgery as an option is one of the main reasons pancreatic cancer is such a challenge to treat.
PanCAN: What is contributing to the progress we’re seeing related to the survival rate?
Lynn: When we report the five-year survival rate, we’re actually looking at patients who were diagnosed up to 11 years ago. We are just catching up now -- some of those survival increases are from drugs and approaches that were approved a decade ago, like the chemotherapy treatments Gemzar® + ABRAXANE® and then FOLFIRINOX. In addition, survival from these same drugs has improved over time because our supportive care got much better. We have learned how to mitigate some of the side effects from these treatments.
The use of chemotherapy in combination with surgeries for pancreatic cancer, like the Whipple procedure, has also evolved. It used to be that patients were either considered eligible for surgery or got chemotherapy. Now, doctors often give chemotherapy first before surgery – called neoadjuvant therapy. In some cases, this treatment, delivered systemically, makes a patient who wasn’t originally eligible able to have surgery, which is clearly a benefit. And in theory, the systemic therapy can kill some of the little circulating cancer cells that are starting to be metastatic. At the moment, there isn’t clear consensus or strict guidelines on the use of neoadjuvant treatment in the United States, so additional clinical evidence will be necessary to define best practices.
PanCAN: Since January is Pancreatic Cancer Clinical Trials Awareness Month, we’d love to hear more about how clinical trials contribute to the increase in survival rate.
Lynn: There are two main ways we improve survival. One is early detection. We catch the cancer earlier, giving people more chance for surgery, more chance for chemotherapeutic agents to work. PanCAN is working to improve early detection through our Early Detection Initiative, which is a clinical trial exploring whether imaging some patients at the time of new-onset diabetes can find pancreatic cancer in time for surgery.
The other way we improve survival is by making treatments for more advanced disease better. How do we make them more effective? How do we lessen side effects so that people can tolerate treatment longer? Those are the types of studies that pancreatic cancer clinical trials have been focused on -- in particular studies of chemotherapy since we see so many patients whose disease is either initially metastatic or becomes metastatic. The way that we find better treatments is we test new drugs and approaches in people with pancreatic cancer to see how they compare to the treatments we currently have.
The clinical trial process is how we make progress against pancreatic cancer. This is how we learn. This is how we make advances. But it’s not only good for everyone, it’s good for each individual patient as well. Sometimes a patient gets the standard of care, sometimes they get the new experimental drug, but either way, they’re very closely monitored. They get the absolute best care that we have. We very much encourage individuals to consider clinical trials at all stages of their pancreatic cancer journey.
PanCAN does its best to not let knowledge of trials be a barrier. The more representative our clinical trial population is of the population that gets pancreatic cancer, the better we understand whether a drug is going to be more effective or not. We keep a comprehensive database of clinical trials and we make sure that it’s as up-to-date as it can possibly be. We know which trials are open and their eligibility requirements. We try to give people good information that they can share with their oncologist to help make the best decisions for their treatment.
PanCAN: How is PanCAN’s work contributing to the increase in survival?
Lynn: We have a comprehensive approach to improving patient outcomes. We have levers that we can use across the whole spectrum. I, of course, am very focused on research. It’s through research that we’re going to improve treatment and improve early detection, and that’s how we’re going to get to better survival. But you can’t do research without funds. You also need patients to be aware of and participate in clinical research. Supportive care is important. All of those things contribute to the survival rate.
I’m very proud of PanCAN because of our comprehensive approach. We’re saying, “This is a complex process. We’re going to figure out as many ways as we can to make things better so that we can get where we want to go.” That’s a very practical, realistic and effective way to approach a complex disease like pancreatic cancer.