The pancreas (orange) is a small digestive organ located near the stomach. Pancreatic tumors are hard to detect early and are not easily treated with surgery or chemotherapy once they spread to other organs.
Just 7% of people with pancreatic cancer are alive after five years. The pancreatic cancer survival rate after ten years is less than 2%.
Yet among these dismal statistics is a faint glimmer of hope. Some people with pancreatic cancer manage to beat the odds, surviving for many years after their initial diagnosis — maybe even long enough for doctors to use the word “cure.”
“Nobody knows why these patients live longer than other people with pancreatic cancer,” says Vinod Balachandran, a surgeon-scientist affiliated with the David M. Rubenstein Center for Pancreatic Cancer Research and a member of the Parker Institute for Cancer Immunotherapy at Memorial Sloan Kettering who specializes in the disease. “But something is clearly setting them apart.”
In a study, he and his colleagues set out to identify what that something is. Suspecting that the immune system might be involved, they looked at the number of immune cells present in a tumor and found the more immune cells, the longer the survival.
What’s more, they were able to identify the particular components of the tumor that drew those immune cells in. The results, reported in the journal Nature, have implications for the design of more-effective immunotherapies for people with all types of cancer, including the deadly pancreatic cancer.
Uncloak and Dagger
Dr. Balachandran and his colleagues, including Jedd Wolchok, Timothy Chan, Steven Leach, and Taha Merghoub, looked at patients whose pancreatic tumors were surgically removed and who in some cases received subsequent chemotherapy. Compared with pancreatic tumors from people who had low survival rates, tumors from long-term survivors (average survival of six years) had nearly 12 times the number of immune cells called T cells inside them. The presence of many T cells meant a better pancreatic cancer prognosis.
T cells are specialized at distinguishing foreign invaders, like infections and cancer, from normal body cells. They recognize bits of proteins on the cells’ surface called antigens, which serve as a kind of molecular fingerprint.
Dr. Balachandran and his team took a closer look at the antigens found in the tumors. They focused on a subset of these called neoantigens, which cancer cells accumulate as a result of mutations when they divide. The group discovered that tumors of long-term survivors contained particularly good neoantigens — ones that T cells could recognize as foreign. As Dr. Balachandran explains, these neoantigens may have, in effect, uncloaked the tumors to T cells, allowing T cells to attack and kill them.
Even more striking, T cells recognizing these neoantigens were present in the blood of long-term survivors up to 12 years after the tumors had been removed by surgery. This result suggests that the immune system in these people had generated long-lasting “memory” of the cancer and was keeping it in check. “We think that these long-term survivors highlight how neoantigens can be used in generating long-lasting immune responses against tumors,” Dr. Balachandran says.
An advantage of the study was its relatively large size. “Before our work, the largest study looking at long-term survivors of pancreatic cancer had only eight patients,” Dr. Balachandran says. “We had 82.”
To further define what makes a good neoantigen, the MSK team joined up with computational biologists Benjamin Greenbaum and Marta Luksza from the Icahn School of Medicine at Mount Sinai. They built an algorithm to predict the best neoantigens out of the many possible ones. These results were reported in a separate article, also published in Nature.
Back to topBoosting Immune Responses
Knowing what the immune system is seeing in particular tumors opens the door to therapeutic approaches geared toward deliberately focusing on these targets. For example, doctors could make a therapeutic cancer vaccine composed of several distinctive neoantigens identified from a patient’s own tumor. A form of personalized immunotherapy, this type of vaccine would help boost the immune system against those targets that are most likely to generate an effective and lasting immune response. Recent reports have demonstrated the feasibility of this approach in people with other cancers.
Is pancreatic cancer curable? The answer is a long way off, but immunotherapy will likely play an important role if this goal is achieved.
“We think our findings are a step forward in being able to predict rationally which neoantigens will be the most effective at stimulating an immune response,” he says. “We envision using these results to design more effective cancer vaccines to be used in combination with other immune therapies.”
The team is now engaging with the pharmaceutical companies Genentech and BioNTech to determine how to use these insights in clinical trials evaluating personalized neoantigen vaccines in a spectrum of cancers, including pancreatic cancer and melanoma. “We are determined to move this forward to clinical trials as quickly as possible,” Dr. Balachandran says.
Back to topComments
Federico Agnir
Nov 10, 2017 • 4:10 PM
Memorial Sloan Kettering
Nov 10, 2017 • 5:13 PM
In reply to I have been diagnosed with… by Federico Agnir
Dear Federico, we’re very sorry to hear about your diagnosis. If you would like to speak with someone at MSK about whether there may be a clinical trial that you could participate in, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment, and best wishes to you.
Aerick Ngu
Nov 30, 2017 • 4:55 AM
Hi, my dad had been diagnosed with stage 4 pancreatic cancer in Malaysia earlier on this November 2017. The doctor in Malaysia advice not to have any surgery or chemotherapy but I feel there is hope after reading your website. Is there any hope for us to send him over to your hospital for treatment or your hospital actually have some working partner in Asia?
Dear Aerick, we’re very sorry to hear about your dad’s diagnosis. If he would like to come to MSK for treatment, or have his medical records reviewed, you can contact our International Center at international@mskcc.org or go to https://www.mskcc.org/experience/become-patient/international-patients for more information. Someone at the center may also be able to refer you to a hospital that is closer to you. Thank you for your comment, and best wishes to you and your family.
Jeri Shevat
Dec 15, 2017 • 10:52 AM
Memorial Sloan Kettering
Dec 15, 2017 • 10:58 AM
In reply to I will be a 5 year survivor… by Jeri Shevat
Diana Halvey
Mar 4, 2018 • 5:39 PM
Memorial Sloan Kettering
Mar 5, 2018 • 2:33 PM
In reply to My husband was diagnosed in… by Diana Halvey
Judy
May 27, 2018 • 9:40 PM
Dear Judy, we’re very sorry to hear your brother is going through this. We recommend that you discuss your concerns with his medical team. If he would like to come to MSK for a second opinion, he can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment, and best wishes to you and your family.
Jim Gillen
Jun 7, 2018 • 10:09 AM
My wife is a 6-year survivor. She had the Whipple in 2012, but the cancer had spread to her lungs. She has numerous nodules which have been held in check by Abraxane and Gemcitobine, but she is worn out from 6 years of treatment. We have begun exploring options after two bouts with pancreatitis. Does Sloan Kettering have anything to offer in treatment options?
Memorial Sloan Kettering
Jun 7, 2018 • 12:35 PM
In reply to My wife is a 6-year survivor… by Jim Gillen
Jim, we are sorry to hear about your wife’s condition. If you would like to come to MSK for a consultation to learn about treatment options, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information.
Thank you for your comment, and best wishes to you.
Cheryl Lynn Blosser
Jun 9, 2018 • 7:51 AM
This is a super interesting article. I have a twist on it this Saturday morning. Could it be that the people who live longer than 5 years to 12 years really never had pancreatic cancer in the first place. Maybe they just had a tumor on their pancreas from another cancer and they were misdiagnosed!? Maybe they are being treated with the wrong chemotherapy in the first place and the wrong chemotherapy is actually decreasing their life span. Maybe people who are doing too well should be paid even more attention to to look at the reason why instead of just to continue to treat them incorrectly.
Hana Blume
Sep 14, 2018 • 4:49 PM
Memorial Sloan Kettering
Sep 17, 2018 • 9:55 AM
In reply to Given the implications that… by Hana Blume
S B
Oct 12, 2018 • 2:19 PM
We are sorry to hear about your brother’s diagnosis. If he is interested in coming to Memorial Sloan Kettering for a consultation or having his records reviewed, he can contact our International Center by calling 1-212-639-4900 or going to https://www.mskcc.org/experience/become-patient/international-patients. The email address is international@mskcc.org.
Teri S
Nov 12, 2018 • 8:06 PM
Senta HB
Nov 15, 2018 • 8:42 AM
Dolly Thomas
Nov 18, 2018 • 10:58 AM
Memorial Sloan Kettering
Nov 19, 2018 • 8:59 AM
In reply to Whipple March 2011 for 7cm… by Dolly Thomas
Ashley
Dec 18, 2018 • 7:14 PM
Dear Ashley, we’re very sorry to hear about your dad’s diagnosis. If he would like to come to MSK for treatment, the number to call is 800-525-2225. You can go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment and best wishes to both of you.
John
Dec 21, 2018 • 4:34 AM
My mom was diagnosed with pancreatic cancer just 6 hours ago. She was losing weight this last year, went from about 117lbs to 90lbs this week as you would barely eat much.
She's 90 years and 6 months old now, with Diabetes, AFIB, Congestive Heart Failure, She beat Breast Cancer over 20 years ago, beat Colon Cancer with the help of Dr Weiser at MSK just one of the best Laparoscopic surgeons on the planet!
Had a valve replacement TAVR 6 years ago, PAD surgery on both legs I can go on and on with more.
But with PC I don't see the point at this late stage of her life and frail health.I have to let her go, I'm devastated
John
Anthony
Dec 26, 2018 • 2:10 PM
My Brother was diagnosed with stage 2 pancreatic cancer September 2018. 2 tumors in his pancreas. They were too close the doctor claimed to a blood vessel so hw was given a light dose chemo markers went down he looks great(lost his hair) first ct with contrast he told the tech he felt wet ant cold. He was wet on his side. Sylvester hospital in Miami wanted new scans those were not clear. They came back and now he’s a stage 4 spread to the liver. All because of a scan. His blood check fine then? Now we’re lost. Went from your going to be cured to 50/50. I want him to come to Sloan. He had an A blood transfusion. His white count drops slightly. I knew he was better off going back to our roots NYC. PLEASE ANY HELP YOU CAN PROVIDE..Many blessings to all who are fighting. Don’t stop. I fight and pray for all of you!!!
Anthony
Dear Anthony, we’re very sorry to hear about your brother. If he would like to come to MSK for a consultation, the number to call is 800-525-2225. You can go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment and best wishes to both of you.
Kathryn Ringrose
Jan 18, 2019 • 2:03 AM
My husband is 80 years old. In February, 2018 he was diagnosed with stage four metastatic pancreatic cancer and a return (in the lung) of earlier prostate cancer. We now know that he is brca 2. In March he began treatment with Gemcitabine and Abraxane and by July all of his tumors were gone (at least radiologically). His oncologists say that he is in remission, but the question now is where to go from here: continue chemo? stop chem? chemo with platinum? parp inhibitors? take a watchful break? He has never had any symptoms of pancreatic cancer - his tumor was found by accident on a scan, but it was tested carefully and is definitely an adenocarcinoma. Initially he lost weight, but has put that back on and then some. The chemo is proving to be hard on his body and he is beginning to show some early signs of neuropathy. If you know of someone who has dealt with a case of this kind please let us know and we will call to arrange a consultation.
Memorial Sloan Kettering
Jan 21, 2019 • 9:19 AM
In reply to My husband is 80 years old. … by Kathryn Ringrose
Kathryn, we are sorry to hear that your husband is going through this. It is not unusual for pancreatic cancer to cause no symptoms. We are glad to hear that he appears to be in remission. We recommend that you discuss your concerns about the chemotherapy effects with his medical team. If he would like to come to MSK for a second opinion, he can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment, and best wishes to you and your family.
Terry Drake
Feb 15, 2019 • 4:29 PM
My husband had patriotic cancer in 2005 he had two tumors removed and went through chemo he has less than 10% of his pancreas left has had diabetes every since the operation. He’s doing very well but after reading about the survival rates I’m very worried! He just turned 60 and they’ve stopped his oncology appointments because they say he’s cancer free now but I’m still worried I think He should still be going to the oncologist for routine bloodwork what are your thoughts on this?
Memorial Sloan Kettering
Feb 16, 2019 • 10:13 AM
In reply to My husband had patriotic… by Terry drake
Gary Robinsonv
Feb 28, 2019 • 7:35 PM
Survivor of stage 2A Whipple , 5 fusion chemo with 120 radiation treatments, then 6 months of Gemcitabine. September 18 , 2013 began, ended July of 2014. Routine checkups, bouts of IBS never was diabetic until September 2018 two weeks in MICU with sepsis. Now type 1 diabetic, just had my A1C blood lab today saw my AKLP-277. Read up on this, and now worried again. I am 65 will turn this July. Cabinet maker Architectural millworker, installer, never a smoker or drinker. Never abused drugs, but feeling poorly these last few month. Have a oppointment with a gastroenterologist at UAMS on 3/11/19. Was hoping to make the 2% list. Any thoughts. Gary
Memorial Sloan Kettering
Mar 1, 2019 • 8:10 AM
In reply to Survivor of stage 2A Whipple… by Gary Robinsonv
Dear Gary, we’re sorry to hear you’re not feeling well. If you would like to arrange a consultation with one of our doctors, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.
Elizabeth
Mar 7, 2019 • 1:34 AM
I would like to encourage everyone seeking medical advice and solutions to medical concerns. Remember, to try Jesus, as he is still in the miracle working business.
I pray for all of our doctors, researchers, and pharmaceutical communities that God, continue to give you resources, strength, insight, energy, knowledge, creativity, and visions of cure's.
I pray healing for those in need and wisdom, strength, and courage to those administering, help, healing and favorable and unfavorable diagnoses.
Peace and good health to all!
Domenica
Mar 7, 2019 • 12:08 PM
Dear Domenica, there are no screening standards for pancreatic cancer, but because you know that you carry this mutation, we recommend that you speak with a genetic counselor about your overall cancer risk. If you’re interested, you can make an appointment with MSK’s Clinical Genetics Service by calling 646-888-4050. Thank you for your comment and best wishes to you.
Marianne
Mar 7, 2019 • 2:11 PM
My mom was diagnosed with pancreatic cancer in 2001. She had a whipple procedure done at that time and was given a 2-5 year survival rate. It is now March 2019, and my mom is still with us. While her health is not perfect, she still goes out and gets her hair done, a trip to a restaurant, a few hours at the casino, etc. She is a miracle for sure. I thank God every day that she is still with us. That whipple procedure saved her life.
Robert Mabry
Mar 7, 2019 • 6:41 PM
Angela
Mar 7, 2019 • 8:07 PM
Just a thought, I truly wonder if the people who have beat pancreatic cancer because they have these abundance of T-cells had a co existing condition like psoriatic arthritis or a different autoimmune disease. These patients may be prone to cancer but would have an already over-active amount of t-cells due to the autoimmune disease. This would contradict the fact that the pancreatic cancer patient developed these abundant tCells during a period in which they had cancer but rather they had already been produced before the cancer. I wonder if the study tracked pre/co -existing diseases.
Randye Ringler
Mar 8, 2019 • 1:08 AM
Wondering if someone with an autoimmune disease would possibly have a better chance then of fighting off a recurrence of pancreatic cancer? I noticed after the Chemo that my immune system was squelched enough hat my Crohn’s symptoms were not as strong so I am curious about these connections. I know that autoimmune patients are excluded from the PC immunology trials.
Lisa VanLonkhuyzen
Mar 9, 2019 • 5:16 PM
Memorial Sloan Kettering
Mar 11, 2019 • 8:54 AM
In reply to My husband was diagnosed… by Lisa VanLonkhuyzen
Karen Perrupato
Mar 10, 2019 • 12:32 AM
My husband was diagnosed with pancreatic adenocarcinoma. It was an accidental early finding. He had surgery at MSK in October. Stage 1, no evidence of spreading and no lymph node involvement. We were told surgery was successful. As a precaution he was started on an aggressive regime of folfirinox every 2weeks. We have that done closer to home. He’s completed 7 of 14 cycles. Needless to say we are hoping to beat the low survival rate. When he became a patient at MSK he signed consent for clinical research and genomic profiling. How do we go about receiving results of tumor testing?
Memorial Sloan Kettering
Mar 11, 2019 • 8:40 AM
In reply to My husband was diagnosed… by Karen Perrupato
Karen Perrupato
Mar 10, 2019 • 12:58 AM
Memorial Sloan Kettering
Mar 11, 2019 • 8:38 AM
In reply to This article was from… by Karen Perrupato
Dear Karen, you can read about the latest research in pancreatic cancer in this blog post. Thank you for your comment.
Salvatore Lombardo
Mar 10, 2019 • 10:20 AM
My grandfather passed away in 1982 of PC at the age of 67. My dad passed away at that same age but because of a car-related accident, so I’d never know if he’d have gotten PC. I’m now 56 but would be interested in knowing if there are any tests that can be done early to screen for PC. I’ve also signed up for one of those DNA testing sites with the hope that I could be forewarned of a gene I might have that hints at an increased risk of PC. Am I overthinking this? Is there any information you can share with me to help? Thank you in advance.
Memorial Sloan Kettering
Mar 11, 2019 • 8:32 AM
In reply to My grandfather passed away… by Salvatore Lombardo
Dear Salvatore, if you are concerned about your family history of cancer, we recommend that you speak with a genetic counselor who is an expert in hereditary cancers. If you’re interested in making an appointment with MSK’s Clinical Genetics Service you can call 646-888-4050.
Thank you for your comment and best wishes to you.
R. MACALISANG
Mar 10, 2019 • 12:10 PM
Memorial Sloan Kettering
Mar 11, 2019 • 8:28 AM
In reply to How is PC diagnose, symptoms? by R. MACALISANG
I have been diagnosed with stage 4 pancreatic cancer that has metastasized to the liver. I was diagnosed August 15, 2017. Is there any hope for me?