Why Do Some People Beat the Odds against Pancreatic Cancer?

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By Matthew Tontonoz

An illustration of the human pancreas

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 survive more than five years. Less than 2% are alive after ten years.

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.

Nobody knows why these patients live longer than other people with pancreatic cancer, but something is clearly setting them apart.
Vinod P. Balachandran surgeon-scientist

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.

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.

Compared with pancreatic tumors from people who had low survival rates, tumors from long-term survivors had nearly 12 times the number of immune cells called T cells inside 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.

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Boosting Immune Responses

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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.

“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.

Pancreatic Cancer Clinical Trials & Research
Through clinical trials, we’re studying new approaches to treating pancreatic cancer and coming closer to finding promising solutions.
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This work received financial support from the National Institutes of Health, the Pancreatic Cancer Action Network-AACR Research Acceleration Network supported by Celgene, the Suzanne Cohn Simon Pancreatic Cancer Research Fund, the National Cancer Institute, the Damon Runyon Cancer Research Foundation, Stand Up To Cancer, the V Foundation for Cancer Research, the Lustgarten Foundation, the National Science Foundation, the Parker Institute for Cancer Immunotherapy, Dr. Robert and Mrs. Nancy Magoon, Cycle for Survival, the Marie-Josée and Henry R. Kravis Center for Molecular Oncology, the Ludwig Center for Cancer Immunotherapy, and Swim Across America.

 

Comments

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Federico Agnir

Nov 10, 2017 • 4:10 PM

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?

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?

Memorial Sloan Kettering

Dec 1, 2017 • 11:46 AM

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

I will be a 5 year survivor in January! I had whipple January 22, 2013. I am cancer free at this time.

Memorial Sloan Kettering

Dec 15, 2017 • 10:58 AM

Thanks for sharing your great news, Jeri! We’re glad to hear you’re doing well. Best wishes to you.

Diana Halvey

Mar 4, 2018 • 5:39 PM

My husband was diagnosed in May 2012 he passed on April 22 2013, when we met with surgeon he was not a candidate for the whipple I am assuming becuase of the stage I have blocked out many of my questions or meetings during that time. I am wondering if immunotherapy is helping new patients.

Memorial Sloan Kettering

Mar 5, 2018 • 2:33 PM

Dear Diana, we are very sorry for your loss. Best wishes to you.

Judy

May 27, 2018 • 9:40 PM

My brother was diagnosed with stage IV PC, he is having issues with blood clots through out, also we can't seem to get him to eat or even drink. Is that normal? also seems to be over medicated.

Memorial Sloan Kettering

May 29, 2018 • 9:07 AM

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?

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

Given the implications that immune responses might be involved in pancreatic cancer survivorship, what are your thoughts on immune system supplementations? e.g. mushroom extracts such as "turkey tail," or marijuana components?

Memorial Sloan Kettering

Sep 17, 2018 • 9:55 AM

Dear Hana, there is no scientific evidence that these products are effective in treating pancreatic cancer. If you are a patient, we recommend that you discuss the use of any herbs or other supplements with your healthcare team. Thank you for your comment and best wishes to you.

S B

Oct 12, 2018 • 2:19 PM

My brother in Canada has been diagnosed with Pancreatic cancer with spots on Liver too. Treatment (flofirinox, then Radiation and now Gemcitabine Nebraxane) is going on. How can we consult with your hospital for further treatment and clinical trial options.

Thanks,

S

Teri S

Nov 12, 2018 • 8:06 PM

Please keep researching anything that can help us live longer after getting treatment. Long-term should mean a lot longer than it does now. Thanks.

Senta HB

Nov 15, 2018 • 8:42 AM

I was diagnosed June 2015; chemo, radiation, Whipple & more chemo later, I've been NED for over three years now. Stage 3B. I'd be happy to donate blood samples for your important research. Thank you for your work!

Dolly Thomas

Nov 18, 2018 • 10:58 AM

Whipple March 2011 for 7cm tumor. Refused chemo and radiation. So far, so good.

Memorial Sloan Kettering

Nov 19, 2018 • 8:59 AM

Dear Dolly, we’re glad to hear that your surgery was successful and that you are doing well. Best wishes to you.

Ashley

Dec 18, 2018 • 7:14 PM

My dad was diagnosed with pancreatic cancer with mets to liver, spleen, and lungs. We need help.

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

Memorial Sloan Kettering

Dec 21, 2018 • 11:09 AM

Dear John, we are so very sorry to hear about your mother’s diagnosis. We are wishing you and your family peace this holiday season.

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

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

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

Dear Terry, this is something that your husband should discuss with his cancer care team. Thank you for your comment and best wishes to both of you.

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

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

I am BRACA 2 positive......and pancreatic cancer is increased is there anything I can do profylactically.....i had my ovaries removed to decrease risk for ovarian cancer what measures can I take to monitor for pancreatic cancer ????

Memorial Sloan Kettering

Mar 8, 2019 • 2:34 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

Thank you for this article. As a 4+ year survivor of adenocarcinoma of the pancreas I continue to hope for breakthroughs in treatment, particularly along the lines of immunotherapy.

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

My husband was diagnosed just this week and will be having the Whipple on Tuesday. His cancer was caught early. Please keep up the important research in this area!

Memorial Sloan Kettering

Mar 11, 2019 • 8:54 AM

Dear Lisa, thank you for your comment. Best wishes to your husband on his surgery this week.

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

Dear Karen, we recommend you discuss this with your husband’s doctors at MSK. Thank you for your comment and best wishes to both of you.

Karen Perrupato

Mar 10, 2019 • 12:58 AM

This article was from November 2017. Has there been any progress since?

Memorial Sloan Kettering

Mar 11, 2019 • 8:38 AM

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

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

How is PC diagnose, symptoms?

Memorial Sloan Kettering

Mar 11, 2019 • 8:28 AM

You can learn more about the symptoms of pancreatic cancer here.

You can learn more about the diagnosis here.

Thank you for your comment.