Why Do Some People Beat the Odds against Pancreatic Cancer?

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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 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.

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. 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.

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. The presence of many T cells meant a better pancreatic cancer prognosis.

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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Therapeutic cancer vaccines train your body to protect itself against its own damaged or abnormal cells — including cancer cells.
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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.

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.

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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Thank you for a great article. I am very interested in the T cell vaccine trials for Her2+ Breast ca.

I had pancreatic cancer 10 years ago. The mass was 10 pounds. They removed the body and tail and been cancer free ever since

My mom passed away 7 weeks after diagnosis of pancreatic cancer, I seem to have followed in her footsteps as far as thyroid problems and a few other health issues and was curious about the genetic testing? What information do have?

I was dianosed with stage 4 in March 2017; I had a 15x5 cm metastasis removed along with both ovaries. 11 rounds of Folifirnox, 4 mos on an oral chemo combo with weekly infusions (zeloda?), then in Juy 2018 I had the tail (incl. tumor) of Pancreas removed along with my spleen. The diagnosed me to have MicroSatelite Instability.......what can you tell me about that condition? I live in Denmark, but went to the US for surgery and will be returning to the Ohio in May this year, to live. I want to find a oncologist that takes interest in me and can guide me through this diagnosis. I have 3 clear scans since surgery. I was treated at Swedish Medical center in Denver by Dr. Kortz (Surgeon) and Dr. Bupathi (oncologist), I feel taht noone knows anything and are unwilling to tell me my future.Thank you

Dear Lillian, we are sorry to hear about your diagnosis. The immunotherapy drug pembrolizumab (Keytruda) is often used to treat cancers with high microsatellite instability. You can learn more about it from this blog post. We recommend you discuss with a doctor whether this drug may be right for you. Thank you for your comment and best wishes to you.

My mother was diagnosed with Pancreatic cancer earlier this year. She is currently doing chemo. Your article gives hope. I'm very interested in obtaining more information for my mother.

Dear Kim, we’re sorry to hear about your mother’s diagnosis. If she would like to come to MSK for a consultation, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to both of you.

My beautiful mother was diagnosed with stage 4 PC and had spots on her liver. She went thru 2 treatments of chemo. After the 2nd treatment, she went downhill for 3 days but my stepdad never told us. He didn't let us talk to her either. We all live out of state, but I live the closest. My brother called and as soon as he heard my mothers voice, he demanded my stepdad call an ambulance. When she got to ER we were told different things by different nurses and the Dr. From being dehydrated to close to a diabetic coma. A nurse told me she had sepsis and was in kidney failure. My stepdad didn't believe me, accused me of making it up, and the last week of my mothers life was spent defending myself to my stepdad and brothers. She aspirated and 3 of her ribs were broken bringing her back to life. 2 hours before she aspirated, my stepdad laid into me, in front of my mother, and I asked him why he was upsetting my mother with this crap when she is so sick? My mother was put on a ventilator and passed the next morning. My mother was the best mother and my best friend. I am unable to get her hospital records because I am not next of kin. Her death certificate stated her cause of death was sepsis and kidney failure. So, he pulled that stuff on me for no reason, never apologized, had her immediately cremated and is spreading her ashes in FL with my brothers, but I am not invited. Can you tell me how I can get a copy of her medical records. I am convinced he wanted her to pass quickly because she hadn't signed the will. He is the only one who cared about the will. My brothers and I didn't want anything but sentimental stuff, her childhood photo album, her favorite sweater, etc. He refused to let us have them and sold everything to a thrift store and wont tell us where. I am devastated as are my brothers. They tell me to drop it but if he knew she had sepsis and pulled that crap on me to upset my mother on purpose, causing her to aspirate, he needs to be held accountable. My mother was always a bundle of nerves. Any little family conflict made her very sick. To pick a fight with me in front of her, accusing me of lying about the sepsis and kidney failure, knowing how bad her nerves were, plus she hadn't eaten in 3 weeks, is very disturbing. I just need to know if I can get copies of her medical records without hiring an attorney. Thankyou for all you do. My mom was so strong heading into her battle. I was so proud of her. She died in a way nobody would ever want their mother to die, and I want to know if he knew she had sepsis and told everyone I was lying. I'm sorry.
My beautiful mother died 5 weeks after diagnosis. God bless everyone fighting PC.

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

I have found this thread to be a big help in knowing that there is good research taking place out there and that there is some hope for PC patients and their families.
My dad was diagnosed 2yrs ago. Underwent whipple surgery and had no chemo. He recently survived a 5 day coma due to high ammonia levels which we thought he would not come through only 2months ago but deteriorated in the few weeks that followed his release from hospital and unfortunately we lost him 4 weeks ago.
Wish we had known of this research sooner however while it cannot help my dad now, I know he would be very happy that it could help others. He worked in the medical industry and knew the prognosis was poor but fought to the bitter end.
If I can assist in any way to help find a "cure" It would be a nice way to honor my dad xx
Good luck to those with this horrible diagnosis. Stay strong.

Dear Janelle, we are very sorry for your loss. Thank you for sharing your father’s experiences. Best wishes to you.

I am 7 weeks post Pancreatic Cancer Surgery, stage 1 b. I am 60 yrs old. I am working with Mayo. Do you work with them. Could my situation be helpful in your studies?
My uncle died of pc 15 yrs ago.

Dear Diane, we’re glad to hear your cancer was caught early. We recommend you discuss the possibility of participating in research with your doctors at the Mayo Clinic. Thank you for your comment and best wishes to you.

In April 2016 after having a sick stomach and pain I was diagnosed with Neuroendocrine Pancreatic Cancer. 80% of my pancreas tail and body tumor was removed, as well as my spleen and 6 lymph nodes, with only 3 having cancer. I didn’t receive any other treatment because all 3 month scans showed only something in my liver. My doctor felt it was a vein only. In February 2017 my liver showed tumors. I was put on a chemo pill Sunitab or something like that. Then switched to Sutent 37.5 and because of blistered feet, switched to Affinitor twice daily. My tumors started to show shrink and continued to shrink until 2018. Then y90 radiation treatment to both sides of my liver. The left side tumors seem to be dead, but the larger right one they didn’t give two treatments as they did left, no clue why but it didn’t die, but shows shrinkage. My last appointment in January still shows all dead in liver. So I was excited and thought I was in remission. That’s when I learned that I have several lymph nodes that are cancerous. I wasn’t told about these or I thought he was talking about my liver. I was told they are slowly shrinking and I am still on a lower dose of Sutent, due to the peeling and blistering on my feet. However the longer I was on the lower dose the side effects of my feet have become just as bad. I’m Praying that you all come up with new meds to slow it down more and maybe cure it. I’m only 54, I’ve been treating three years and I’m not ready to leave my 10 grandchildren.

Dear Krysti, we’re very sorry to hear about your diagnosis. If you’re interested in arranging a consultation with an expert at MSK to learn about your treatment options, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

My father passed away on 4-29-19. he died from complications from pneumonia. He was also a 16 year survivor of stage 4 pancreatic cancer that had also affected liver, stomach, lymph nodes and lungs. He was told he would not make 4 months, let alone 6 months to his 50th anniversary. I'm sorry that i don't have the medical knowledge or know the proper terminology to explain his treatment, but I am here to offer hope in a seemingly hopeless diagnosis. I nor any Dr.s seem to be able to explain why my father was able to beat this horrible disease, but the bottom line is he did, for 16 years. He witnessed three marriages, four graduations, births of four grand children and one great grand child......never give up!

Dear Rick, we are sorry for the loss of your father, but glad to hear that he lived for so long after his diagnosis of pancreatic cancer. Thank you for sharing your family’s story.

My Mom was diagnosed with 2B in April PC.
After her second treatment her CA19.9 went from 45 to 23. PETSCAN to be done after two more treatments. Shouldnt a scan be done now since the number has decreased so much?

Dear Adine, we’re sorry to hear about your mom’s diagnosis. Unfortunately we are not able to answer medical questions on our blog. If your mom would like to come to MSK for a consultation, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to both of you.

My Dad is dignosed with Pancreatic cancer in Mar 2019 and had gone for Whipple in the end of March 2019. He is 73 Years and was never having any disease. Doctors suggested Gemsitabine in Chemotherapy. But my father is reluctant to go for Chemotherapy.
1. Any other way to have this cure.
2. What test gives the Details of the pancreatic cancer. How can I know its decreasing or not?
Thanks for any geniune advice.
Regards,
Chandan

Dear Chandan, we are very sorry to hear about your father’s diagnosis. You can learn about MSK’s approach to treating pancreatic cancer here. Thank you for your comment and best wishes to you and your father.

I was diagnosed with Stage 3 PC following a Whipple in December. Small and large vessel invasions; 25% of 42 lymph nodes were hot. Refused chemo and radiation (had to do Whipple first because of complication with getting biopsy to confirm adenocarcinoma). One said 3-6 months before recurrence. Curious as to what your experience has been in terms of recurrence.

Dear Liz, because every case is different, we are not able to make general predictions like this. If you are interested in speaking with one of our doctors about this, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

My husband is 62 yrs old and found his stage 4 pancreatic cancer by accident while having an ultrasound on May 10th. Later that morning went into outpatient surgery for a scope and a stent put in his duct to assist with jaundice and eating. He had lost some weight and thought he had acid reflux. We saw a specialist at Norton Hospital in Louisville, Ky on March 13th. Surgery and radiation was not mentioned from the ultrasound results that were forwarded. This doctor sent him for a CT head to toe same morning and blood work. Still now surgery or radiation mentioned. Referred us to a cancer center closer to home for chemo on a 21 day cycle. DOES THIS MEAN his cancer has spread too far and his days are numbered? Extremely stressed out thinking that everything has not been done for my husband of 42 years. We will celebrate our 43rd year this month on the 26th. He has too much fishing, farming, bowling and living left to do. What is your suggestion or comments? Thank you.

Vickie, we are sorry to hear about your husband’s diagnosis. Although we cannot comment on individual cancer cases, it is true that surgery is not usually an option for stage IV pancreatic cancer. You can find more information here:

https://www.pancan.org/facing-pancreatic-cancer/diagnosis/staging/stage-4/

https://www.cancer.org/cancer/pancreatic-cancer/treating/by-stage.html

Memorial Sloan Kettering has several clinical trials under way for people with advanced pancreatic cancer:

https://www.mskcc.org/cancer-care/types/pancreatic/clinical-trials

You also might look at clinicaltrials.gov, which has clinical trials for stage IV pancreatic cancer:

https://clinicaltrials.gov/ct2/results?cond=Pancreatic+Cancer+Stage+IV&Search=Apply&recrs=a&age_v=&gndr=&type=&rslt=

I am a Pancreatic cancer survivor. I was diagnosed with a stage IIB adenocarcinoma on the head of my pancrease in July 2016. I had a whipple in Aug 2016. Have been clear so far. My last CT earlier this month showed a few lung nodules that appeared to have grown. My oncologist recommended following it closely and having another CT in 3 months. My next CT is'nt until Sep 6th. mY CA19-9 levels are in the normal range but seem higer than usual, and my alkaline phosphatase levels are high. Should I be concerned? Do you have a clinical trial to increase T-cells that I could be a part of? Please let me know

Thank you for sharing your story. We are not able to offer medical advice on our blog. If you’d like to arrange a consultation with one of our doctors, including to find out about the possibility of participating in a clinical trial, you can make an appointment online or call 800-525-2225. Best wishes to you.

Hi -

My mom is BRACA 2 positive and she now has advanced stage pancreatic cancer with metastasis to liver. Please help, I don't know what to do :(

Dear Jon, we’re very sorry to hear about your mom’s diagnosis. If she would like to come to MSK for a consultation, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you both.

MSK - My mother-in-law had pancreatic cancer and a whipple performed in late March 1989 at the age of 51. She celebrated her 82nd birthday earlier this year. You might want to hear her story...too much to go into here.

We’re glad to hear your mother-in-law is doing well. Best wishes to her and to your whole family!

I am a 13 year pancreatic cancer survivor. I had the Whipple surgery 5/6/2006 followed chemo and rediation. Praising God that I'm still living. I can't find the article now, but it stated that if you lived over 10-12 years, it'spossible that you never had pancreatic cancer. Is there any truth to that? Thanks for your feedback!

Dear Deborah, we’re glad to hear that you’re doing well. Thank you for sharing your story.

Recently lost a relative go PC. Died within 2 months of diagnosis. I am wondering if any attempt made to gather from patients once diagnosed, symptoms however mild, for example, aversion to foods once loved especially ancestral foods, and the time relevant to diagnosis time the symptom started. Hind sight is 20/20.

Dear Sri, we are very sorry for your loss. Best wishes to you and your family.

Our 27 year old son was diagnosed with a Stage 4 Aggressive Endocrine Tumors pancreatic cancer in March of this year. He had 6 rounds of chemo, however after the 6th round, the tumors did not shrink. He is currently on shots every 4 weeks. He will receive a CAT scan on 12 weeks and if the tumors stay the same or continue to shrink he will stay on shots. If they grow, he will begin chemo again. Men between the ages of 20-39 only have a .8% of being diagnosed with pancreatic cancer. It shocks me everyday that our son was one of those. He is a huge fighter and is willing to do anything to beat this horrible disease. I pray everyday that new treatments to extend their life span, put them in long term remission or even cure them comes soon.

My mom (age 78) was diagnosed with inoperable PC on June 6, 2018. She was then given 3-6 months. But now, with chemo and radiation treatments, she's stabilized to some extent but she continues to need blood transfusions, in recent months, averaging once every 5-6 days (when her HB dropped to 4.2) but after APC procedure, her need for transfusion is now in the 21 day range... How long does this continue? Can she make a 'recovery?' She's being treated in Hyderabad, India at Apollo Hospital. Is there a chance she can go into remission with further treatment that you may have to offer? Many thanks

Dear Sadhana, we’re sorry to hear about your mom’s diagnosis but glad to hear she is stable after treatment. We recommend that you discuss her prognosis and future treatments with her medical team. Thank you for your comment and best wishes to you and your family.

My small Pancreatic tumor was found by Ultrasound in Dec, 2018. I had 7 months of tough chemo & 4 weeks of radiation along with a more Chemo. I need to get a final Cat Scan to see where I am. I have some side effects that caused my left arm to become painful when used. Worried that more radiation from Cat Scan will cause more side effects. I am 78. I am afraid of Whipple. Fear that it will cause unpleasant final good life style.I never had any illness in my life before this tumor.

I had whipple in Oct of 2012 and now 6 years cancer free. I am very thankful and one of the lucky few.

We’re glad you’re doing well. Thank you for sharing your story and best wishes to you.