MarketWatch Article Aug. 2009
Dirty Dancing" star Patrick Swayze, Apple co-founder Steve Jobs and Supreme Court Justice Ruth Bader Ginsburg all share one amazing feat. They've so far survived pancreatic cancer, the fourth leading cause of cancer deaths in the U.S.
For years, research into this lethal disease has suffered from chronic under-funding, but some developments are yielding new hope -- and new research dollars.
Consider the case of Jeff Ross. In April 2003, Ross was working in his yard when he passed out. "When I came to about two minutes later, the pain across my abdomen was excruciating," he said.
The following July, the then-54-year-old Laguna Beach, Calif.-based certified public accountant underwent Whipple procedure surgery to remove a growth in his pancreas, a tiny organ to the right of the abdomen that helps digest food, regulate blood sugar and produce insulin. His doctor extracted a malignant tumor, then sent him to a radiation oncologist who said that with radiation, he might live another year.
Ross opted instead to visit another oncologist who aggressively applied both radiation and chemotherapy. After an exhausting six-month regimen, he appeared to be cancer-free.
"I asked, 'was I in remission?' and the oncologist said he wouldn't use that word," Ross said. "It wasn't until the five-year anniversary that he said, 'I guess I saved your life.'"
Six years later, Ross is a diabetic and suffers from hypertension, side effects from the stress his body underwent during his treatments. But he also is one of a fortunate 5% of pancreatic-cancer victims who live five or more years after diagnosis. The aggressive therapy likely would not have worked if the cancer had metastasized, or spread into surrounding organs such as the liver.
In 2009, an estimated 42,470 people will receive the diagnosis. Of the newly-diagnosed, about 75% die within the first year no matter what treatment they receive, and patients with metastatic disease may survive just three to six months, according to the American Cancer Society. Survival rates haven't budged
While most other cancers have seen a rise in survival rates, the rate for pancreatic cancer has stayed steady for the past 30 years. A major reason is the lack of symptoms. Most patients don't realize they have cancer until it is at a late stage and already metastatic, said David Kooby, associate professor of surgery in the division of surgical oncology at Emory University School of Medicine in Atlanta.
The symptoms that do eventually manifest are often mistaken for signs of diabetes or abdominal or gastrointestinal issues, such as abdominal or back pain, weight loss, jaundice, appetite loss, nausea and stool changes.
Another challenge is that significantly fewer dollars are available to inspire scientists to pursue research, said Julie Fleshman, chief executive of the Pancreatic Cancer Action Network (PanCAN), a national nonprofit organization providing research funding, patient support and advocacy for a cure.
"If you compare the five-year survival rates and funding for the major cancers, there absolutely is a correlation," she said. "Those cancers [that] have the most research funding have better outcomes."
Federal funding for pancreatic cancer research was $87.2 million in 2008, a 20% increase from 2007. Still, that's much less than the some $248 million spent on lung cancer, $274 million on colon cancer, $285 million on prostate cancer and $573 million on breast cancer -- the four other top cancer killers.
Conversely, five-year survival rates are 98.9% for prostate cancer, 88.7% for breast cancer, 64.4% for colon cancer, and 15.2% for lung cancer.
The Pancreatic Cancer Research and Education Act, a bipartisan bill recently introduced in the U.S. House of Representatives, would be the first major federal measure to increase disease awareness and prioritize National Cancer Institute funds for research into new screening and treatment methods.
The bill is expected to be introduced in the Senate soon, Fleshman said.
High-profile cases bring attention
One reason why pancreatic cancer funding has lagged behind other major cancers is the lack of survivors, including celebrity spokespeople, to advocate for the cause, Fleshman said.
But that's changing. The recent high-profile cases of survivors such as Swayze, Jobs, and Ginsburg -- as well as people who've died in recent years, including Randy Pausch, the Carnegie Mellon professor who told his story in the popular book "The Last Lecture"; opera tenor Luciano Pavarotti; NFL Players Association President Gene Upshaw; and former Detroit Pistons coach Chuck Daly -- have focused a spotlight on the disease.
"We've absolutely seen a spike in the visibility and awareness of the disease with the number of times it has been mentioned in the media recently," Fleshman said. Also, the volume of donations to PanCAN has jumped 55% in the 12-month period through June, while the $10 million total was 18% higher than the previous year.
More research dollars definitely translates into more scientists interested in a disease and developing studies, said Dr. Daniel Laheru, associate professor of oncology at the Johns Hopkins University School of Medicine in Baltimore, Md. New avenues of research
If dollars are available, a map of the entire genetic blueprint for pancreatic cancer completed by Johns Hopkins researchers could provide a guide for developing a host of more effective chemotherapy drugs, he said. Currently, only three medications have received FDA approval for pancreatic cancer treatment -- fluorouracil (5-FU), gemcitabine (Gemzar®) and erlotinib (Tarceva®).
The blueprint includes various pathways that are present in patients with pancreatic tumors. Through molecules and chemical signals, these pathways allow cancer cells to instruct each other how to grow and spread.
"If you can identify which pathways are turned on in pancreatic cancer and only in pancreatic cancer, you can target those pathways and leave normal cells alone," Laheru said. "The implications of this work are not going to be realized for years to come."
San Diego-based biotech start-up Kalos Therapeutics Inc. is trying to raise capital to start human clinical trials on another provocative therapy that has cured human pancreatic tumors in animal studies at James A. Haley Veterans Administration Medical Center in Tampa, Fla. There Dr. David Vesely has been injecting large doses of peptides, hormones which occur naturally in the human heart, into mice.
"A lot of times you hear with pancreatic cancer that the medicine shrunk the tumor and it grew back," said Dr. Vesely, professor of medicine at the University of South Florida. "This is different. The peptide hormones stopped the tumors from growing, made them go completely away, and they never grow back."
While the heart makes peptides in order to lower blood pressure, it cannot create enough to battle the cancer, he said. If human trials are successful, the results could be significant not just for pancreatic cancer sufferers but for patients with a variety of cancers, he said.
Vesely's research also has yielded encouraging results in eliminating breast cancer and small cell lung cancer, and peptide therapy is already being tested in Australian human clinical trials for treating congestive heart failure.
"It's probably important to stress that we have not tried this therapy on a single human with cancer, but we are very hopeful," he said. Survivors had unique cancers
As for the recent celebrity survivors, their better-than-average outcomes likely reflect the unique attributes of their cancers, Kooby said.
Apple's Jobs was one of 5% of sufferers with a less malignant variety of the cancer, while Ginsburg's tumor was tiny and found at an early stage. Both underwent surgical removal. Swayze's condition was inoperable, but his 18-months-and-counting likely has to do with his tumor's position and precise characteristics, said Kooby who did not treat the actor.
Those factors likely played into Swayze's ability to qualify for a clinical trial at Stanford University Medical Center which combined chemotherapy and radiation therapy using CyberKnife, a device which uses a robotic arm to focus radiation more precisely on hard-to-reach tumors.
While an intriguing new strategy, it must be investigated further to assess whether it can meaningfully increase survival rates, Kooby said. "He's at 18 months, but that's not five years."
For the some 20% of patients whose tumors can be removed with the Whipple procedure, followed by radiation and/or chemotherapy, that strategy continues to hold the best prognosis, Kooby said.
Scientists also are studying stem cells for treatment strategies and trying to develop screening techniques for high-risk individuals. A PanCAN registry lists 115 ongoing clinical trials.
"In the big picture," Fleshman said, "this is a really exciting time."