• Posted June 2, 2022

Experimental Therapy May Be New Tool Against Pancreatic Cancer

In what could turn out to be a potential breakthrough in the treatment of pancreatic cancer, a new report suggests a key component of a patient's immune system can be rewired to assassinate tumor cells.

The experimental approach has already shown promise in one patient.

Kathy Wilkes, 71, had been struggling with advanced pancreatic cancer that had spread to other organs and proven largely unresponsive to complicated and painful treatments since her diagnosis at age 67.

"I just went through with it. I certainly wasn't ready to die," the Florida resident told the New York Times. "I had this voice inside saying, 'You can best this one.'"

In 2021, she was treated with the new therapy.

The novel approach, described in the June 2 issue of the New England Journal of Medicine, focused on a particular type of white blood cell known as T-cells, which naturally fight infections.

Wilkes received a single treatment, which involved several days of infusion with the re-engineered killer T-cells. Eleven days later, she was discharged. Within a month, cancerous tumors in her lungs had diminished by upwards of 67%.

Wilkes continues to fare well a year later, according to the study team led by oncologist Dr. Rom Leidner, of the Earle A. Chiles Research Institute in the Providence Cancer Institute in Portland, Ore.

"We are cautiously optimistic," Wilkes told the Times.

During a Wednesday briefing by the journal on Wilkes' case, NEJM Editor-in-Chief Dr. Eric Rubin noted that an extremely complex rejiggering process showed that "we can also take those [T-cells] and engineer them so they can kill tumor cells."

In essence, it's a "very specific kind of immunotherapy," he explained. Immunotherapy typically involves treating patients with targeted medicines that prompt the patient's immune system to attack and kill cancer cells.

Rubin described the achievement as both "encouraging" and "a big step" forward. In theory, he said, it could point the way towards markedly improved treatments both for pancreatic cancer and "other diseases that are relatively recalcitrant to therapy."

In the case of pancreatic cancer, Rubin stressed that having more effective interventions would be a welcome development, given that "pancreatic tumors are very difficult to treat, have high mortality rates and people die very quickly."

According to the American Cancer Society (ACS), 7% of all cancer deaths each year are the result of pancreatic cancer, even though the disease accounts for just 3% of all cancer diagnoses.

The ACS estimates that more than 62,000 Americans will receive a pancreatic cancer diagnosis -- and nearly 50,000 will die -- this year alone.

Current treatments for pancreatic cancer include surgery to remove cancerous cells; radiation; chemotherapy; and/or the nonsurgical killing of cancer cells (ablation) by exposing them to extreme heat, cold, radiofrequencies and/or alcohol.

Unfortunately, outcomes are often poor, though how well a patient fares depends on how advanced their disease is at diagnosis.

For example, among patients whose tumors remain confined to the pancreas -- about 42% are still alive five years following diagnosis, the ACS notes. But among those with advanced disease -- meaning their cancer has spread to other areas such as the lungs, liver or bones -- five-year survival is pegged at just 3%.

Rubin cautioned that what has been achieved so far is a preliminary result seen in just one patient. Another patient who received the same treatment did not respond and died of her disease.

"We have yet to really see proof that it's going to work with any consistency in people," he noted, adding that the experimental approach "is certainly far from a cure."

Still, some experts heralded the finding.

"This outcome is a dramatic improvement over the arduous chemotherapy concoctions commonly used today that confer only a few months advantage," said Dr. Cesar Castro, a physician investigator with the Massachusetts General Hospital Cancer Center in Boston.

Castro, who was not part of the study team, said the new approach "is a worthy early effort that could conceivably be personalized to other patients' unique tumors, and start to make a dent in pancreatic cancer outcomes."

And Lynn Matrisian, chief science officer at the Pancreatic Cancer Action Network (PanCAN), added that the findings should be seen as "an attractive strategy that has potential to benefit many patients with this dismal disease."

More information

There's more on pancreatic cancer treatment at American Cancer Society.

SOURCES: Eric Rubin, MD, PhD, editor-in-chief, New England Journal of Medicine; Cesar M. Castro, MD, MMSc, associate professor of medicine, Harvard Medical School, and physician investigator, Massachusetts General Hospital Cancer Center, Boston; Lynn Matrisian, PhD, MBA, chief science officer, Pancreatic Cancer Action Network (PanCAN); New England Journal of Medicine, June 2, 2022; New York Times