TAMPA, Fla. - Pancreatic Cancer is the No. 4 cancer killer in the US and compared to the other leading causes of cancer death has historically received the least amount of funding to advance research efforts. Moffitt Cancer Center takes a proactive approach in hopes of increasing chances for early detection methods while also searching for a cure.
More than 115 people a day are diagnosed with pancreatic cancer, meaning 42,400 individuals learn of their diagnosis each year. In the United States, the 5-year survival rate is at only 6%, which according to the American Cancer Society is the lowest survival rate of all types of cancer. While pancreatic cancer typically strikes those in their 60s and 70s, it doesn’t strictly adhere to that age group, according to the American Cancer Society.
Pancreatic Cancer is one of the few cancers for which survival has not improved substantially over the last 25 years. However, those that make it past the first year have been known to live significantly longer today than those diagnosed before 2006.
Part of the reason for the poor survival is the fact that there are no reliable methods to diagnose pancreatic cancer at an early, operable stage.
“One promising strategy to reduce the number of people affected by pancreatic cancer is to identify and treat premalignant pancreatic cysts called intraductal papillary mucinous neoplasms,” says Jennifer Permuth, Ph.D., M.S., assistant member in the Departments of Cancer Epidemiology and Gastrointestinal Oncology at Moffitt. “IPMNs are established precursor lesions to pancreatic cancer that account for approximately half of all asymptomatic pancreatic cysts incidentally detected by computerized tomography (CT) scans or magnetic resonance imaging (MRI) in the U.S. each year. IPMNs are also detected in individuals at increased risk to develop pancreatic cancer because of a family history of the disease or a known inherited predisposition due to an abnormality or ‘mutation’ in a cancer-related gene.
Once detected, there are no ways to accurately predict the severity of the IPMN which can range from a low- or moderate-grade lesion that can be monitored to a high-grade or invasive lesion that should be surgically resected. The only way to treat IPMNs and examine their severity is through removal of the IPMN(s), but high risks are associated with such procedures, especially if someone really has ‘low-risk’ disease. On the other hand, taking a ‘watch and wait’ approach could lead to a missed opportunity to cure a patient with more severe disease than is hidden to the human eye.
Moffitt researchers want to develop a fast, cost-effective blood test that can aid in reliably distinguishing low-risk IPMNs that can be monitored from high-risk IPMNsthat need to be surgically removed. By studying the blood profile of microRNAs (miRNAs), a class of small molecules that regulate key genes involved in the development and progression of cancer, they have made important first steps to try to make this goal a reality in the coming years by conducting a proof-of-principle study. It was funded by the American Cancer Society.
Through funding from the State of Florida and the newly established Florida Academic Cancer Center Alliance, Dr. Permuth, Mokenge Malafa, MD, chair of the department of Gastrointestinal Oncology at Moffitt, and other Moffitt researchers plan to further their research on IPMNs by partnering with researchers from the University of Florida Health Cancer Center and the University of Miami/Sylvester Comprehensive Cancer Center. This new partnership, called the Florida Pancreas Collaborative, represents the first state-wide multi-cancer center collaboration dedicated to conducting research on IPMNs with the ultimate goal of promoting the prevention and early detection of pancreatic cancer. “Considering that Florida ranks second in the number of pancreatic cancer deaths that occur each year and the fact that pancreatic cancer is projected to surpass breast, prostate, and colorectal cancer and become the second leading cause of cancer deaths by 2020, we are thrilled that our state is committed to investing in pancreatic cancer research now,” said Permuth.
Drs. Permuth and Malafa added that early detection and screening studies are the most effective ways for ‘at-risk’ individuals to minimize the potential for developing pancreatic cancer. Screening and diagnostic procedures for pancreatic cysts and other gastrointestinal conditions can be performed at Moffitt’s state-of-the-art endoscopy clinic.
Moffitt Researchers Develop Genetic Test that Predicts which Early Stage Pancreatic Cancer Patients will Have Improved Survival
Only twenty percent of patients with pancreatic cancer have early-stage (stage I or II) disease and are candidates for potential curative treatment that typically includes surgical resection followed by chemotherapy with or without radiation treatment. While the five-year survival rate for curative-intent surgical resection for early-stage pancreatic cancer is 15 to 30%, there is substantial individual variation. Researchers at Moffitt have utilized modern advanced technology and developed a prognostic test that can determine which early-stage pancreatic cancer patients will have a better outcome following surgery.
“There is an unmet need to develop a reliable test which will better predict prognosis for patients with early pancreatic cancer and thereby allow for personalized treatment and the wise investigation of novel interventions. New strategies, such as our discovery of a gene signature that can discriminate between patients, hold the promise that in the future patients who will not benefit from surgery can be identified and offered other treatments that may be more beneficial to them,” said first author Dung-Tsa Chen, Ph.D., senior member of the Biostatistics and Bioinformatics Department at Moffitt.
Moffitt researchers wanted to devise a genetic test that could function as a prognostic indicator to determine which patients with early stage pancreatic cancer are more likely to have better outcomes. They analyzed the genetic signature of 63 patients who had surgery for early stage pancreatic cancer and discovered that low expression of a set of 15 genes was associated with longer survival while high expression was associated with shorter survival. The researchers validated that the 15-gene signature could predict survival by testing it in an independent study with 102 early-stage pancreatic cancer patients and also translated the signature from microarray platform to NanoString platform for future clinical use.
The researchers hope that in the future, patients will be tested for the presence or absence of this 15-gene signature and placed into a surgery/chemotherapy treatment plan only if they will benefit from it. All other patients could be assigned a different treatment plan that could offer a better outcome and longer survival.
Robotic Whipple Surgery
Moffitt was the first to perform a fully robotic Whipple procedure in Florida in 2013. The Whipple is the most commonly performed surgery to remove tumors in the pancreas.
The Moffitt Institute for Robotic Cancer Surgery boasts an advanced minimally invasive and robotic gastrointestinal surgery program. Moffitt is among the highest volume centers for Whipples in the country and is the first to use the da Vinci Surgical System for the procedure in Florida. Using this method allows patients to experience faster long-term recovery with the minimally invasive surgery. It also means shorter recovery times, lower complication rates and smaller scars, as well as higher satisfaction rates.
Dr. Mokenge Malafa, estimates that half of Moffitt’s Whipple surgeries can be performed robotically. Candidates eligible for the robotic Whipple procedure include patients with a tumor in the head of the pancreas that can be treated surgically. The patient must be able to undergo general anesthesia.
While robotic technology is one of the leading innovations in modern surgery, robotic systems are only as good as the surgeons who use them. Nobody understands that better than Moffitt, a high-volume cancer center where surgeons perform robotic procedures virtually every day. Because our surgeons complete robotic operations on a regular basis, they are intimately familiar with the da Vinci® Surgical System and the most effective ways to use the technology during surgery.
Open Screening Studies and Clinical Trials
The Florida Pancreas Collaborative: A Partnership Dedicated to the Early Detection and Prevention of Pancreatic Cancer
This study seeks to discover approaches that may aid in the prevention, early detection, and/or treatment of pancreatic cancer, pancreatic cysts, and other conditions of the pancreas and to accelerate the translation of new research advances to those affected by or at-risk for pancreatic conditions.
Protocol for High-Risk Assessment, Screening, and Early Detection of Pancreatic Cancer at Moffitt Cancer Center
Researchers hope this study will find out whether Endoscopic Ultrasound (EUS) can detect early stage pre-cancerous or cancerous changes in the pancreas in patients at high-risk for the development of pancreatic cancer. Endoscopic refers to the use of an instrument called an endoscope— a thin, flexible tube with a tiny video camera and light on the end. Ultrasound refers to an imaging technique that uses sound waves to produce pictures. EUS in this research study is a method of combining endoscopy and ultrasound imaging to obtain high quality images of the pancreas.
Phase 3 Study of the Efficacy and Safety of Glufosfamide Compared with Fluorouracil (5-FU) in Patients with Metastatic Pancreatic Adenocarcinoma Previously Treated with Gemcitabine
The effectiveness of glufosfamide, an investigational drug, is still undetermined. This study aims to estimate the validity of the drug.
A Phase 1 Trial with Cohort Expansion of Enzalutamide in Combination with Gemcitabine and Nab-Paclitaxel for the Treatment of Advanced Pancreatic Cancer
The purpose of this study is to determinethe dose of enzalutamide that can be safely given with gemcitabine and nab-paclitaxel in patients with advanced pancreatic cancer. Researchers also want to discover what side effects may appear when the drugs are given together. This study will also help determine the effect on tumors when the drugs are used in combination. In the first part of the study, different doses of enzalutamide will be tested. In the second part of the study, all patients will be started at the same dose of enzalutamide.
A Phase 1, Open Label, Dose Escalation Study of MGA271 (Fc-optimized Humanized Anti-B7-H3 Monoclonal Antibody) in Patients with Refractory B7-H3-Expressing Neoplasms or Neoplasms Whose Vasculature Expresses B7-H3
The purpose of this study is to evaluate the safety of MGA271 when given by intravenous (IV) infusion to patients with refractory cancer. The study will also evaluate how long MGA271 stays in the blood and how long it takes for it to leave the body, what is the highest dose that can safely be given, and whether it may have an effect on tumors.
A Phase 1 Trial with Cohort Expansion of BYL719 in Combination with Gemcitabine and (Nab)-Paclitaxel in Locally Advanced and Metastatic Pancreatic Cancer
Researchers will use this study to determine if BYL719 is safe to be given to patients in combination with gemcitabine and nab-paclitaxel. Gemcitabine and nab-paclitaxel is an FDA-approved regimen to treat pancreatic cancer. The study will also allow researchers to see the effect this drug combination has on tumors.
A Phase 1/2 Study Exploring the Safety, Tolerability, and Efficacy of INCB024360 in Combination With MEDI4736 in Subjects With Selected Advanced Solid Tumors
Determining the safety and toleration of Epacadostat and Durvalumab when combined and given together in patients with previously treated lung cancer, melanoma, head and neck cancer, or pancreatic cancer is the purpose of this study. It will also determine a tolerated dose of this combination to be further explored, and to assess if these types of cancer respond to the combination of study drugs.
A Phase 1, Open-Label, Multicenter, Safety Study of Nivolumab (BMS-936558) in Combination with Nab-Paclitaxel Plus or Minus Gemcitabine in Pancreatic Cancer, Nab-Paclitaxel / Carboplatin in Stage IIIB/IV Non-Small Cell Lung Cancer or Nab-Paclitaxel in Recurrent Metastatic Breast Cancer
Assessing the safety of nab-paclitaxel based chemotherapy regimens administered prior to and/or in combination with nivolumab in Pancreatic Cancer, Non Small Cell Lung Cancer (NSCLC) and Metastatic Breast Cancer (mBC) is the purpose of this study.
Nov. 7— PurpleStride Tampa Bay 2015 is the signature event of the Pancreatic Cancer Action Network. The 5K Run and Family-Friendly Walk at Albert Whitted Park in St. Petersburg is presented by Stan Weaver & Company for Carol Roberts. For details or to register, click here.
About Moffitt Cancer Center
Located in Tampa, Moffitt is one of only 45 National Cancer Institute-designated Comprehensive Cancer Centers, a distinction that recognizes Moffitt’s excellence in research, its contributions to clinical trials, prevention and cancer control. Moffitt is the top-ranked cancer hospital in Florida and has been listed in U.S. News & World Report as one of the “Best Hospitals” for cancer care since 1999. With more than 4,600 team members, Moffitt has an economic impact in the state of $1.9 billion. For more information, visit MOFFITT.org, and follow the Moffitt momentum on Facebook, Twitter and YouTube.