The future for pancreatic cancer
Difficult to diagnose and difficult to treat, pancreatic cancer is predicted to become the second most common cause of cancer-related deaths in the UK within the next few years. So said Professor Roger Kirby, President of the Royal Society of Medicine, as he welcomed three pancreatic cancer experts to share the platform for the 2023 London Clinic lecture.
Titled ‘Pancreatic cancer – the future’ this public lecture presented the latest updates on pancreatic cancer surgery, the biology of pancreatic cancer and oncological research and treatment for pancreatic cancer.
“Around one in 71 people will get pancreatic cancer so it is important that we have a plan as to how we're going to handle this disease,” said Mr Krish Menon, Consultant Liver Transplant and Hepatobiliary Surgeon at King's College Hospital NHS Foundation Trust.
His talk covered the history of pancreatic cancer surgery, the anatomy of the pancreas and the significant challenges of operating on patients with tumours involving important adjacent blood vessels, known as borderline resectable pancreatic cancer.
“Of every hundred patients you see, you can operate on 15, maybe 20 at best,” he said. “It's a complex operation, taking four to six hours to at best, if it all goes smoothly.”
Mr Menon then presented the evidence for different surgical approaches, the correct approach for tumours involving the blood vessels and the options for shrinking the tumour with chemotherapy prior to surgery.
He concluded his talk by emphasising the relevance of biology in this area. “There is no doubt that biology is king,” he said as he introduced Professor Hermant Kocher, Professor of Liver and Pancreas Surgery at the University of London, to talk about the interface between the laboratory and the hospitals where he works.
Professor Kocher and his research teams focus on understanding tumour stroma (the tumour stroma mainly consists of the basement membrane, fibroblasts, extracellular matrix, immune cells, and vasculature) for the early diagnosis and treatment of pancreatic cancer. He began his talk by describing the cross-talk between different cells in the pancreas, and the amplified signals which allow cancer cells to proliferate, invade, migrate and spread throughout the body.
He then described the pioneering research he is leading at the Barts Cancer Institute which is aiming to make chemotherapy more effective for locally advanced pancreatic cancer, including the STARPAC-2 randomised controlled trial currently underway in patients with arterial and venous involvement. “This is the first time we’ll be able to understand whether the locally advanced pancreas cancer has a different genetic make-up,” he said. “And we hope to develop a lot of biomarkers using our national tissue bank.”
Professor Kocher went on to talk about the Pancreatic Cancer Research Trust Tissue Bank, hosted at the Barts Cancer Institute, which researchers can use to request samples or data for their own work.
“This is the world’s first and only national tissue bank for pancreas cancer and we are now having global impact. I’m very proud that we have helped a number of researchers further their research into new diagnostics and new treatments for pancreatic cancer,” he said.
The final speaker was Professor Shivan Sivakumar, Clinical Career Development Fellow at the University of Oxford, whose talk was titled ‘Will there ever by any oncological developments in pancreatic cancer?’
He began by examining the five-year survival of different cancers over a span of 50 years, where there has been significant improvement in the UK. But unfortunately, this does not include pancreatic cancer, which is at the bottom of the league table. “There’s clearly a great clinical and scientific challenge to improve this,” he said.
Currently the mainstay is chemotherapy, although the response rates and the actual survival benefits from treatment “aren’t great”, he said. There is some agreement to giving immunotherapy within this disease, but only for the one in two hundred patients who have a particular syndrome called the Lynch syndrome.
“Oncologically, we’re going to do better if we capture people quicker and earlier,” said Professor Sivakumar, who talked about the work he and his team in Oxford are doing using big data. Some of the projects he described included a project published with a GP academic colleague looking at 28,000 patient health care records from primary care with a diagnosis of pancreatic cancer; and identifying common symptoms that are subsequently (in some patients) associated with a pancreatic cancer diagnosis. He and his group are also identifying the phenotypes of T-cells (immune cells) within pancreatic cancer; and in the largest ever single cell experiment within pancreatic cancer have identified “a whole host of cells” and “a lot of interesting biology that we’re exploring, especially among the myeloid cells.”
Professor Sivakumar believes there is a route for drug discovery within pancreatic cancer that doesn’t necessarily need to involve big complex studies. “Essentially, you get five to 10 patients, give them a novel therapeutic and resect [cut out] the patient’s tumour after two to three cycles of treatment,” he said. “With the tumours resected, we’re able to look, biologically at if the drug has worked or not. If it hasn’t worked, we don’t really have to run a phase two or phase three trial and spend a billion plus developing that drug.”
The meeting ended with questions to the three speakers from the audience, chaired by Professor Kirby, and an agreement amongst the panel and audience that there are at last grounds for optimism in the treatment of pancreatic cancer, with new drugs and therapies on the horizon with the capability to increase survival rates.
‘Pancreatic cancer – the future: 2023 London Clinic lecture’ was held at the Royal Society of Medicine on Monday 13 February 2023. It was a public engagement event organised in collaboration with The London Clinic.