Early Detection May Define the Future of Pancreatic Cancer Care

John Whyte, MD; Lynn Matrisian, PhD, MBA


November 05, 2021

JOHN WHYTE: Welcome, everyone. I'm Dr. John Whyte, the chief medical officer at WebMD. And you're watching Cancer in Context.

Pancreatic cancer: It affects nearly 60,000 people a year. Where are we in terms of advancements and diagnostics? Typically, it's a cancer that's difficult to diagnose. We've had challenges with screening tests. There's been limited treatments. But we have made some progress in the last few years.

Joining me today is Lynn Matrisian. She's the chief science officer of the Pancreatic Cancer Action Network, often known as PanCAN. Lynn, thanks for joining me today.

LYNN MATRISIAN: It's a pleasure to be here, John.

JOHN WHYTE: Well, let's start off in reminding our viewers about pancreatic cancer. How does it typically present?

LYNN MATRISIAN: Well, as you said, it is quite hard to diagnose. So the symptoms are back pain, stomach pain, indigestion, nausea maybe, and things, that, especially in older individuals, we kind of take for granted. And so, sometimes it's not really recognized as being a symptom of a disease like pancreatic cancer.

JOHN WHYTE: And sometimes doctors misdiagnose it. We don't immediately come to cancer of the pancreas when someone presents with abdominal pain. So it often takes some time, which then can make it challenging, because people present with higher-stage pancreatic cancer, and then treatments can be challenging. And let's be honest, we've all heard stories in the press of celebrities who have gotten pancreatic cancer and the outcome hasn't been great. We all know people that have had pancreatic cancer. Tell us a little bit about where we are with treatments.

LYNN MATRISIAN: So, yes, you're right. Unfortunately, about half of the individuals who are diagnosed with pancreatic cancer, it's already metastasized. It's already at stage IV, and that really limits our ability to treat them. So, the real treatment then is chemotherapy. And there are some chemotherapy regimens that are used. But we certainly wish they would be much better. They really have limitations.

JOHN WHYTE: And Lynn, what are some of those chemotherapies? We're using that as a broad term, in terms of treatment. But maybe walk us through a little bit about that for our viewers.

LYNN MATRISIAN: Yes, there are really two regimens, chemotherapy regimens, that are used frequently for metastatic pancreatic cancer, and that's a combination called gemcitabine plus Abraxane. And the other combination is four drugs called folfirinox that are used in combination. And they're both classic chemotherapies that are really designed to kill growing tumor cells.

JOHN WHYTE: And where do you see us going in terms of treatment? What's on the horizon?

LYNN MATRISIAN: So there's a lot of clinical trials ongoing in pancreatic cancer. And they include immunotherapies, so ways to activate the immune system to attack the cancer. They include some alterations in metabolism. Pancreatic cancer cells use a different metabolic system than normal cells. And that's perhaps an opportunity. And there's also this dense stroma around pancreatic cancer, connective tissue that not all tumors have. And there's some interesting approaches to try to loosen that up, so that the chemotherapies can work better against the cancer cells.

JOHN WHYTE: And there's lots of clinical trials going on. And we always want to encourage folks to learn about clinical trials and consider them because it might be right for their individual circumstance.

I want to get back to what we started early on, in terms of how pancreatic cancer is one of those cancers that's hard to diagnose, because people present with symptoms that can be a lot of other conditions. We've had challenges with good screening tests. We don't have a colonoscopy for pancreatic cancer or mammograms, as we do for colon cancer and breast cancer. But there have been some exciting advances in screening. And you've been one of the folks that have been an advocate and have been talking about these different screening technologies. Can you fill our audience in on what's going on in potential screening for pancreatic cancer?

LYNN MATRISIAN: Yes, you're right. There have been some advances. Researchers have been working for a long time to find an easy way to find a pancreatic cancer, and that's been a difficult challenge. But lately, there's been two tests that just came on the market, that at least is a start towards a screening and early detection test for pancreatic cancer. One is specifically for pancreatic cancer. It's called the IMMray PanCan-d test, and the other one is for multiple cancers, and that's called the Galleri test. But that one also can pick up pancreatic cancer early.

JOHN WHYTE: Now who are these tests for? And we should caution: There are some caveats about all of these different types of tests and how effective they are. But who should consider having one? Is it for general screening? Is it for when there is some concern that there might be pancreatic cancer? What's the latest recommendation?

LYNN MATRISIAN: So, in particular, for the IMMray test, the one that's pancreatic cancer-specific, that is for individuals that are at high risk for pancreatic cancer. So it isn't really for the general population. High risk means having familial pancreatic cancer, which means that in your family, there are two first-degree relatives that have been diagnosed with the disease. So that family, then, as a family member, you would be at risk for having inherited, in essence, the predisposition to get pancreatic cancer.

The other group is where we know that there's an inherited predisposition gene, so there's genes that we know that individuals inherit that cause an increased probability of increased risk of getting sometimes multiple cancers and sometimes pancreatic cancer.

JOHN WHYTE: So that's the first test. Tell us about this Galleri test.

LYNN MATRISIAN: So the Galleri test is a multi-cancer detection test. And that means it can detect up to 50 cancers with a blood test. That's for individuals over 50 years of age. Now both of these tests need to be ordered by a physician. So there needs to be, in essence, a reason for ordering the test. But they're both now commercially available, and that's really an advance -- something that we didn't have just a short time ago.

JOHN WHYTE: But even the second test isn't considered for general screening, for just anyone. Is that right?

LYNN MATRISIAN: That's right. It really needs to be ordered by a physician. There should be a reason. It is indicated for individuals over 50 years of age. And in essence, it needs to be ordered by a physician.

JOHN WHYTE: Does it replace any other type of screening tests?

LYNN MATRISIAN: Neither one of them are diagnostic tests. They both require subsequent workup in order to really determine whether pancreatic cancer, or any other cancer, exists or not. In itself, it's an indication, that either an image needs to be taken, or some sort of biopsy needs to be taken, some sort of subsequent test that would then determine, for sure, whether cancer was there or not. These are not diagnostic tests. They're an early indication that subsequent workup would be required.

JOHN WHYTE: And folks should talk to their doctors about the pros and cons of these tests. But they're really exciting when you think about where we are today versus where we were a few years ago. And this concept, correct me if I'm wrong, that cancer cells really shed some fragments and these tests, primarily blood tests, are trying to find these fragments, which might be an indication of a certain type of cancer.

LYNN MATRISIAN: Yes, you're absolutely right. It really is a testament to the research community that they've been able to develop the technology that allows us to find those tiny little pieces that indicate that there might be a cancer someplace in the body. It's really quite remarkable.

JOHN WHYTE: What does pancreatic cancer care look like in 5 years? What is PanCAN going to be talking about?

LYNN MATRISIAN: That's a great question. Yes, I do think that these kinds of early detection tests are going to make a remarkable change in pancreatic cancer care. We're going to be able to find the cancers when they're much smaller, and that gives those individuals the potential of going to surgery. Right now, only about 15% of pancreatic cancer patients can get surgery, and that's really the best chance of long-term survival. So I'm really anticipating seeing a nice shift in the stage at which patients are diagnosed, and therefore more treatment options, and therefore much longer survival.

JOHN WHYTE: Well, Lynn, I want to thank you for taking the time today to chat. I want to thank you for all that PanCAN is doing to help advocate for patients, families that have pancreatic cancer, or have it in their family lines. And really saying, “How do we get more effective screening, how do we get more effective treatment?” So thank you for all that you're doing.

LYNN MATRISIAN: And if anybody has any questions about pancreatic cancer, please, we have a call center, a helpline. Contact us through our website, pancan.org. We're happy to help with any questions that may come up about pancreatic cancer.

This interview originally appeared on WebMD on November, 1, 2021

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