It is estimated that more than 60,000 Americans will be diagnosed with pancreatic cancer in 2021. That is more than 160 people every day and a 5% increase over last year’s estimate.
Pancreatic cancer is the third-leading cause of cancer-related deaths in the U.S., and despite significant advances in radiographic and endoscopic staging, improved surgical treatments and chemotherapy, the overall five-year survival rate is less than 10%.
Compared to other cancers, pancreatic cancer can be more difficult to diagnose. This disease currently does not have effective screening tests, begins to metastasize early, and shows vague early symptoms.
Dr. Ramsay Camp, chief of surgical oncology in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, working alongside Dr. Ben Musher, medical director of medical oncology at the Dan L Duncan Comprehensive Cancer Center, have initiated a clinical trial with the potential to improve the prognosis for patients with pancreatic adenocarcinoma.
Currently, only 5% of pancreatic cancer patients nationwide are enrolled in clinical trials. Camp and his team are hoping to change that by using a unique combination of immune checkpoint therapy and chemotherapy.
Immune checkpoint therapy is a type of immunotherapy that targets regulatory pathways in T cells to enhance anti-tumor immune response. It’s effective against many cancers, but on its own, it has not proven effective for pancreatic cancer patients.
Pancreatic cancer tumors actively suppress the immune system through a variety of strategies. Immunotherapy such as immune checkpoint therapy harnesses the patient’s own immune system to fight the cancer. Checkpoint therapy such as programmed cell death protein 1 inhibit these molecules to make the T cells work most effectively. In the case of checkpoint therapy, the treatment essentially allows the tumor-fighting T lymphocytes to become activated.
Most pancreatic adenocarcinoma tumors are immunologically “cold,” as defined by the lack of effector T cells in the tumor. Traditionally, this is partially attributed to the low mutational load of pancreatic cancer that yields few neoantigens for T cells to recognize. In contrast to melanoma and non-small cell lung cancer, immune checkpoint therapy as a single agent has been ineffective.
Recently, numerous studies in cancers such as lung and breast cancer have shown that a combination of the immune checkpoint therapy administered alongside cytotoxic chemotherapy creates a response that is more promising than the treatments alone. Camp and his team are aiming to harness and refine those findings in their trial.
Camp’s trial, which is funded by Merck, is called “Phase II Study of Neoadjuvant FOLFIRNOX Chemotherapy Combined with Pembrolizumab Followed by Surgery for Patients with Localized, Resectable Adenocarcinoma of the Pancreas.” The study will consist of providing chemotherapy with immunotherapy to patients who have pancreatic cancer and are candidates for surgery.
“Clinical trials are essential for pancreatic cancer because we desperately need to improve upon the status quo, which still does not cure enough patients,” Camp said. “I am particularly excited for this trial to use traditional chemotherapy, not only to shrink the tumor, but to activate tumor-killing T cells with the addition of immunotherapy.”
“Through in-depth study and characterization of the trial’s immune activity, we will gather clues as to how the drugs work and why they work,” Camp said. “We hope to create better treatment protocols for patients with this serious cancer.”
See pancreatic cancer clinical trials at Baylor.
-By Amanda May, senior communications and corporate affairs associate in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine