Pancreatic cancer discussed at Sanford Burnham Prebys

It can’t be often that names like Alex Trebek and Steve Jobs come up in a lecture at the Sanford Burnham Prebys (SBP) Medical Discovery Institute. But the La Jolla institution’s quarterly Insights series presents updates and breakthroughs in medical science to lay audiences. And, during Nov. 21’s event, both the host of television’s “Jeopardy” and the co-founder of Apple were discussed as examples of how not to deal with pancreatic cancer.

Trebek, who is end-stage, has already stated that he wished he didn’t ignore the persistent stomach ache he experienced before his diagnosis. And Moores UCSD Cancer Center professor of surgery Andrew Lowy — Sally Ride’s physician until she died of pancreatic cancer in 2012 — explained why Jobs should still be rolling out new iPhones to this day.

“He had a rarer type, which tends to be a slower-growing, less-aggressive form of the disease which, if localized, most of the time can be cured with surgery,” Lowy told an audience of 30.

“He had an operable tumor when he was diagnosed and he elected not to have surgery. When he did elect to have surgery, he elected to have an operation that never works, which is a liver transplant.

“He was a brilliant guy except when it came to managing his health,” Lowy said.

Insights begins with 20-minute talks by a doctor, a SBP scientist and a patient about a specific disease. The speakers then sit down together to field audience questions. Lowy was joined by SBP Medical Discovery Institute assistant professor Cosimo Commisso and six-year pancreatic cancer survivor Russell Gold.

Although pancreatic cancer is still a rare disease that only 1.5 percent of Americans will develop, it accounts for 3 percent of total U.S. deaths and is the third most-common cause of cancer death in the U.S. (It is projected to become the second in the 2020s.) Its five-year survival rate is only 9 percent — so low because the cancer is usually aggressive and invasive, and symptoms do not show up until it is too late for a cure.

However, if pancreatic cancer is caught early enough — before tumors grow bigger than half a centimeter — 90 percent of people can be cured with surgery, Lowy said.

“That tells us we have to do a better job of finding this early,” he said. “Really, what’s going to be a breakthrough is some type of other screening test like a blood test.”

Lowy said one test currently being evaluated is CancerSEEK from Johns Hopkins, which screens for biomarkers from six or seven of the most common cancers. Others look for panels of proteins that are expressed more often in pancreatic cancer patients. He said all look promising.

Drugwise, a lot of hope had been pinned on PEGPH20 from Halozyme Therapeutics, but it failed in its phase 3 trial earlier this month.

“Preclinical data on PEGPH20 looked pretty solid,” Commisso said. “But one of the things we haven’t done very well is learn why drugs don’t work. We move on. But we’re missing an opportunity.”

Commisso’s research specialty is how tumors get their nutrients. He explained that when the cancer masses get hungry for nutrients, they grow tentacle-like extensions and send them out to capture sugars, amino acids and vitamins from the body.

“What we’re trying to do in the lab is stop this process,” Commisso explained, adding that an answer does not seem too far down the road.

Until better tests and drugs are developed, however, Lowy recommends the current standard of pancreatic-cancer screening — tests such as endoscopic ultrasound and the Invitae Pancreatic Cancer Panel — but only for high-risk individuals.

These include those with a strong family history of pancreatic cancer and those with precancerous cysts already detected in their pancreas. Screening should start 10 years before the family member developed it, he said.

“Screening the whole population will probably never be possible,” Lowy said, “because the incidence of the disease is too low.”