New Treatments for Pancreatic Cancer

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus on Pancreatic Cancer Conference. In this blog, she discusses treatments for pancreatic cancer including proton therapy for pancreatic cancer.

“Penn is setting the standard in terms of survival and outcomes for pancreatic cancer.”
Ursina Teitelbaum, MD, medical oncologist at Penn Medicine

Changing the Paradigm for Chemotherapy

In opening her talk at the recent 2nd Focus On Pancreatic Cancer Conference, Dr. Teitelbaum acknowledged that for many years, pancreatic cancer treatment has characterized by “well deserved gloom.” Gemcitabine, introduced in 1996, was the first drug to show activity against pancreatic cancer, and has been the standard of therapy, but its effectiveness is limited. The multitude of trials using a variety of drugs and combinations of drugs yielded little progress. The scenario began to change in 2010 with the introduction of FOLFIRINOX, a combination of drugs that has demonstrated higher response rates, better control of the cancer and improved quality of life.

The second step in what Dr. Teitelbaum called “sudden, dramatic progress” has been the introduction of nab-paclitaxel, or Abraxane in 2012. Abraxane is a drug that has been used to treat a number of different types of cancer and is currently being tested against several others, including pancreatic cancer. It works by penetrating the stromal tissue, in effect, allowing the other drugs to be more effective in reaching cancer cells. Abraxane given with gemcitabine demonstrates significantly better overall survival for pancreatic cancer patients with advanced disease.

“These new treatments represent a true paradigm shift. It has been a long journey.” Dr. Teiltelbaum

Proton Therapy for Pancreatic Cancer

“The evidence is clear that treatment outcomes for pancreatic cancer are better in centers that treat a high volume of these tumors. These centers of excellence have cutting edge therapies that make a difference.” Edgar Ben-Josef, MD, radiation oncologist at Penn Medicine

Local Control is Important

For many pancreatic cancer patients, local control of their disease is crucial to both improving survival and maintaining quality of life. Many problems caused by pancreatic cancer result from the tumor’s progression around the primary site, not from distant metastases. Radiation therapy can play an important role in helping to achieve this local control. At Penn, sophisticated ways of planning and delivering radiation therapy are improving the outcomes and reducing the side effects for patients with pancreatic cancer. This includes IMRT, which allows doctors to increase the dose to the tumor while reducing the effects on other organs. Another approach teaches patients to hold their breath for 15-20 seconds while the radiation is delivered, overcoming the loss of accuracy that occurs when the simple act of breathing causes the pancreas and other organs to shift their position.

Penn is also involved in research that combines radiation therapy with other treatments, including a study to determine if radiation therapy and Abraxane can improve the prognosis for patients with borderline resectable pancreatic cancers, potentially making these patients candidates for surgery. Another protocol is studying whether high doses of radiation therapy can stimulate the immune system.

Proton Therapy For Pancreatic Cancer

Penn is one of just 10 centers nationally offering proton therapy, a modality that is increasingly being used to treat pancreatic cancer. Protons are another approach to delivering high doses o radiation to the tumor while sparing neighboring tissue. Penn is treating protons to treat advanced stage pancreatic patients with some promising results in extending life and relieving symptoms.

A Safer Approach to Pancreatic Cancer Surgery

The original surgical procedure for pancreatic cancer, the Whipple procedure, had a mortality rate of 30 to 35 percent. According to Robert Roses, MD, surgical oncologist, the major breakthrough that has occurred in surgery for this disease is a significant improvement in its overall safety and reduced complications for patients who undergo the modern day version of the Whipple, known as the pancreaticoduodectomy.

“Our pancreatic cancer patients generally stay in the hospital for seven to 10 days,” says Roses, “and we focus on assuring that they have a good, safe recovery. They do sometimes have setbacks, but they are often self limited and can be well managed. The most important thing is that this surgery is often curative.”

Read More

What’s New in Pancreatic Cancer Research?

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus on Pancreatic Cancer Conference. In this blog, she discusses new advancements in pancreatic cancer research.

Chi Van Dang, MD, PhD, at the 2nd FO Pancreatic Cancer

Starving Pancreatic Cancers

What do pancreatic cancers require to “feed” themselves? How can that information be used to design new treatments for this disease? Greg Beatty, MD, PhD, noted at the 2nd Focus On Pancreatic Cancer Conference that different approaches to imaging are increasingly being used to understand the tumor’s biology. Today, imaging encompasses much more than the standard x-ray or cat scan can provide. Novel imaging modalities allow doctors to understand not just the way tissue looks, but also how it functions and behaves—with significant implications for new approaches to treating cancer.

One such new approach, using FDG-PET, involves looking at metabolic images. Pancreatic cancers require large amounts of glucose—a kind of sugar—in order to grow. Creating visual images of which cells are taking up large amounts of these sugars makes it possible not only to identify cancers, but potentially to find them earlier and to distinguish primary cancers from metastatic disease, as well as providing a useful method of determining if a treatment is working in as little as two weeks from the beginning of treatment. Understanding the metabolism of pancreatic cancer opens the possibility of developing targeted treatments that deprive these tumors of the nutrients they need, in effect starving them to death—work that is already underway at Penn and other research centers.

Improving the Neighborhood

Better understanding of the biology of pancreatic cancers is also one key to another novel approach to treating this disease. Researchers now know that the neighborhood in which the pancreatic cancer exists plays a critical role in helping the tumor to grow.

“Pancreatic cancers form islands of tumor cells surrounded by a sea of what is known as stromal tissue,” says Dr. Beatty. “In animal models, we have seen that this stromal tissue in some ways isolates the tumor. The chemotherapy that we deliver though the blood vessels ends up being far from the cancer cells themselves, and being delivered to the stromal tissue. So the drugs have a hard time getting to the cancer cells. If we can break down the stroma, we can improve the efficiency of our current therapies.”

Better Education for the Immune System

Researchers have known for years that pancreatic cancer somehow co-opts the immune system, educating our natural defenses to help the tumor grow and spread. Now, with what Dr. Beatty describes as an “exponential increase in knowledge about the role of the immune system in pancreatic cancer,” the potential exists for “re-educating” out immune cells to fight the cancer. The neighborhood, or stroma, plays a key role in this approach as well. To use a different analogy, our tissue is like a wall, with the cancer being the bricks and the stroma being the mortar or supporting structure. If you can attack that supporting structure, you can break down the wall—and destroy the tumor.

One new approach uses an antibody known as CD40 to activate the immune system, turning on cells called macrophages to attack and kill cancer cells, and to eat away at the stroma. Another new treatment utilizes specially engineered cells taken from the patient’s own body to activate T-cells to kill cancer cells. Both of these efforts to provide good education to our immune cells are the basis for clinical trials now underway at Penn.

Read More

Pancreatic Cysts: Diagnosis and Treatment

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus on Pancreatic Cancer Conference. In this blog, she discusses pancreatic cysts.

In recent years, the number of pancreatic cysts detected has increased significantly. Most of these are found “incidentally,” meaning that they show up on imaging studies done for other reasons, not because they are causing any symptoms.

The question, according to Vinay Chandrasekhara, MD, Penn gastroenterologist, is “what to do about them?” The key to answering that question lies in determining the type of cyst, and what its potential is for becoming cancerous. Based on that, about half of all pancreatic cysts will require close monitoring or treatment.

The primary difference is between neoplastic cysts—which have the potential to be or become cancerous and non-neoplastic cysts which are largely the result of inflammation and rarely, if ever, become malignant. Dr. Chandrasekhara recently spoke a the 2nd Focus on Pancreatic Cancer Conference and noted there are very specific features that doctors look for when they make this determination. He also noted that, in most cases, this requires a procedure known as a guided aspiration, in which the doctor is able both to visualize the cyst and try to withdraw fluid from it for examination under the microscope.

“What to do about them” depends on the type of cyst, its size and stability. Many patients with worrisome cysts undergo surgery, while others have follow up surveillance to determine if the cyst is growing or changing.

For patients, a pancreatic cyst can be a source of concern or uncertainty. The best approach is to have pancreatic cysts diagnosed, evaluated, followed and if necessary, treated in a center that has experience in this area.

Read More

Genetic Risk and Pancreatic Cancer Prevention

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus on Pancreatic Cancer Conference. In this blog, she discusses genetic factors that may put someone at higher risk for pancreatic cancer.

Anil Rustgi, MD

Of the 40,000 new cases of pancreatic cancer diagnosed each year, approximately 10 percent, or 4,000 of these have a hereditary or familial basis, according to Penn expert, Anil Rustgi, MD, chief of gastroenterology. Patients are anxious to identify family members who are risk for the disease, and take steps to minimize those risks or prevent them from developing pancreatic cancer.

It is important to note that having pancreatic cancer does not necessarily mean that your family is at increased risk. Dr. Rustgi points out that there are very specific conditions linked to higher rates of this disease. They include:

• Hereditary pancreatitis: This is an inherited condition. It occurs early in life, even in childhood, and is characterized by nausea and pain. As the condition becomes more chronic, patients develop severe diarrhea and diabetes. Smoking and alcohol use make the symptoms worse. Having this condition, which is caused by a specific genetic mutation, increases the risk of developing pancreatic cancer by 35%.
• FAMM: Familial atypical mole and multiple melanoma syndrome. This is a rare condition, also caused by a specific genetic mutation. If a patient has two or more family members with melanoma, or one member with multiple melanomas and pancreatic cancer, family members should be tested for this condition.
• BRCA 1 and 2: These genetic mutations are more often associated with breast cancer, but are now being linked to other cancers as well, including pancreatic, ovarian and prostate cancer.

There are several other rare genetic syndromes associated with an increased risk of pancreatic cancer. All of these, according to Dr. Rustgi, are amenable to genetic testing, counseling and intervention.
The GI Genetics Program at Penn can help patients understand their level or risk, establish the source of that risk, educate patients and family members on the best approaches to targeted screening and intervention. It can also identify patients and families who are NOT at increased risk for pancreatic cancer.

Learn more about your risk for gastrointestinal cancer at the GI Cancer Risk Evaluation Program.

Read More

Collaborative Science Brings New Approaches to Pancreatic Cancer Treatment

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus on Pancreatic Cancer Conference. In this blog, she discusses Stand Up To Cancer, and the pancreatic Dream Team at Penn Medicine.

Jeffrey Drebin, MD, PhD

Jeffrey Drebin, MD, PhD, recently spoke about the pancreatic cancer initiative funded by Stand Up To Cancer at the 2nd Focus on Pancreatic Cancer Conference. This grant from Stand Up To Cancer (SU2C) includes scientists and clinicians from Penn, Johns Hopkins and a number of other leading institutions, working together, sharing knowledge and data to develop new treatments for pancreatic cancer. The SU2C grant has led to enrolling over 1,000 patients in clinical trials, with the results of those trials generating new trials that are underway or planned. The SU2C trials are not only multidisciplinary, and multi-institutional, but also translational—meaning that that they are seeking new understanding of the biology and genetics of pancreatic cancer, in order to apply that knowledge to developing new treatments. Promising areas of research include new ways to deliver drugs to cancers, better understanding of the role of neighboring tissue, the stroma, in promoting cancer growth, new approaches to metabolic therapies—those that deprive the cancer cell of needed nutrients, and identifying unique targets on pancreatic cancer cells for which new drugs can be developed.

“We know that pancreatic cancer is an increasing cause of cancer death, and we know that we have not had enough long term survivors of this disease,” says Dr. Drebin, “but we believe that this research will take us to the next stages of treatment, and better outcomes.”

Learn more about Penn Medicine's Pancreatic Cancer Dream Team

Read More

Funding for Cancer Research Saves Lives and Dollars

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus on Pancreatic Cancer Conference. In this blog, she discusses funding for cancer research.

Margaret Foti, PhD, chief executive officer of the American Association for Cancer Research, opened the 2nd Focus on Pancreatic Cancer Conference with a comprehensive overview of the progress made against cancer and the challenges facing researchers, clinicians and patients today. Dr. Foti noted that while there has been significant progress in a “new era of science and medicine,” the global incidence of cancer continues to rise, and “we have not stemmed the tide of many major cancers.”

She pointed to the ongoing need to foster innovative approaches, exemplified by the work at the Abramson Cancer Center, in order to reach the point where we can “deliver the right dose of the right drug to the right patient at the right time.” She also noted that in many instances, cancer is increasingly becoming a chronic disease. Penn, she noted, is “uniquely equipped to translate research, provide access to clinical trials, multidisciplinary treatment and expertise in treating rare and difficult cancers.”

Dr. Foti called on the audience to support a “decisive assault on cancer, harnessing the collective knowledge, passion and smarts of scientists and clinicians from a broad spectrum of fields. She pointed to Stand Up To Cancer’s $200 million commitment in cancer research, which includes a grant to Penn to study new approaches to pancreatic cancer, as an outstanding example of an innovative funding mechanism that brings together researchers from different disciplines and institutions. Dr. Foti called on the audience to tap the power of individuals, the power of public leaders and the power of patient leaders to make cancer research a national priority.

Learn more about Penn Medicine's Stand Up To Cancer Pancreatic Cancer Dream Team here. 

Read More

Treating Pancreatic Cancer with Proton Therapy

For most people, protons are those positive sub-atomic particles they stopped thinking about almost immediately after middle school chemistry class. But, for some patients with pancreatic cancer, there is another positive aspect of protons worth considering—proton therapy for pancreatic cancer.

Proton therapy is a non-invasive medical treatment that uses a beam of high-speed protons to destroy the DNA of cancer cells. This kills the cell and therefore prevents it from multiplying.

For pancreatic cancer patients, the precision of proton therapy treatment adds to the positive results of killing cancer cells. Proton therapy for pancreatic cancer is effective because the beam of protons can be adjusted to target very specific areas, making it perhaps the most advanced treatment for cancer tumors of the pancreas. Proton therapy allows doctors to target radiation doses into the tumor while avoiding harming cells in the nearby liver, kidneys and spinal cord.

Conventional radiation treatment is limited by the amount and frequency of radiation doses it can safely deliver. But with proton therapy for pancreatic cancer, the protons release their energy directly into the pancreatic tumor, limiting the radiation dose beyond that tumor, which causes less damage to surrounding tissue and organs and causes fewer side effects.

Proton Therapy at Penn Medicine

The Roberts Proton Therapy Center is the only center in the Philadelphia region, and one of the few in the world that offers patients pencil beam scanning. Pencil beam scanning is the procedure of tuning a proton beam to a precise range and intensity. With proton therapy for pancreatic cancer, doctors can use this beam to paint the tumor with a powerful dose of extremely targeted radiation.

The Roberts Proton Therapy Center is also the only center in the world that offers multi-leaf collimator precision. The collimator is a device that shapes the proton beam to match a 3-D profile of a patient’s tumor, allowing for proton delivery in the exact shape of the tumor.

More effective treatment with fewer side effects and complications. Learn more about proton therapy for pancreatic cancer at the Roberts Proton Therapy Center.

Read More

Proton Therapy for Pancreatic Cancer

Pancreatic cancer is one of the most difficult forms of cancer to treat because it is so difficult to find.

However, advanced treatments like Penn Medicine’s proton therapy for pancreatic cancer offers new hope and may someday change the statistics, despite the challenges pancreatic cancer poses for both researchers and clinicians.

Why is Pancreatic Cancer So Difficult?

There are currently no detection tools to diagnose pancreatic cancer in its early stages when treatment would be most effective, and the symptoms (abdominal pain, weight loss, jaundice) mimic those of several other ailments. Therefore, pancreatic cancer has the highest mortality rate of all major forms of cancer. Ninety-four percent of those diagnosed with pancreatic cancer die within five years. If the cancer has metastasized, life expectancy is less than six months. Unlike so many other types of cancer, these statistics have not improved substantially in nearly 40 years.

Stephen Hahn, MD (l) and James Metz, MD

Given the typical late detection of the disease, pancreatic cancer has limited treatment options. As symptoms usually arise in the late stages, only 20 percent of patients are still eligible for surgery at the time of detection. For those eligible for surgery, adjuvant chemotherapy and radiation therapy has been shown to increase the five-year survival rate from 10 to 20 percent.

Radiation Therapy for Pancreatic Cancer

As surgery is often not an option, chemotherapy and radiation are the primary forms of treatment for pancreatic cancer. The FDA currently approves only three drugs for chemotherapy treatment. That’s why physicians at Penn Medicine recommend clinical trials for pancreatic cancer when available.

“Most clinical trials are using the best available therapies plus something else,” said Jeffrey Drebin, MD, PhD, chairman of surgery at Penn Medicine. “We hit a lot of singles with our standard therapies; we don’t hit a lot of home runs. Clinical trials offer that chance to be in the group of patients who are first treated with a really new and innovative therapy.”

With radiation treatment, the amount of radiation that can be given with conventional doses is limited due to the proximity of the pancreas to critical organs such as the liver and kidneys, as well as the spinal cord. That is why Penn offers proton therapy for pancreatic cancer treatment at the Roberts Proton Therapy Center.

“It’s all about depositing the dose where you want it,” said James Metz, MD, vice chair clinical division, department of radiation oncology and professor of radiation oncology at Penn Medicine.

“Proton therapy allows us to pinpoint exactly where we want to put that radiation dose while missing the normal tissues,” says Dr. Metz.

This is a key benefit of proton therapy for pancreatic cancer, as exposing normal tissue to radiation causes significant side effects.

“They get nauseous, they get diarrhea, they feel lousy, their quality of life is not as good,” says Dr. Metz of patients undergoing conventional radiation treatment. “Many of the patients that get protons have a tendency to really go through treatment easier, and I think that’s really important from a quality of life perspective.”

Who Can Get Proton Therapy for Pancreatic Cancer?

Not all patients are eligible for proton therapy for pancreatic cancer. Where the tumor is and how it moves inside the pancreas, along with several other technical reasons, helps the cancer team at Penn Medicine to determine the correct course of treatment. The team includes specialists in surgery, medical oncology, and radiation oncology, along with several other disciplines, all collaborating on the patient’s behalf.

“We have to analyze what’s been done before, where you are now, and figure out if that’s the right thing for you,” says Dr. Metz. “It’s not right for everyone. That is something the physician needs to decide when you come in.”

The Roberts Proton Therapy Center is the only place that offers proton therapy for pancreatic cancer in the Philadelphia region.

To set up an appointment to learn if proton therapy is right for you, call 800-789-PENN.

Read More

Meet the Pancreatic Cancer Dream Team

As the fourth leading cause of cancer death in the United States, pancreatic cancer remains one of the most deadly forms of cancer. More than 90 percent of patients die within the first year of diagnosis. Recent advancements have had little impact, and a new approach is desperately needed.

As featured in Time Magazine, Penn Medicine’s Dr. Jeffery Drebin and the Stand Up 2 Cancer Pancreatic Dream Team is answering that call. Their team-based multi-disciplinary approach is translating scientific breakthroughs into new treatment options faster than ever before.

Dr. Drebin and the pancreatic cancer dream team is focused on developing tests using advanced imaging technology to understand pancreatic cancer cells and developing new, personalized pancreatic cancer treatments based on their research.

About Pancreatic Cancer

Pancreatic cancer is cancer that develops within the pancreas, the gland about six inches long that is responsible for making hormones, including the enzymes responsible for the digestion of food and control of blood sugar.

Pancreatic cancer develops when cells within the pancreas begin to grow out of control. It may spread, or metastasize, to nearby lymph nodes and organs such as the liver and lungs.
About Pancreatic Cancer Treatment at Penn Medicine
At Penn Medicine, patients with pancreatic cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Learn more about pancreatic cancer treatment at Penn.

Read More

Pancreatic Cancer: A Free Conference at Penn

The 2nd Focus On Pancreatic Cancer Conference is a full day designed to address the personal and medical issues facing those with pancreatic cancer; including those in treatment, survivors, their loved ones, and caregivers.

Get information on the latest advances in pancreatic cancer risk, prevention, diagnosis, treatment, symptom management and psychosocial issues; as well as the opportunity to network and gain support from other pancreatic cancer survivors.

Who Should Attend

• Those who are newly diagnosed, currently in treatment of a long-term survivor of pancreatic cancer.
• Family members, caregivers or health care professional of a pancreatic cancer patient or survivor.

Register for the 2nd Focus On Pancreatic Cancer Conference

Date: Friday, March 22
Time: 7:30 am to 10:30 am
Location: Hilton Hotel, 4200 City Avenue, Bala Cynwyd, PA

Register for this free event here.

These conferences are made possible through philanthropic funding. Help support our efforts to empower patients and survivors to become more active participants in their care by making a donation to the Abramson Cancer Center today.

Read More

Get Answers to Your Questions about Pancreatic Cancer

Jeffery Drebin, MD

On Wednesday, February 27, from 4 to 6 pm, Penn Medicine's pancreatic cancer experts will be answering your questions about pancreatic cancer and pancreatic cancer treatment and research.

Submit your questions to Penn Medicine's James Metz, assistant professor of radiation oncology, and Jeffery Drebin, the John Rhea Barton Professor of Surgery, and chairman of surgery at Penn.

They will be conducting an online video chat this Wednesday, 2/27 from 4 to 6 pm to answer your questions about pancreatic cancer treatment.

James Metz, MD

Submit your questions about pancreatic cancer and pancreatic cancer treatment here. 

About Pancreatic Cancer

Pancreatic cancer is cancer that develops within the pancreas, the gland about six inches long that is responsible for making hormones, including the enzymes responsible for the digestion of food and control of blood sugar.

Pancreatic cancer develops when cells within the pancreas begin to grow out of control. It may spread, or metastasize, to nearby lymph nodes and organs such as the liver and lungs.

As the fourth leading cause of cancer death in the United States, pancreatic cancer remains one of the most deadly forms of cancer. More than 90 percent of patients die within the first year of diagnosis. Recent advancements have had little impact, and a new approach is desperately needed.

About Pancreatic Cancer Treatment at Penn Medicine

At Penn Medicine, patients with pancreatic cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

The Stand Up to Cancer Dream Team at Penn is actively researching better ways to prevent, diagnose and treat pancreatic cancer. Together, members of the Pancreatic Cancer Dream Team are working to translate scientific breakthroughs into new treatment options faster than ever before. Their research focuses on developing tests using advanced imaging technology to understand pancreatic cancer cells and developing new, personalized pancreatic cancer treatments based on their research.

Learn more about pancreatic cancer treatment at Penn.

Read More

10 Facts About Pancreatic Cancer

November is National Pancreatic Cancer Awareness Month. Pancreatic cancer remains the fourth leading cause of cancer death in the United States.

1. Pancreatic cancer is cancer that develops within the pancreas, the gland about six inches long that is responsible for making hormones, including the enzymes responsible for the digestion of food and control of blood sugar.
2. Pancreatic cancer survival rates are poor as more than 90 percent of pancreatic cancer patients die within the first year of diagnosis. Recent advancements in pancreatic cancer research have had little impact patients' pancreatic cancer prognosis, and new pancreatic cancer treatments are desperately needed.
3. It's estimated that more than 37,000 people died from pancreatic cancer last year, and another 44,000 will be diagnosed with pancreatic cancer this year.
4. Risk factors for pancreatic cancer include smoking, having diabetes, being obese, being over the age of 65, having chronic inflammation of the pancreas, or a family history of pancreatic cancer.
5. Penn's pancreatic cancer team is nationally recognized for its specialized techniques in treating pancreatic cancer, and is part of the multidisciplinary team of cancer specialists at the Abramson Cancer Center.
6. Pancreas surgery is technically difficult, and surgeons at Penn Medicine perform the highest volume of pancreatic procedures, including the Whipple surgery (procedure), in the Philadelphia region, and are among the top 10 in the United States.
7. There are currently multiple active clinical trials for pancreatic cancer at Penn, two of which are related to the Stand Up 2 Cancer effort. Penn and its fellow pancreatic cancer dream team sites have recruited more than 1,000 patients for these studies thus far, while only a few thousand patients enroll in pancreatic cancer clinical trials in the Unites States every year.
8. The Stand Up To Cancer (SU2C or Stand Up 2 Cancer) Dream Team at Penn Medicine supports and contributes to pancreatic cancer research.
9. Members of the Stand Up 2 Cancer Dream Team for pancreatic cancer research at Penn are developing tests using advanced imaging technology to understand pancreatic cancer cells and develop new, personalized pancreatic cancer treatments based on their pancreatic cancer research.
10.  Penn Medicine's Abramson Cancer Center is one of seven sites coordinating "Dream Teams" and the only site coordinating projects focusing on pancreatic cancer.

Learn more about pancreatic cancer and pancreatic cancer research at Penn Medicine through Stand Up 2 Cancer. 

Read More

What is Pancreatic Cancer?

Carly Roop RD, CSO, is a registered dietitian at the Joan Karnell Cancer Center (JKCC). She provides nutrition education and support to patients while addressing nutrition-related side effects from chemotherapy and radiation. Dietitians at JKCC provide educational nutrition programs that are open to patients as well as the community.

For many, the first time they heard about pancreatic cancer may have been when celebrity, Patrick Swayze or Apple CEO, Steve Jobs, was diagnosed with pancreatic cancer. Pancreatic cancer is the fourth leading cause of cancer death in the United States.

What is the Pancreas?

The pancreas is an organ that is located behind the stomach, it plays an essential role in converting the food we eat into energy for the body’s cells. The pancreas actually has two main functions; the first function is to secrete enzymes to aid in the digestion of protein, fat and carbohydrates and the second function is to create and release insulin, a hormone responsible for lowering blood sugar and glucagon, a hormone that raises blood sugar.

This year, an estimated 43,920 people will be diagnosed with pancreatic cancer in the United States and approximately 37,390 will die from the disease.

Risk Factors for Pancreatic Cancer

Risk factors for developing pancreatic cancer include:

• Family history pancreatic cancer
• Age
• Chronic or hereditary pancreatitis
• Recent-onset of diabetes
• Smoking
• Being overweight, especially in the abdomen.

The American Institute for Cancer Research estimates that being lean can prevent 19% of the pancreatic cases that occur in the United States each year. Pancreatic cancer is easily concealed; it may cause only vague symptoms that could be mistaken for many different conditions within the gastrointestinal tract. Unfortunately, there are no detection tools to diagnose the disease in its early stages when it the tumor can be surgically removed, this is one of the main reasons pancreatic cancer is a leading cause of cancer death.

Pancreatic Cancer Treatment at Penn

At Penn, patients with pancreatic cancer are treated by a multidisciplinary team of cancer specialists who see more patients with gastrointestinal (GI) cancers in one year than many doctors see in their careers.

The Penn Medicine SU2C Dream Team

As the fourth leading cause of cancer death in the United States, pancreatic cancer remains one of the most deadly forms of cancer. More than 90 percent of patients die within the first year of diagnosis. Recent advancements have had little impact, and a new approach is desperately needed.

The SU2C Dream Team at Penn is actively researching better ways to prevent, diagnose and treat pancreatic cancer. Together, members of the Pancreatic Cancer Dream Team working to translate scientific breakthroughs into new treatment options faster than ever before. Their research focuses on developing tests using advanced imaging technology to understand pancreatic cancer cells and developing new, personalized pancreatic cancer treatments based on their research.

Learn more about pancreatic cancer treatment at Penn.

Read More

Support Pancreatic Cancer Awareness and Research

Carly Roop RD, CSO, is a registered dietitian at the Joan Karnell Cancer Center (JKCC). She provides nutrition education and support to patients while addressing nutrition-related side effects from chemotherapy and radiation. Dietitians at JKCC provide educational nutrition programs that are open to patients as well as the community.

This year, an estimated 43,920 people will be diagnosed with pancreatic cancer in the United States and approximately 37,390 will die from the disease.

Pancreatic cancer is easily concealed; it may cause only vague symptoms that could be mistaken for many different conditions within the gastrointestinal tract. Unfortunately, there are no detection tools to diagnose the disease in its early stages when it the tumor can be surgically removed, this is one of the main reasons pancreatic cancer is a leading cause of cancer death.

 

Pancreatic Cancer Awareness Walk in Philadelphia

Building awareness for pancreatic cancer builds hope.

Join us November 3, 2012, for Purple Stride Philadelphia, at Memorial Hall in Fairmount Park.
Not only will you help support the fight against pancreatic cancer, but being active will personally help you fight against pancreatic cancer as well.

So grab your family, friends or dog and join our team, Together We Can Make Strides!

Read More

Stand Up 2 Cancer Special on Tonight

Tonight, celebrities, and musicians will come together to build awareness for cancer and raise money for cancer research through the Stand Up to Cancer (SU2C) telethon. 100 percent of all public donations from the special will go to cancer research.

Watch the Stand Up 2 Cancer Special

The Stand Up 2 Cancer Special airs TONIGHT from 8 to 9 pm ET.

The SU2C Special will air on all major networks without commercial interruption. Networks include ABC, NBC, CBS as well as BIO, E!, HBO, MLB Network, Palladia, Showtime TBS, VH1 and STARZ.

About SU2C

Founded in 2008, SU2C has raised more than $180 million for innovative cancer research. Since its inception, SU2C has made grants to seven multi-disciplinary “Dream Teams” of researchers as well as to 26 young innovative scientists who are undertaking high-risk, potentially high-reward projects to end the reign of cancer as a leading cause of death in the world today.

Eighty-five institutions are currently involved, including Penn Medicine’s Abramson Cancer Center.

Watch SU2C and Join the Conversation

Watch Stand Up to Cancer on Friday, September 7 at 8 pm ET, and join Penn Medicine on Twitter as we discuss pancreatic cancer and its treatment at Penn Medicine, and how researchers and clinicians on the SU2C Pancreatic Cancer Dream Team are changing the way cancer is treated today.

Read More

Stand Up 2 Cancer Special Returns to Prime Time

On Friday, September 7 at 8 pm ET, celebrities and musicians will come together to build awareness for cancer and raise money for cancer research through the Stand Up 2 Cancer (SU2C) telethon.

100 percent of all public donations from the special will go to cancer research.

Watch the Stand Up 2 Cancer Special

The Stand Up to Cancer Special airs Friday, September 7 from 8 to 9 pm ET.

The Stand Up to Cancer Special will air on all major networks without commercial interruption. Networks include ABC, NBC, CBS as well as BIO, E!, HBO, MLB Network, Palladia, Showtime TBS, VH1 and STARZ.

About Stand Up 2 Cancer

Founded in 2008, SU2C has raised more than $180 million for innovative cancer research. Since its inception, SU2C has made grants to seven multi-disciplinary “Dream Teams” of researchers as well as to 26 young innovative scientists who are undertaking potentially high-reward projects to end the reign of cancer as a leading cause of death in the world today.

Eighty-five institutions are currently involved, including Penn Medicine’s Abramson Cancer Center.

The Penn Medicine SU2C Dream Team

As the fourth leading cause of cancer death in the United States, pancreatic cancer remains one of the most deadly forms of cancer. More than 90 percent of patients die within the first year of diagnosis. Recent advancements have had little impact, and a new approach is desperately needed.

The SU2C Dream Team at Penn is actively researching better ways to prevent, diagnose and treat pancreatic cancer. Together, members of the Pancreatic Cancer Dream Team working to translate scientific breakthroughs into new treatment options faster than ever before. Their research focuses on developing tests using advanced imaging technology to understand pancreatic cancer cells and developing new, personalized pancreatic cancer treatments based on their research.

Members of the Pancreatic Cancer SU2C Dream Team at Penn Medicine

Pancreatic cancer researchers at Penn Medicine are at the forefront of developing new, personalized approaches to pancreatic cancer treatment.

These Penn clinicians and researchers are part of the SU2C Pancreatic Cancer Dream Team.

Chi Van Dang, MD, PhD
Professor of Medicine, Hematology/Oncology
Director, Abramson Cancer Center
Director, Abramson Family Cancer Research Institute

Jeffrey A. Drebin, MD, PhD, FACS
John Rhea Barton Professor of Surgery
Chairman, Department of Surgery

Hank Kung, PhD
Professor of Radiology and Pharmacology
Department of Radiology
Perelman School of Medicine

Peter J. O’Dwyer, MBBCh, MD
Professor of Medicine, Hematology/Oncology
Perelman School of Medicine

Watch Stand Up 2 Cancer and Join the Conversation

Watch Stand Up to Cancer on Friday, September 7 at 8 pm ET, and join Penn Medicine on Twitter as we discuss pancreatic cancer and its treatment at Penn Medicine, and how researchers and clinicians on the SU2C Pancreatic Cancer Dream Team are changing the way cancer is treated today.

Read More

Who is at Risk for Pancreatic Cancer?

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s Focus On Pancreatic Cancer Conference. In this blog, she recaps the conference. You can view the conference in its entirety, including presentations here.

Approximately five to 10 percent of pancreatic cancer is considered to be familial, or hereditary.  For those who have a family history of pancreatic cancer or one of several genetically linked syndromes that predispose them to pancreatic cancer, it is very important to identify that risk and get appropriate screening and intervention. 

Anyone who has had at least one parent or sibling (first-degree relative) with pancreatic cancer should meet with a certified genetic counselor to develop a comprehensive family history, and discuss their own risk for developing pancreatic cancer.  A genetic counselor can also help identify conditions such as hereditary pancreatitis that can significantly increase the risk of developing pancreatic cancer, as well as specific genetic mutations that increase the risk of developing other cancers.

The gene mutation BRCA1, for example, is associated with a high incidence of breast cancer, and has also been linked to increases in pancreatic cancer. 

It is important to realize not all risks are equal. By learning family history, every person can understand their own personal risk level. That information can be used to make decisions about screenings and tests as well as medical interventions that may reduce the chance of someone developing pancreatic cancer. 

The Abramson Cancer Center’s Gastrointestinal Cancer Risk Evaluation Program offers complete genetic testing and can provide clinical, genetic and research services for people with concerns about their risk for developing pancreatic as well as other GI cancers.

View the Focus on Pancreatic Cancer Conference to learn more about your risk for pancreatic cancer.

Read More

Understanding How Pancreatic Cancer Spreads

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s Focus On Pancreatic Cancer Conference. In this blog, she recaps the conference. You can view the conference in its entirety, including presentations here.

The ability of cancer cells to invade neighboring tissue and spread to distant organs, called metastasis, is what makes pancreatic cancer such a dangerous and potentially deadly disease. How does metastasis occur? When do cancer cells start to spread?

Metastasis is a very complex, multistep process that requires a gradual accumulation of changes in the cells, or mutations. At the cellular level, metastasis is actually very rare. Only a very few cells in a tumor ever develop the ability to spread, which makes it difficult to study.

At the Focus On Pancreatic Cancer conference, Ben Stanger, MD, PhD, likened the challenge to that of "finding Waldo." Stanger's research aims to understand which cells metastasize and how and when they do.

Early results of his research indicate in pancreatic cancer, the process may begin much earlier than previously thought. Even some pre-malignant cells appear to begin moving away from their site of origin and taking on the characteristics of the cells that surround them, which are critical steps in metastasis. Dr. Stanger’s work provides important clues as to why pancreatic cancer is so difficult to treat effectively, and it could potentially lead to the development of new therapies.

Using the Immune System to Fight Pancreatic Cancer

Greg Beatty, MD, PhD, is taking another approach to understanding how pancreatic cancers interact with normal cells in the body. His research centers on the ways in which pancreatic cancer "teaches our immune systems to help them grow and spread, cloaking themselves to avoid detection."

The body’s immune system has the ability to identify cancer cells as enemies and destroy them. But in many cases this doesn't occur and the cancer cells actually are able to interact with surrounding tissue and the immune system to help promote their growth.

Dr. Beatty calls this "bad education," and is working on approaches to send the immune system "back to school," re-educating it to attack and destroy cancer cells. Pre-clinical research has yielded positive results, and a clinical trial that utilizes an antibody known as CD40 to treat metastatic pancreatic cancer is under way at Penn.

View the Focus on Pancreatic Cancer Conference to learn more about pancreatic cancer research being done at the Abramson Cancer Center

Read More

Improving Results for Pancreatic Cancer Treatment

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s Focus On Pancreatic Cancer Conference. In this blog, she recaps the conference. You can view the conference in its entirety, including presentations here.

Anyone who has been affected by pancreatic cancer, either as a patient, caregiver or member of the treatment team, knows pancreatic cancer is difficult to detect in its early stages and to treat effectively. Pancreatic cancer often grows silently, and the symptoms pancreatic tumors cause are similar to those resulting from other gastrointestinal conditions. In fact, many patients experience months of symptoms and are treated for a variety of other problems before pancreatic cancer is diagnosed.

There are no screening tests or biomarkers available for pancreatic cancer, and even standard CT scans often do not detect these tumors. The result is that many patients are diagnosed with pancreatic cancer at such a late stage that it cannot be surgically removed and therefore is not potentially curable. Patients who do undergo surgery often experience recurrences.

The future of pancreatic cancer treatment depends on new understanding of the biology and genetics of this disease, and there is real hope on the horizon, but what can be done for today's patients?

Greater awareness of pancreatic cancer among primary physicians and patients
It's very important that both doctors and their patients be attuned to the possibility of pancreatic cancer and take appropriate steps to detect these tumors early. Patients at risk include those who experience unexplained weight loss or persistent GI symptoms, a sudden onset of type 2 diabetes or a sudden worsening of existing diabetes, or repeated episodes of pancreatitis.

Patients with a family history of pancreatic cancer should be seen by a certified genetic counselor.

Appropriate diagnostic interventions for suspected pancreatic tumors.
A standard abdominal CT scan does not detect many pancreatic tumors, so a special pancreatic scan is required. Using the wrong imaging technique can lead to extensive delays in diagnosis. It is also important that pancreatic cysts, which can range from harmless to premalignant, be evaluated and managed appropriately.

Penn offers a comprehensive pancreatic cyst program headed by Nuzhat Ahmad, MD.

Careful evaluation of patients to select those who are candidates for surgery
Evaluating newly diagnosed pancreatic cancer patients for surgery is one of the most difficult and critical steps in the treatment process. Surgery offers the only possible cure, but the surgery itself is a major procedure that can lead to significant complications.

Michael Kochman, MD, co-director at the GI Cancer Evaluation Center explained at the Focus on Pancreatic Cancer conference the importance of using the appropriate imaging to determine who is and isn't a candidate for surgery. Endoscopic ultrasound has become the most widely used and an effective means of making this determination, but it needs to be done in a facility that has experience and expertise in pancreatic cancer.

Surgery done by an experienced, expert team
Jeffrey Drebin, MD, PhD, chair of Penn's department of surgery, stressed the critical importance of having a highly experienced surgical team , skilled in performing a complicated surgery called the Whipple procedure, for pancreatic cancer. He noted that proper selection of patients for the surgery and the combination of high surgical volume and expertise markedly affects outcomes.

Penn's long-term survival results for surgically resected pancreatic cancer patients are close to double the national average with significantly reduced complication rates.

Availability of radiation therapy options for all stages of pancreatic cancer
James Metz, MD, clinical director of radiation oncology at Penn, stressed the new options and innovative approaches that are being developed at Penn for pancreatic cancer patients. These include the use of proton therapy to minimize the dose of radiation to normal tissues. Proton therapy, available at only eight centers in the United States, also has the potential to be used for "retreatment" of areas that have already received doses of radiation therapy for metastatic disease. Metz also pointed to the integration of radiation therapy with other modes of treatment, including new drugs that make tissue more sensitive to the effects of the radiation.

Aggressive chemotherapy approaches
Chemotherapy is used for almost all stages of pancreatic cancer.

For patients whose tumors can be surgically removed, or resected, chemotherapy is given either before or after surgery. Patients with borderline resectable tumors receive chemotherapy to help shrink their tumors and those with advanced or metastatic disease get chemotherapy to help control their tumors.

Weijing Sun, MD, director of GI medical oncology, discussed the efforts that are under way to improve the results of chemotherapy by developing new targeted agents and combining existing drugs in new ways or with other approaches such as immunotherapy. The results are slow, but are showing steady improvements in survival.

For most patients with pancreatic cancer, clinical trials are an important option and should be a part of the treatment planning discussion from the day of diagnosis.

Comprehensive management of the whole patient and the problems pancreatic cancer can cause
Patients with pancreatic cancer frequently face multiple physical and psychosocial challenges. Understanding these issues and managing them requires a full team of well-trained, experienced professionals.

At the Abramson Cancer Center’s Integrative Oncology Program, led by Jun Mao, MD, MSCE, patients learn the value of mindfulness, yoga, reiki and physical therapy in conjunction with standard medical treatment. For patients with pancreatic cancer, proactive management of physical and psychosocial issues is an essential part of treatment.

View the Focus On Pancreatic Cancer Conference to learn more about treatment options at the Abramson Cancer Center for patients with pancreatic cancer.

Read More

New Uses for Old Drugs to Treat Pancreatic Cancer

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s Focus On Pancreatic Cancer Conference. In this blog, she recaps the conference. You can view the conference in its entirety, including presentations here.

A Day of Cautious Optimism

"I have been to everyone of these pancreatic cancer conferences, and this is the most hopeful one yet."

These are the words of the wife of a six-year survivor of pancreatic cancer.  They speak to a genuine sense of cautious optimism that pervaded the annual Focus on Pancreatic Cancer Conference sponsored by Penn’s Abramson Cancer Center.  This new hope, grounded within innovative research, doesn't replace realism about the heavy toll pancreatic cancer takes and the persistently disappointing outcomes for most patients.  Patients, caregivers and physicians share an understanding that pancreatic cancer remains one of the most difficult forms of cancer to diagnose early and treat effectively. 

For the first time, though, there is real excitement about progress on a number of fronts, including better understanding of the biology and genetics of pancreatic cancer, improved technology for imaging and surgical interventions, and a more proactive approach to identifying individuals and families who are at increased risk of developing pancreatic cancer.  These aggressive approaches to diagnosing and treating pancreatic cancer are beginning to yield small, but real improvements in survival rates. 

Pancreatic cancer experts from all clinical disciplines discussed the promise of the future and the work under way at Penn to find better ways to diagnose and treat this disease to an audience of 200 patients and caregivers.

Innovative Research:  "Seeing Cancer Differently"

Starving Cancer Cells

Abramson Cancer Center Director, Chi Van Dang, MD, PhD, welcomed attendees, providing a short, clear primer on the complex biology of how pancreatic cancer cells grow, divide and invade neighboring tissue. The key to the future, he said, is "in seeing cancer differently." 

One key area of inquiry for pancreatic cancers is in studying the way these cells utilize energy – in effect what and how they feed themselves. The theory, Dr. Dang, explained, is that normal cells take in nutrients to divide, and then stop when the process is complete.  Cancer cells, on the other hand, are "addicted to nutrients," constantly gorging on them so that they can continue to grow and divide in an uncontrolled way.  They may also use different "food" than normal cells. 

One very exciting line of research is directed at this "addiction model" of pancreatic cells with the goal of basically starving cancer cells to death by depriving them of the nutrients they require.  The concept sounds simple, the implementation is far more complex, but the potential for developing targeted, metabolically based therapies is very real.

New Uses for Old Drugs

Most people think of new cancer treatments as developing new drugs. But in at least two cases, drugs that have been used to treat other conditions for many years are showing promise for treating pancreatic cancer. 

Led by researcher Peter O'Dwyer, MD, Penn is launching a clinical trial for cancer to test the efficacy of chloroquine, a drug used to treat malaria. Research has shown that chloroquine is highly effective in inhibiting what is known as autophagy, the ability of cells to replenish needed nutrients by eating themselves until they are able to find new sources of nutrition.  Pancreatic cancer cells are known to have a very high rate of autophagy and the hope is that chloroquine will stop that from happening and in the process slow down or stop the growth of the cancer. 

Metformin is another drug that is being "repurposed," finding new uses as an anti-cancer agent.  Metformin is traditionally used to treat diabetes.  It inhibits one step in the metabolic process and thus slows down the ability of cells to grow and divide. Like chloroquine, metformin is known to be safe.
Both of these drugs provide real hope for developing new therapies that will in effect cut the fuel line for pancreatic cancer cells.  In Dr. Van Dang's words, this research focuses on the "many differences between cancer cells and normal cells," differences that are becoming the basis for innovative clinical approaches to treating pancreatic cancers.

Learn more about pancreatic cancer clinical trials offered at the Abramson Cancer Center.

View the Focus On Pancreatic Cancer Conference to learn more about treatment options for pancreatic cancer at the Abramson Cancer Center.

Read More