They call it the “silent killer.” It knows how to hide itself, to evade the ammunition that can be used to neutralize it, and when it finally shows its face, it’s usually too late. Pancreatic cancer is the most lethal of tumors: life expectancy at the time of diagnosis is barely five months, and just 7% of patients survive beyond five years.
In the last 40 years, scientific advances in the field have been irregular, and there have been scant improvements in prognoses and survival rates. It’s a stone in the shoe of researchers, admits Núria Malats, the head of the genetic and molecular epidemiology group at Spain’s CNIO national oncological research center, and who has spent 15 years looking for risk factors.
“Pancreatic cancer kills patients and also the research career of scientists, although this scenario is changing,” she explains. Without early-detection measures and with the majority of diagnoses in advanced stages of the illness, chemotherapy remains the major weapon against a tumor that is still resisting the promising advances in immunotherapy and other targeted therapies.
María Belén Villalonga, 56, knows well that science never sleeps. At a routine health check in October 2019, doctors found a pancreatic tumor and she joined a clinical trial with chemotherapy to reduce the malignancy. After six months of treatment, the tumor shrank and surgery was possible. Surgeons removed three-quarters of her pancreas, but three months after the procedure, a metastasis appeared in her liver, and she had to start all over again.
“I did two immunotherapy trials that lasted two months each, but in my case, they didn’t work,” she explains. “We started chemotherapy, which didn’t work either, and then we moved onto more chemo which is like the first round, and which produced a positive reaction by paralyzing the metastasis,” she explains. A former bank executive, she says she now has a “peaceful” life and only wants to “make the tumor chronic.” She trusts “them,” she says in reference to her doctors, as she looks toward her oncologist Teresa Macarulla.
If the battle between science and pancreatic cancer were a card game, the tumor would have the better hand right from the deal. To start with, the organ is located in an area of the abdomen that is hard to see and access. Nor are there methods for early detection, and nor does the nature of the tumor help, given that it tends to quickly spread to other organs.
Symptoms are often non-specific, and can include yellow skin, weight or appetite loss, stomach problems and back pain. According to the European Gastroenterology Union (UEG), at the time of diagnosis, 80% of patients have incurable tumors and in the remaining 20%, only surgery has the potential for cure, although eight of 10 of these cases will relapse.
If you don’t give patients weapons to fight, the tumor will always winOncologist Teresa Macarulla
Despite having the deck stacked against it, the scientific community is not giving up. The successes so far, however, have been few and far between. For example, Macarulla’s team led a study that in 2019 opened the door to personalized medicine for pancreatic cancer: in a specific subgroup of patients with metastasis and a determined genetic mutation, a medication called Olaparib improved survival after chemotherapy treatment. This was the first step, although just 7% of patients with pancreatic cancer could benefit from this therapy. “Since 2019 we haven’t had any more positive studies that have changed treatment standards,” explains Macarulla. “That’s why it’s important to continue research.”
A 2021 study on cancer outcomes warned that while global mortality from the disease is falling, a specific focus is required for pancreatic tumors because the rate in this case has plateaued. In fact, while the incidence is low (2.7% in Spain, for example, compared to 12% for breast cancer), it’s the third-most deadly, according to the Spanish Society of Medical Oncology (SEOM). A report from UEG shows that the rate of pancreatic cancer deaths between 1990 and 2016 rose 5% while it fell for breast, lung and colon cancer by 25%, 20% and 14%, respectively.
Immunotherapy, which stimulates your immune system so that it attacks the cancerous cells, has been the revolution against cancer in the last decade. But in the case of pancreatic cancer, things have been different. “As much as you stimulate the cells in the immune system so that they attack the tumor, if they can’t get there and there is an environment in which they are being rejected, you can’t do anything,” explains Macarulla.
Scientists are calling for more resources so that they can continue researching. A report from the UEG warned in 2018 that, despite being the third-most deadly tumor in Europe, pancreatic cancer receives just 2% of funds dedicated to cancer research.
They also want fewer bureaucratic hurdles. For example, the Olaparib used for Macarulla’s trial has been given the green light by the European Medicines Agency, but in Spain, its use has not been approved. “While there is no approval from the ministry, we can request special uses, with more administrative hurdles and more difficulties in some hospitals than in others,” Macarulla explains. “With pancreatic cancer, we can’t allow for these drugs to not be approved. I couldn’t care less if they benefit just 4% of the population, because we don’t have many alternatives, and patients need weapons. If you don’t give them weapons to fight, the tumor will always win,” she states.