If you or a loved one is facing a diagnosis of pancreatic cancer, or you seek a second opinion, the oncology experts of Roswell Park Comprehensive Cancer Center are here for you. We believe every patient is unique, and we approach pancreatic cancer treatment on an individual and personal basis, treating the whole person, not just the cancer.
Joining the show to discuss the latest advances in pancreatic cancer is Dr. Christos Fountzilas. He is a board certified medical oncologist in the gastrointestinal medical oncology department at Roswell Park Comprehensive Cancer Center with a focus in pancreatic cancer.
Selected Podcast
New Advances in Pancreatic Cancer Treatments
Featured Speaker:
Learn more about Christos Fountzilas, MD
Christos Fountzilas, MD
Christos Fountzilas, MD is a board certified medical oncologist in the gastrointestinal medical oncology department at Roswell Park Comprehensive Cancer Center with a focus in pancreatic cancer. His research interests include oncolytic virotherapy, biomarker discovery, and immunotherapy for gastrointestinal cancers.Learn more about Christos Fountzilas, MD
Transcription:
New Advances in Pancreatic Cancer Treatments
Bill Klaproth (Host): Pancreatic cancer is the third learning cause of cancer-related deaths in the US, killing more people than breast cancer, but there have been advances in treatment over the last few years. Here to talk with us about those advances in pancreatic cancer treatment, is Dr.Christos Fountzilas, Assistant Professor of Oncology at Roswell Park Comprehensive Cancer Center. Dr. Fountzilas, thank you so much, for your time. First off, why is pancreatic cancer so hard to treat?
Dr. Christos Fountzilas (Guest): Good afternoon, Bill. Really, indeed, pancreas cancer is a very challenging cancer, and that’s because we don’t only deal with the cancer cells, but also with all of the benign cells – quote benign, within the tumor environment. If you analyze – if you look at the pancreas tumor – pancreas cancer under the microscope you see that approximately two-thirds of the tumor is scar tissue and a third approximately cells. Half of those cells are cancer cells, and the rest are cells that can decrease the effectiveness of medicines. They can make the tumor very resistant to immunotherapy and surveillance by the immune system. Up until recently, we didn’t know those things. Now, we start digging more into the biology of pancreatic cancer and coming up with new medicines and new strategies to treat it.
All the chemotherapeutic agents, if you’d like have their limitations. Their main limitation is penetration of the tumor. As explained before, just because of that tumor really being scarred. We mostly have issues with chemotherapeutics entering within the tumor. Over the last couple of years, we have developed new combination strategies to try to overcome that problem, and we are coming with new, novel medicines to try to decrease that scar and also improve that effectiveness of treatments.
Bill: So, pinpointing the tumor within the pancreas, that’s been the issue?
Dr. Fountzilas: Um-hum. Really, we’ve been trying to find the Achilles heel, if you’d like, of pancreatic cancer. The Achilles heel should be one of the components of the microenvironment of the cancer, meaning all of the supportive cells that are helping the cancer to thrive – not specifically cancer cells, but all of the supportive cells that look benign, but really they’re not that benign.
Bill: What has been the most common form of treatment for pancreatic cancer up until this point?
Dr. Fountzilas: The main treatment for pancreatic cancer, especially for advanced pancreatic cancer – and that, unfortunately, consists of most cases of pancreatic cancer – is chemotherapy. Up until the beginning of this decade, we just had two medicines. Right now, we have two main combination strategies that have really improved the survival of pts with advanced pancreatic cancer. Now, we have two main combination strategies that have really improved the survival of patients with advanced pancreatic cancer. One involves the combination of three medicines. We call it Folfirinox. The second combination is a combination that is based on gemcitabine.
Those two strategies are the – what we call, the standard of care of patients with pancreatic cancer. We can use them only in patients who really have, what we say, a very good performance status. Unfortunately, those life-prolonging therapies are not good for all patients. Only approximately half of the patients are really in the position to receive those life-prolonging therapies because of the side effects that are associated with them. Really, patient selection is very, very important.
Bill: So, immunotherapy has been developed to try to attack pancreatic cancer?
Dr. Fountzilas: Yes, immunotherapy, the way we know it now and the way it’s advertised on TV, really is approved for approximately 1% of patients with pancreatic cancer. Patients whose tumors have a specific abnormality – a specific genetic abnormality that’s called microsatellite instability. For that 1% of patients with pancreatic cancer, we can use FDA-approved immunotherapy medicine. In general, pancreatic cancer is a very immunosuppressive tumor. Those benign cells – quote, benign – that I was referring to before are cells that can really limit the effectiveness of approved immunotherapy. What we’re trying to do both at Roswell and at other institutes around the country and the world, is to try to make pancreas cancer more susceptible to immunotherapy using combination strategies.
Bill: Well, that is definitely good news. With that, why so it important to incorporate supportive care into the treatment plan?
Dr. Fountzilas: As I said before, only 50% of advanced pancreatic cancer can tolerate the combination chemotherapy treatments that have been proven to prolong life. In order to make more patients eligible for those treatments, we need to improve the way they feel and improve the way they function in their everyday life. Supportive care is really the cornerstone for that – being able to manage pain more effectively, being able to manage emotional symptoms more effectively. All of these can really improve, as we say, someone’s performance status, and we know that if we can do that, more patients will be able to get life-prolonging therapies and participate in clinical trials.
Bill: Which is very important. Speaking of clinical trials, can you talk about the research that’s being developed by you and others at Roswell Park Cancer Institute?
Dr. Fountzilas: Yes, so right now at Roswell Park, what we’re trying to do – the main focus is taking agents that are approved in other cancers that share similar biological pathways to pancreatic cancer and see whether using them in pancreatic cancer can improve outcomes. For example, we have a clinical trial for patients with pancreatic cancer who have received prior treatment with gemcitabine as a regimen. This site is using a class of medicines that are called PARK inhibitors. PARK inhibitors are improved in other cancer types like ovarian cancer. What we’re trying to see in this study -- that’s not actually just a Roswell study, it’s a study that’s going on nationally – is whether adding those medicine in the standard of care can improve outcomes.
We are also going to have soon, a clinical trial that is trying to increase the effectiveness of immunotherapy by using combination strategies. We anticipate that to be fully active in a few months. We also have clinical trials that are trying to improve our first-line, as we say, treatments – more or less, treatments that we’re using in patients who have not received any prior chemotherapy – by using novel formulations of medicines that can achieve higher penetration within the tumor and higher concentration of this medicine within the tumor.
Furthermore, we’re looking into more animal models and cellular models about how we can increase the effectiveness of immunotherapy in pancreas cancer. We expect that to be available for use in clinical trials in actual humans in about one to two years.
Bill: That’s excellent news, and keep up the good work with those trials and those research products. It’s great to hear that you’re attacking this problem and you’re going after new methods constantly. We appreciate the work that you’re doing in this area. And lastly, Dr. Fountzilas, can you tell us about the upcoming pancreatic cancer event for patients and caregivers, on Friday, December 1st, 2017.
Dr. Fountzilas: Yes, this is an event that we’ve been designing for a couple of months now. More or less, what is is discussing the multidisciplinary management of pancreatic cancer in various disease states. What we mean by multidisciplinary management is how we incorporate surgery, chemotherapy, and supportive care in the management of pancreatic cancer. This event is not just for patients with pancreatic cancer or survivors; it’s for their families as well.
What we’re going to discuss is novel surgical techniques and what patients can expect from those techniques, use of chemotherapy in pancreatic cancer from stage one to stage four, focusing not just on the indications for using chemotherapy, but how to manage the most common side effects of chemotherapy. And as I said before, discussing the importance of supportive care – patients with pancreatic cancer, not just in the advanced, incurable stage, but also in the earlier stages of the disease.
We’re also going to have a special session on nutrition. The pancreas is a major gland in our body. It is very, very important not just for controlling our blood sugar, but also for digesting nutrients, proteins, fats, and patients with pancreatic cancer suffer from malabsorption of nutrients, so nutrition is a very important part in the management of patients with pancreatic cancer, so we’re going to have a special session for that.
Bill: Well, it sounds like a great event, and thank you for telling us about that, Dr. Fountzilas. For more information, visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
New Advances in Pancreatic Cancer Treatments
Bill Klaproth (Host): Pancreatic cancer is the third learning cause of cancer-related deaths in the US, killing more people than breast cancer, but there have been advances in treatment over the last few years. Here to talk with us about those advances in pancreatic cancer treatment, is Dr.Christos Fountzilas, Assistant Professor of Oncology at Roswell Park Comprehensive Cancer Center. Dr. Fountzilas, thank you so much, for your time. First off, why is pancreatic cancer so hard to treat?
Dr. Christos Fountzilas (Guest): Good afternoon, Bill. Really, indeed, pancreas cancer is a very challenging cancer, and that’s because we don’t only deal with the cancer cells, but also with all of the benign cells – quote benign, within the tumor environment. If you analyze – if you look at the pancreas tumor – pancreas cancer under the microscope you see that approximately two-thirds of the tumor is scar tissue and a third approximately cells. Half of those cells are cancer cells, and the rest are cells that can decrease the effectiveness of medicines. They can make the tumor very resistant to immunotherapy and surveillance by the immune system. Up until recently, we didn’t know those things. Now, we start digging more into the biology of pancreatic cancer and coming up with new medicines and new strategies to treat it.
All the chemotherapeutic agents, if you’d like have their limitations. Their main limitation is penetration of the tumor. As explained before, just because of that tumor really being scarred. We mostly have issues with chemotherapeutics entering within the tumor. Over the last couple of years, we have developed new combination strategies to try to overcome that problem, and we are coming with new, novel medicines to try to decrease that scar and also improve that effectiveness of treatments.
Bill: So, pinpointing the tumor within the pancreas, that’s been the issue?
Dr. Fountzilas: Um-hum. Really, we’ve been trying to find the Achilles heel, if you’d like, of pancreatic cancer. The Achilles heel should be one of the components of the microenvironment of the cancer, meaning all of the supportive cells that are helping the cancer to thrive – not specifically cancer cells, but all of the supportive cells that look benign, but really they’re not that benign.
Bill: What has been the most common form of treatment for pancreatic cancer up until this point?
Dr. Fountzilas: The main treatment for pancreatic cancer, especially for advanced pancreatic cancer – and that, unfortunately, consists of most cases of pancreatic cancer – is chemotherapy. Up until the beginning of this decade, we just had two medicines. Right now, we have two main combination strategies that have really improved the survival of pts with advanced pancreatic cancer. Now, we have two main combination strategies that have really improved the survival of patients with advanced pancreatic cancer. One involves the combination of three medicines. We call it Folfirinox. The second combination is a combination that is based on gemcitabine.
Those two strategies are the – what we call, the standard of care of patients with pancreatic cancer. We can use them only in patients who really have, what we say, a very good performance status. Unfortunately, those life-prolonging therapies are not good for all patients. Only approximately half of the patients are really in the position to receive those life-prolonging therapies because of the side effects that are associated with them. Really, patient selection is very, very important.
Bill: So, immunotherapy has been developed to try to attack pancreatic cancer?
Dr. Fountzilas: Yes, immunotherapy, the way we know it now and the way it’s advertised on TV, really is approved for approximately 1% of patients with pancreatic cancer. Patients whose tumors have a specific abnormality – a specific genetic abnormality that’s called microsatellite instability. For that 1% of patients with pancreatic cancer, we can use FDA-approved immunotherapy medicine. In general, pancreatic cancer is a very immunosuppressive tumor. Those benign cells – quote, benign – that I was referring to before are cells that can really limit the effectiveness of approved immunotherapy. What we’re trying to do both at Roswell and at other institutes around the country and the world, is to try to make pancreas cancer more susceptible to immunotherapy using combination strategies.
Bill: Well, that is definitely good news. With that, why so it important to incorporate supportive care into the treatment plan?
Dr. Fountzilas: As I said before, only 50% of advanced pancreatic cancer can tolerate the combination chemotherapy treatments that have been proven to prolong life. In order to make more patients eligible for those treatments, we need to improve the way they feel and improve the way they function in their everyday life. Supportive care is really the cornerstone for that – being able to manage pain more effectively, being able to manage emotional symptoms more effectively. All of these can really improve, as we say, someone’s performance status, and we know that if we can do that, more patients will be able to get life-prolonging therapies and participate in clinical trials.
Bill: Which is very important. Speaking of clinical trials, can you talk about the research that’s being developed by you and others at Roswell Park Cancer Institute?
Dr. Fountzilas: Yes, so right now at Roswell Park, what we’re trying to do – the main focus is taking agents that are approved in other cancers that share similar biological pathways to pancreatic cancer and see whether using them in pancreatic cancer can improve outcomes. For example, we have a clinical trial for patients with pancreatic cancer who have received prior treatment with gemcitabine as a regimen. This site is using a class of medicines that are called PARK inhibitors. PARK inhibitors are improved in other cancer types like ovarian cancer. What we’re trying to see in this study -- that’s not actually just a Roswell study, it’s a study that’s going on nationally – is whether adding those medicine in the standard of care can improve outcomes.
We are also going to have soon, a clinical trial that is trying to increase the effectiveness of immunotherapy by using combination strategies. We anticipate that to be fully active in a few months. We also have clinical trials that are trying to improve our first-line, as we say, treatments – more or less, treatments that we’re using in patients who have not received any prior chemotherapy – by using novel formulations of medicines that can achieve higher penetration within the tumor and higher concentration of this medicine within the tumor.
Furthermore, we’re looking into more animal models and cellular models about how we can increase the effectiveness of immunotherapy in pancreas cancer. We expect that to be available for use in clinical trials in actual humans in about one to two years.
Bill: That’s excellent news, and keep up the good work with those trials and those research products. It’s great to hear that you’re attacking this problem and you’re going after new methods constantly. We appreciate the work that you’re doing in this area. And lastly, Dr. Fountzilas, can you tell us about the upcoming pancreatic cancer event for patients and caregivers, on Friday, December 1st, 2017.
Dr. Fountzilas: Yes, this is an event that we’ve been designing for a couple of months now. More or less, what is is discussing the multidisciplinary management of pancreatic cancer in various disease states. What we mean by multidisciplinary management is how we incorporate surgery, chemotherapy, and supportive care in the management of pancreatic cancer. This event is not just for patients with pancreatic cancer or survivors; it’s for their families as well.
What we’re going to discuss is novel surgical techniques and what patients can expect from those techniques, use of chemotherapy in pancreatic cancer from stage one to stage four, focusing not just on the indications for using chemotherapy, but how to manage the most common side effects of chemotherapy. And as I said before, discussing the importance of supportive care – patients with pancreatic cancer, not just in the advanced, incurable stage, but also in the earlier stages of the disease.
We’re also going to have a special session on nutrition. The pancreas is a major gland in our body. It is very, very important not just for controlling our blood sugar, but also for digesting nutrients, proteins, fats, and patients with pancreatic cancer suffer from malabsorption of nutrients, so nutrition is a very important part in the management of patients with pancreatic cancer, so we’re going to have a special session for that.
Bill: Well, it sounds like a great event, and thank you for telling us about that, Dr. Fountzilas. For more information, visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.