One of the major breakthroughs announced in 2023 was a small study that used a novel approach to treating pancreatic cancer. Pancreatic cancer is expected to be the third leading cause of cancer death in 2024. It is estimated that 7,100 Canadians will be diagnosed and 6,100 will die from it. The most common type of cancer in the pancreas is pancreatic ductal adenocarcinoma. It is more likely in men over 50, in people of African or Caribbean ancestry and in those with two or more cases of pancreatic cancer in their families. This is linked to other genetically associated cancers as well. Emerging trends show that one of the highest rates of increased incidence is among women under 55.

Smoking, drinking alcohol, excess weight, diabetes and chronic pancreatitis also increase your risks. There is evidence that drinking fructose containing foods and drinks may increase your chances as well. And, it occurs in people who have none of these risk factors! We have struggled to find a cure for this disease. Newer immune stimulating drugs that have been so effective on other cancers do not work on pancreatic cancer. This is why it is so exciting that in 2023, Dr. Balachandran from Memorial Sloan Kettering Cancer Centre in New York reported on a small trial showing benefit from an mRNA vaccine. Tumour samples from 19 people were sent to BionTech, a lab that developed a Covid vaccine, to identify proteins in that tumour that would provoke their own body to produce an immune response to the cancer. These vaccines were customized to each individual’s cancer. I’m sure making this is a very expensive procedure.

Before treatment they were given a drug known to prevent cancer cells from suppressing their own immune system. Normally, these cancer cells have a way of masking themselves, so your immune system cannot recognize them. This drug removes that barrier so that your T cells recognize them as something foreign that they need to remove. They were given a series of eight vaccines followed by traditional chemotherapy for pancreatic cancer and then a month later, revaccinated. In the people who developed a strong response and produced T cells, they were cancer free in 18 months. Now, three-year data shows these T cells are still present. Unfortunately in those that did not develop these T cells, cancer returned within a year. A distinct advantage of this approach is the specificity of this immune response to only attack the cancer cells. Hopefully, this will provide a long-term solution to this devastating disease.

Also in 2023, Dr. Weinberg, an MD from UCLA Health, reported on the Amplify -201 trial that is using a vaccine that targets KRAS mutations which are present on 25 per cent of solid tumours. These mutations drive 90 per cent of pancreatic cancers and 50 per cent of colorectal cancers. The interesting discovery is these mutations are present in other cancers as well — non-small cell lung cancer, ovarian, biliary and gall bladder cancers. The trial reported in January 2024 included 20 pancreatic and five colorectal partings. Eighty-four had an immune response; those with higher T cell responses had longer disease-free response. This is exciting because it targets a common mutation so perhaps cost will be better than that of developing an individualized vaccine.

We are only at the beginning of our understanding of the effectiveness of this treatment. Several clinical trials are going on in many places, looking for a more robust confirmation of these findings. More information about the trials is available on the Pancreatic Cancer Canada website under ClinicalTrials.gov. I am constantly amazed at the creativity and ingenuity of these researchers to solve our most difficult problems.

Dr. Vicki Holmes is a Saskatoon retired family physician who has a special interest in Palliative Care and Women’s Health. She is passionate about sharing medical information with the public! (Vicki’s Photo: Memories by Mandy)

-Dr. Vicki Holmes