When Rep. John Lewis of Georgia announced on Sunday that he had been diagnosed with stage 4 pancreatic cancer, the 79-year-old Congressman and civil rights activist also said that his doctors assured him that there are many more treatment options for this advanced disease now than there once were — and that he has a “fighting chance.”
I have been in some kind of fight – for freedom, equality, basic human rights – for nearly my entire life. I have never faced a fight quite like the one I have now. https://t.co/XVcbTlsNNv
— John Lewis (@repjohnlewis) December 30, 2019
“While I am clear-eyed about the prognosis, doctors have told me that recent medical advances have made this type of cancer treatable in many cases, that treatment options are no longer as debilitating as they once were, and that I have a fighting chance,” Lewis said in a statement. He went on to say that he will fight the disease as best as he can, adding, “We still have many bridges to cross.”
Lewis said that he will begin treatment in Washington, D.C., shortly — and hopes not to miss too much work.
He joins celebrities like fashion icon Karl Lagerfeld, who passed away from pancreatic cancer earlier this year, and “Jeopardy!” host Alex Trebek, who is currently living with advanced pancreatic cancer, who have brought much-needed attention to the disease. This public awareness is crucial for a disease that until recently, most people considered a death sentence.
Advances in Pancreatic Cancer Treatment
There has been hopeful progress made in the areas of pancreatic cancer research and treatment. While the disease does still have a poor prognosis (it is the only major cancer with a five-year survival rate under 10%), there have been incredible advances over the past couple of years.
One of the biggest developments in cancer research this year involved pancreatic cancer: A clinical trial showed, for the first time, that a class of drugs called PARP inhibitors may be effective in treating pancreatic cancer.
PARP inhibitors work by preventing cancer cells that have been damaged — often during the course of chemotherapy — from naturally healing themselves, and have shown significant promise in treating ovarian cancer and breast cancer. However, a study presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in June revealed that one of these PARP inhibitor drugs, called olaparib (Lynparza), may work for pancreatic cancer as well.
The drug extended the amount of time that patients with advanced stages of pancreatic cancer who had mutations of the BRCA gene could live without the cancer getting any worse (a measurement doctors call “progression-free survival”). The drug was actually just officially granted full Food and Drug Administration (FDA) approval today.
Another study this year showed some promising results for using immunotherapy — or the process of activating a patient’s own immune system to recognize and attack cancer cells — to treat pancreatic cancer. The study, funded by the Parker Institute for Cancer Immunotherapy and released in April, combined two immunotherapy drugs with chemotherapy — and found some patients experienced either shrinking of tumors, or a slowing of the progression of tumors.
Up until this unique combination of drugs was tested, immunotherapy for pancreatic cancer hadn’t historically worked well.
“Up until now, immunotherapy hasn’t had a big role,” Dr. Allyson Ocean, Medical Oncologist at Weill Cornell Medicine and NewYork-Presbyterian, told SurvivorNet at the time. “Now this study is combining two immunotherapy drugs with frontline standard chemotherapy, and we’re seeing response rates that are significantly better than what was published with other chemotherapies alone.”
Immunotherapy does not work for all patients with advanced pancreatic cancer, but the advances presented in this study and others throughout 2019 are giving those facing this disease a lot of hope.
New Set of Radiation Guidelines
A new set of guidelines released late last summer from the American Society for Radiation Oncology (ASTRO) clarified when and how radiation should be used to treat pancreatic cancer. The guidelines are the first to address pancreatic cancer treatment with a newer radiation, called “stereotactic ablative radiation therapy,” or “stereotactic body radiation therapy (SBRT).”
“SBRT,” which is the type of radiation therapy that Justice Ruth Bader Ginsburg received — and the type of radiation that the ASTRO guidelines address in pancreatic cancer for the first time — can administer very high doses of radiation to a precise location in the body. The way this works is through a number of separate high-intensity beams of radiation targeting a tumor from different angles.
“It’s a very focused form of radiation that’s used to treat small tumors… that have not spread to nearby lymph nodes or other parts of the body,” Dr. Billy Loo, an associate professor of Radiation Oncology at Stanford University’s Stanford Cancer Institute, explained to SurvivorNet in a previous conversation.
Why Is Pancreatic Cancer so Difficult to Treat?
One of the biggest challenges with pancreatic cancer is that it is so often diagnosed in later stages, when it has become really difficult to treat. Screening is a major issues because the disease often doesn’t present any symptoms until it has advanced and spread outside of the pancreas.
“Because the pancreas is inside the abdomen, it often doesn’t have symptoms that would tell you that something is wrong with your pancreas,” Dr. Anirban Maitra, co-leader of Pancreatic Cancer Moon Shot at MD Anderson Cancer Center, told SurvivorNet in a previous interview. “By the time individuals walk into the clinic with symptoms like jaundice, weight loss, back pain, or diabetes, it’s often very late in the stage of the disease. Each year in the United States, about 53,000 patients get pancreatic cancer, and unfortunately, most will die from this disease within a few months to a year or so from the diagnosis.”
Dr. Maitra pointed out that a large issue lies in screening methods, which unfortunately, still need to be improved. Testing everyone for the disease, Dr. Maitra said, would lead to too many false positives.
“It is not prudent to be screening everyone,” he said. “So instead, our efforts are now focused on screening only those subsets of individuals who are at higher risk for pancreatic cancer.”
Who is at Risk for Pancreatic Cancer?
Dr. Matira pointed out that those at higher risk would be anyone who has two or more family members who had pancreatic cancer, those with an abnormality in germline DNA and those with cysts in their pancreas.
Detecting pancreatic cancer in early stages opens up treatment options significantly. Because the disease is often diagnosed so late, as it was for Rep. Lewis, most people facing the disease will not be able to undergo surgery to try and remove it. Dr. Maitra pointed out that only about 20% of people diagnosed with pancreatic cancer are eligible for surgery.
While there have been great advances in treating pancreatic cancer in its later stages, early detection for the disease is still crucial.