JAMA: Challenge the "King of Cancer" survival rate What are the long-term survivors of pancreatic cancer...

On average, only 9% of pancreatic cancer patients are still alive five years after diagnosis, according to the American Cancer Society.
is that early symptoms of pancreatic cancer are hidden, and most patients are often late when they are first detected.
, however, even in early stages of local pancreatic cancer, the five-year survival rate is only 37%, pancreatic cancer easily spread rapidly, even after surgical removal often relapse.
because survival rates are lower than most common cancers, treatment challenges are great, pancreatic cancer is also known as the "king of cancer."
but the existence of probability also indicates that there are always some patients who are long-term survivors who are favored.
Such as the late U.S. Justice Ruth Bader Ginsburg, a long-term survivor of pancreatic cancer, who had underwent routine medical examinations to detect early pancreatic cancer and underwent surgery and follow-up treatment, went on for another 11 years.
, what are the differences, or characteristics, between these long-term survivors, giving them an above-average lifetime? Finding the answer to this question will help improve existing treatment strategies and give more patients the opportunity to survive in the long term and improve their quality of life.
recently, the Journal of the American Medical Association published an article reviewing our current understanding of the long-term survival of pancreatic cancer.
Screenshot Source: In metastatic pancreatic cancer, the establishment of the FOLFOXIRI combined chemotherapy program (folate- fluorouracil, iritraquine, olithycon, Oshaliplain) in 2013, and the establishment of the Gisitabin joint nanoparticle albumin binding (nab-) yew alcohol program in 2013 significantly extended the survival of patients.
, however, how to find the most appropriate treatment for patients with metastatic pancreatic cancer is still being explored by many researchers.
, "patients may have only one chance of receiving chemotherapy."
"What we really want is biomarkers from patients' tumors to predict which options they will benefit from above-average," said Dr. Jennifer Knox, co-director of the McCain Center for Pancreatic Cancer at Princess Margaret Cancer Center in Canada.
" Earlier this year, The Lancet-Oncology published a real-world study, Know Your Tumor, led by MD Anderson Cancer Center, which showed that precise treatment based on molecular testing reduced the risk of death in patients with advanced pancreatic cancer by more than half.
by providing individualized testing for nearly 700 pancreatic cancer patients and recommending treatment options by a committee of oncologists, more than a quarter (27%) of molecular groups have matching approved targeted therapies.
, for example, immuno checkpoint inhibitors target MMR defective tumors, antiHER2 antibodies target HER2 amplification or HER2-activated tumors, PARP inhibitors and ATR inhibitors target DDR mutations.
patients who eventually received the corresponding molecularly targeted treatment had a more than one-year increase in the medium total survival (2.58 vs. 1.32 years) and a 66% lower risk of death than those who did not have "match therapy"! In addition, targeted therapy can also help improve the quality of life of patients compared to toxic side effects of multiple rounds of chemotherapy, such as increased fatigue, nausea, diarrhea, constipation, regenerative neurological disorders, kidney damage, and bone marrow suppression.
currently, pancreatic cancer research organization PanCAN, NCCN (National Comprehensive Cancer Network) and the American Society of Clinical Oncology (ASCO) recommend that pancreatic cancer patients detect genetic and tumor mutations.
"this proves that we are screening a small number of patients with pancreatic cancer who are in better condition."
," dr Knox said.
immunotherapy: Turning pancreatic cancer from a "cold" tumor to "hot" is evidence that some pancreatic cancer patients with higher levels of T-cells in tumors live longer.
this provides an opportunity for immunotherapy.
we know that immunotherapy is increasingly being used in different cancer species.
immunotherapy fights cancer by strengthening the immune system and increasing the lethality of T-cells, which tend to be more effective in "hot" tumors, which are also more active T-cells.
most pancreatic cancers are "cold" tumors, and the path path of immune cells to recognize tumor cells is often flawed.
, but long-term survivors of pancreatic cancer are the exception.
Dr. Vinod Balachandran of memorial Sloan Kettering Cancer Center and his team explored how T cells in long-term survivors of pancreatic cancer recognize tumor cells, and found that these patients' T-cells can identify new antigens produced by tumor cell mutations that are not found in normal cells;
if this is common among long-term survivors of pancreatic cancer, dr. Balachandran said, it may be available to promote long-term survival in more patients by increasing immunity to new antigens.
new study by Dr. Balachandran's team also found that tumors in long-term survivors of pancreatic cancer are rich in congenital lymphocyte 2 (ILC2), which stimulates an immune response without the need for antigens.
in animal models, cytokine interlethion 33 (IL-33) increases the number of ILC2, thereby increasing T-cell levels.
his team is developing a recombinant IL-33 drug.
Florencia McAllister of the MD Anderson Cancer Center, a potential anti-tumor effect of the microbiome, has found another force that improves the immune system against cancer: the microbiome.
and her team found that the tumor microbiome in long-term survivors of pancreatic cancer was more diverse.
and these tumor microbiomes may also be associated with the gut microbiome -- about 20 percent of the species overlap.
To observe the effects of the gut microbiome on tumors, the team transplanted fecal microbes from three groups of patients into mice with pancreatic cancer models -- long-term survivors of pancreatic cancer with no signs of disease, currently with pancreatic cancer lesions, and a healthy control group.
found that mice transplanted into the fecal bacteria of long-term survivors of pancreatic cancer had the smallest tumors, lived longer, and had more active T-cells and fewer immunosuppressive cells.
the opposite was true in mice that transplanted the faeces of current pancreatic cancer patients.
the team speculated that the gut microbiome of long-term survivors of pancreatic cancer may have anti-tumor effects.
", by transplanting feces, you can simulate the immune activation of fecal feeds.
is very important, and if immunosuppression can be reversed, then we can consider microbial therapy as the basis for any other type of therapy.
," Dr McAllister said.
currently, Dr. McAllister is planning a small clinical study in which pancreatic cancer patients receive fecal transplants from healthy feeds a month before surgery to compare changes in the patient's tumor microbiome and immune status.
According to a report published in The Lancet-Oncology by the International Agency for Research on Cancer, the five-year survival rate for pancreatic cancer has risen from 3.2%-8.8% to 7.9%-14.6% in seven high-income countries around the world over the past 20 years.
While it is still one of the worst-prognosed cancers, it is expected that by studying the insights gained by long-term survivors, more iterations of treatment strategies will be expected to take survival to the next level.
References . . . Kuehn BM, et al., (2020). Looking to Long-term Survivors for Improved Pancreatic Cancer Treatment. JAMA, DOI: 10.1001/jama.2020.21717 . . . Survival Rates for Pancreatic Cancer. Retrieved November 20, 2020, from Michael J Pishvaian, et al., (2020). Overall survival in patients with pancreatic cancer receiving matched therapies following molecular profiling: a retrospective analysis of the Know Your Tumor registry trial. The Lancet Oncology, DOI: 10.1016/S1470-2045 (20)30074-7