Source: National Cancer Institute via Wikimedia Commons.
The word "cancer" is scary regardless of the type, but few types of cancer are as lethal as pancreatic cancer.
Based on estimates from the American Cancer Society in 2013, an estimated 45,220 people would be diagnosed with pancreatic cancer. Unfortunately, per its projections, 38,460 people would also lose their lives in 2013 because of pancreatic cancer. In other words, it's the 12th most commonly diagnosed cancer, but it's the fourth-leading cancer-based cause of death.
The ACS further lays out the dangers of pancreatic cancer when comparing the five-year survival rates (link opens PDF) of 24 different cancer types for all races against one another.
The good news is that many cancer types, including pancreatic cancer, have seen five-year survival rates improve. However, on the all, pancreatic cancer patients have, by far, the lowest five-year survival potential of all cancer types. Rising from just 2% in 1975-1977 to 6% in 2002-2008, pancreatic cancer demonstrates what a serious and lethal disease it truly is. By comparison, liver and intrahepatic bile duct cancer is the next most lethal cancer with a five-year survival rate of 16%.
Seven states where pancreatic cancer rates are the highest
Pancreatic cancer tends to occur in the U.S., according to the Centers for Disease Control and Prevention, at an average rate of 12.2 cases per 100,000 people. However, some states have been shown to have significantly higher than average rates of pancreatic cancer incidence.
Based on the CDC's statistics, the following seven states rank markedly above the national average in pancreatic cancer age-adjusted incidence rates:
1. Louisiana (14.3 incidences per 100,000 people)
2. Alaska (14)
3. New York (13.8)
4. Alabama (13.7)
5. New Jersey (13.6)
6. Mississippi (13.5)
7. Pennsylvania (13.5)
Age-adjusted incidence rates for pancreatic cancer. Incidence rates per 100,000 people. Source: Centers for Disease Control and Prevention.
What's the cause of this predominantly East Coast bias? No one knows exactly, because researchers can't say with any certainty what leads pancreatic cancer to develop in the first place. However, researchers do believe that genetic mutations, getting older, being obese or overweight, and/or smoking are all risk factors which can increase your chance of getting this terrible disease.
In addition to being a lethal disease, it's also a very expensive disease to treat. Utilizing data from the Surveillance, Epidemiology, and End Results Medicare database, a consortium of six authors in 2012 released their findings on the mean costs attributable to pancreatic patients from diagnosis until they passed away. After studying 15,037 patients, the conclusion was that pancreatic cancer's mean cost is $61,700 per patient – a staggering figure to pay regardless of age.
Source: Micky** via Flickr.
A ray of sunshine
While pancreatic cancer is a dreaded diagnosis there is good news as well. One recently approved drug appears to be improving patients' chances at improved quality of life and overall survival, while a trio of developing drugs lies in wait for its chance to hopefully kick pancreatic cancer's behind.
Before we get to the encouraging drugs in development, let's have a look at the relatively old (but new) drug treating late-stage pancreatic cancer: Abraxane.
Abraxane, manufactured by Celgene (CELG), was originally approved all the way back in 2005 to treat metastatic breast cancer, but has gained additional approvals by the Food and Drug Administration to treat non-small cell lung cancer in 2012, and more recently late-stage pancreatic cancer a year ago. In the study that led to Abraxane's supplemental new drug approval, Abraxane was given in combination with Eli Lilly's (LLY -0.12%) Gemzar and then pitted against a control arm of patients receiving Gemzar by itself. Overall survival from the Abraxane plus Gemzar arm averaged 8.5 months compared to 6.7 months for the Gemzar monotherapy arm. Furthermore, progression-free survival (i.e., the period where tumor growth ceased) improved a similar 1.8 months in the Abraxane arm.
I fully understand that this may not sound like a huge improvement, but on a statistical basis Abraxane helped patients live 27% longer than they otherwise would have taking Gemzar by itself. The ultimate goal of pharmaceutical companies is to fight disease and improve both patients' survival and quality of life, and it would appear that even though the steps being taken here are baby steps at best, that the movement is in the right direction.
Source: Eric Norris via Flickr.
Three pipeline products that could make an impact
Because pancreatic cancer is such a difficult-to-treat disease, pharmaceutical companies have needed to look at new pathways to fight it. Here are three of the most promising ways that biopharmaceutical companies are trying to tackle this disease and improve overall survival.
One of the more exciting drugs in development is Threshold Pharmaceuticals' (NASDAQ: THLD) TH-302. Currently in a late-stage study known as MAESTRO, TH-302 is being combined with Gemzar and, like Abraxane, being compared against a control group taking only Gemzar to determine if there's a statistically significant improvement in overall survival.
What makes TH-302 so unique is that it targets tumor hypoxia, or areas of tumor with low levels of oxygen. Because tumors tend to rapidly replicate they can sometimes grow faster than blood vessels, leaving parts of the tumor "starved" for oxygen. In normal cells hypoxia is quite uncommon. Therefore, a drug which targets areas of the body where hypoxia is present could be extremely effective at fighting hypoxic tumors, or in this case late-stage pancreatic cancer, without harming many, if any, healthy cells.
Secondly, we're seeing biopharmaceutical companies look within our own bodies for assistance. This is where cancer immunotherapy vaccines have come into play. By retraining the body's immune system to recognize cancer cells the idea here is that it could better fight cancer than any manufactured chemotherapy by itself.
NewLink Genetics (NLNK), for example, has two ongoing phase 3 studies known as IMPRESS (which just completed phase 3 enrollment) and PILLAR (which is still enrolling) that'll test its lead immunotherapy Algenpantucel-L as a treatment for resected pancreatic cancer (IMPRESS) and borderline resectable or locally advanced unresectable pancreatic cancer (PILLAR). Last year NewLink noted that three pancreatic cancer patients on its Algenpantucel-L therapy had durable complete responses of 12 to 36 months, potentially signaling that it could be a game-changer in improving patient quality of life.
Finally, and perhaps even more intriguing from a global cancer perspective, is a company like OncoMed Pharmaceuticals (OMED) which is focused on developing anti-cancer stem cell drugs. What's unique about OncoMed is that rather than focusing on stopping cancer cells from proliferating to other parts of the body, or simply slowing tumor growth, its experimental drugs are aimed directly at hard-to-reach cancer stem cells, which are believed to be responsible for the metastasis of cancer to other parts of the body.
Although it's very early in its development, the experimental therapy to watch here which has the potential to improve patient's quality of life is demcizumab. OncoMed is currently partnered with Celgene on the development of six compounds, including demcizumab, and is in the process of testing its lead drug in combination with Abraxane in phase 1b studies against a control group taking only Gemzar. The study is being conducted as a first-line treatment for patients with stage 4 pancreatic cancer.
What really matters
Regardless of how these studies turn out it's important that biopharmaceutical companies continue the fight against this terrible type of cancer. Overall survival data demonstrates that we are slowly inching in the right direction with regard to improving patient's quality of life, but we still have a long way to go. Here's to what I hope are years of continued advancements in pancreatic cancer research and drastic improvements in the quality and longevity of pancreatic cancer patients' lives.
