By Aaron Allen, The Seattle Medium
For decades, a diagnosis of pancreatic cancer has been among the most devastating in medicine, offering patients few effective treatment options and one of the highest mortality rates of any major cancer. Today, however, doctors say a new generation of targeted therapies and advances in treatment are beginning to offer hope against a disease long considered one of medicine’s greatest challenges.
Although pancreatic cancer currently ranks 11th among newly diagnosed cancers in the United States, it is the nation’s third-leading cause of cancer-related deaths. According to Dr. Andrew Coveler, director of Fred Hutch Cancer Center’s Pancreatic Cancer Specialty Clinic, the disease remains exceptionally difficult to treat because it is usually discovered only after it has spread.
“Nine out of ten people who get it pass away from it,” Coveler said. “Most people show up with metastatic disease. The next biggest group is people who, it’s localized but can’t come out. Almost everyone who gets it dies from it.”
According to UW Medicine, pancreatic cancer claims approximately 50,000 lives each year in the United States. A spokesperson for UW Medicine said many of those cancers could be curable if they were diagnosed early and treated with innovative therapies.
“These cancers could be curable if diagnosed early, and if innovative treatments are used,” the spokesperson said. “We are dedicated to developing more accurate methods of early diagnosis and curative treatment of pancreatic cancers.”
While pancreatic cancer affects people of every race and background, it does not affect every community equally.
According to the National Cancer Institute, Black Americans are diagnosed with pancreatic cancer at rates approximately 20% to 30% higher than white Americans and experience lower survival rates.
Researchers say those disparities stem from a combination of factors, including longstanding inequities in health care, delayed diagnoses, reduced access to specialized treatment and clinical trials, lower rates of surgical intervention, and higher rates of associated conditions such as diabetes and chronic pancreatitis that increase pancreatic cancer risk.
One of the greatest challenges facing physicians is that pancreatic cancer rarely announces itself early.
Unlike breast or colorectal cancer, there is no reliable screening test for the general population comparable to a mammogram or colonoscopy.
“The pancreas sits deep in the middle of the abdomen, so you can’t really feel it,” Coveler explained.
Even when symptoms do appear, they are often vague and easily mistaken for more common digestive problems.
“Early symptoms are sometimes just digestion-related where you’re getting bloated or full quickly, or some abdominal discomfort,” Coveler said. “Weight loss and back pain can occur, but by the time pain manifests, the cancer has often spread.”
Compounding the problem is the speed at which pancreatic cancer develops.
“There’s not a lot of lead time,” Coveler said. “There’s not a lot of time where something’s sitting there that you can follow for most cases.”
Although approximately 5% to 10% of pancreatic cancers are hereditary, doctors generally reserve specialized screening for people with strong family histories or known genetic risk factors rather than recommending widespread screening for the general public.
For years, treatment options have remained frustratingly limited.
Most patients receive combinations of aggressive chemotherapy, while promising treatments such as immunotherapy have produced disappointing results.
“Immunotherapy has not worked well in this cancer at all,” Coveler said. “It doesn’t have a lot of things that the immune system can see.”
Likewise, surgery is not an option for many patients because pancreatic tumors frequently wrap around major blood vessels before they are discovered.
That reality has made recent advances in targeted therapy particularly significant.
Nearly 90% to 95% of pancreatic cancers carry a mutation in a gene known as KRAS, a genetic alteration researchers spent nearly four decades trying unsuccessfully to target with medication.
Now, scientists are finally beginning to change that.
At this year’s annual meeting of the American Society of Clinical Oncology (ASCO), researchers presented results from clinical trials involving a new targeted drug called Daraxonrasib, which directly attacks cancers carrying the KRAS mutation.
Rather than replacing chemotherapy altogether, the drug has shown encouraging results for patients whose cancer continued to progress after initial treatment.
“It drastically improved how long people lived in this setting,” Coveler said. “It kind of doubled it, went from about 6.5 months to a little bit over 13 months for patients with pancreas cancer.”
Dr. Gabriela Chiorean of UW Medicine and Fred Hutch says that researchers are making progress on several fronts simultaneously.
“Doctors are finding better ways of treating pancreatic cancer, which is poised to become the second-deadliest tumor type through novel immunotherapy treatments. But advances in surgery and the sequencing of treatment options have improved and extended patients’ lives too,” Chiorean said.
While researchers caution that these advances do not represent a cure, they do represent meaningful progress against a disease that has seen relatively few breakthroughs over the past several decades.
For patients, particularly those in Black communities who continue to bear a disproportionate share of the disease’s burden, those advances offer reason for cautious optimism.
“There’s a lot of hope now in the development of this disease, which hasn’t had a lot of funding for a long time,” Coveler said. “Years of dedicated research are really starting to pay off, so it’s kind of a hopeful time.”
