A diagnosis of any cancer can cause an overwhelming, stressful and emotional reaction. Making it even more daunting is trying to think of what to do first while simultaneously processing the reality of it all. WINGS OF HOPE offers the following resources to supplement your understanding of pancreatic cancer, diagnosis and treatment options and procedures, statistics and other information.
The human immune system is not only smart, but also very powerful, protecting us from a host of harmful invaders that can lead to illness.
Until recently, the human immune system was often thwarted by cancer cells and their ability to grow and spread seemingly unchecked.
But in the last two decades, inroads made in immunotherapy—treatments designed to harness a patient’s own immune system to unmask and destroy these deadly cancer cells—have led to some remarkable successes. Already, some patients with melanoma, non-small cell lung cancer, bladder cancer, kidney cancer, stomach cancer, liver cancer, head and neck cancers, and lymphoma are seeing its benefits, and the approach is showing promise in small cell lung cancer and ovarian cancer.
So far, most cancer patients, especially those with pancreatic cancer, don’t see any benefit. The reasons are numerous.
For example, one of the challenges to pancreatic cancer immunotherapy approaches has been the tumor’s ability to evade the immune response. Specifically, pancreatic tumors can prevent the recruitment of T cells, immune cells that could otherwise recognize and attack the cancer cells as foreign. Early detection of the disease has also been difficult, and currently there is still a less than optimal response to standard treatments. KRAS, one of the primary mutations found in pancreatic cancer, is considered “undruggable,” a term used to describe proteins that can’t be targeted with drugs, though significant research is underway to meet this challenge.
However, there have been recent events that have brightened the prospect of immunotherapy for pancreatic cancer. In a first-of-its-kind of decision earlier this year, the U.S. FDA approved Keytruda for the treatment of solid tumors exhibiting high microsatellite instability mismatch-repair deficiency. Although only about 3 to 4 percent of pancreatic cancer patients fit this profile, it can be a potential game-changer for them, explains Luis A. Diaz, M.D., Head of the Division of Solid Tumor Oncology in the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York.
However, “more than 95 percent of pancreas cancer patients still are unable to take advantage of immunotherapy,” he says. “Immunotherapy as we know it today has not made a lot of advances or had a lot of success for them. We absolutely need to get a better handle on the biology of the disease, especially the surrounding tumor stroma. Once we understand more, immunotherapy trials may show better results.”
Although pancreas cancer does indeed present numerous challenges, Diaz is adamant that “no one is giving up, and we can build upon some prior success.” He adds, “But we need to get a lot more creative and not simply repeat mistakes. Because that is what will ultimately benefit our patients.”
Indeed, there are numerous trials underway exploring the use of novel antibodies that cut the brakes on the immune system, as well as vaccine approaches and genetically reprogramming immune cells so they can fight cancer, among other efforts.
Diaz emphasized that patients who are newly diagnosed with pancreatic cancer should always be considered for clinical trials. “There are clinical trials in different classes of agents, and also, patients who are now being referred for immunotherapy trials,” he says, although at this time there is not a standard treatment immunotherapy.
“It would be arrogant to say that immunotherapy won’t work in pancreatic cancer because the truth is we don’t know,” Diaz adds. “What I do know is there is an active effort to really understand the immunotherapy problem in this disease and to try to put a treatment strategy in place.”
For pancreatic cancer, immunotherapy approaches generally fall into four main categories; checkpoint inhibitors, therapeutic vaccines, adoptive T cell transfer, and monoclonal antibodies.
As the source of insulin that helps in the regulation of blood sugar and of enzymes that help break down fats, carbohydrates, and proteins, the pancreas is a key part of the digestive system.
So it’s not so surprising that cancer of the pancreas can bring with it significant nutritional challenges. Successfully addressing these challenges, however, brings multiple rewards: it can enable and enhance treatment, boost day-to-day well-being, and support healthy recovery.
When assembling a team to tackle your pancreatic cancer, a dietitian should be one of your first recruits, according to Maria Petzel, RD, CSO, LD, CNSC, a senior clinical dietitian at the MD Anderson Cancer Center. Ideally, he or she should have a CSO after their name, signifying they have received oncology nutrition certification, with more than 2,000 hours of clinical oncology experience under their belt. That experience comes in handy when assessing the needs of each patient, which differ from person to person, based on factors such as their body type, treatment history, surgical history, and amount of fat in their diet.
For pancreatic cancer patients it is important that the dietitian is well-educated in enzymes. Pancreatic enzymes help break down fats, proteins, and carbohydrates. A deficit of pancreatic enzymes can affect digestion, cause uncomfortable side effects, and weight loss. Symptoms of inadequate enzyme production include excessive gas, bloating, or indigestion after meals and changes in bowel movements such as light colored or yellow stools or stools that are frequent, floating, oily, or loose.
Fun Fact: A normally functioning pancreas secretes about eight cups of enzyme-containing pancreatic juice into the duodenum daily.
“Inadequate enzyme production can be fixed with pancreatic enzyme replacement therapy (supplementing with prescription enzymes), but it’s not a one-size-fits-all solution,” Petzel says. “Pancreatic cancer patients need to have someone on their healthcare team who can help individuals figure out what brand and dose works best to help minimize symptoms and get maximal digestion and absorption.”
Weight loss due to pancreatic cancer is common, but its causes can be complicated. Some are related to the tumor itself, in which case surgery, chemotherapy, or radiation treatment can help. Others, however, are a result of such treatment.
Nausea, loss of appetite, or the change in taste that often accompany chemo or radiation therapy can be combated through diet and pharmaceutical strategies. These are most successful when tailored to each patient, Petzel explains. One person’s diarrhea could be caused by fat malabsorption due to pancreatic enzyme insufficiency, while another may be suffering the effects of lactose intolerance, bacterial overgrowth, chemotherapy, or dumping syndrome from surgical resection. Enzyme replacement may solve the problem for some patients, while a low-fat, low-fiber, and/or dairy-free diet might do the trick for others.
Maintaining a healthy weight for pancreatic cancer patients can be critical to the success of their treatment. “We know that patients who are able to maintain weight are more likely to get their scheduled doses of treatment,” Petzel adds.
Here is some general advice Petzel offers for patients:
Additional nutritional advice can be found on the Academy of Nutrition and Dietetics Oncology Nutrition website. The American Institute for Cancer Research also provides some culinary inspiration in its recipe archives.
As research for the treatment of pancreas cancer develops, fewer patients are being treated with single-modality therapy. Instead, most patients are being treated with a combination of surgery, chemotherapy and/or radiation therapy. This often makes navigating the healthcare system difficult and overwhelming. In a traditional medical environment, patients are often seen by different specialists over the course of several weeks. The Pancreas and Biliary Multidisciplinary Clinic at the CU Cancer Center is designed so that patients are seen by our team of specialists over one day with the goal of having a treatment plan by the end of the visit. This multidisciplinary approach to care provides patients with the most up-to-date and evidence-based treatment to provide the best care for the highest chance of success and cure of disease.
- Cheryl Meguid, DNP, ACNP
Pancreas and Biliary Cancer Clinic Coordinator
To learn more about the Pancreas and Biliary Cancer Multidisciplinary Clinic or schedule an appointment:
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