Pancreatic Cancer

Difficult to detect at an early stage, and resistant to treatment once advanced, pancreatic cancer has one of the lowest survival rates for cancer. Life expectancy for 75% of patients is only one year past diagnosis. And only 10% (80 of the 800 people diagnosed each year in B.C.) will live for five years.

But as BC Cancer continues to investigate the genomic characteristics of pancreatic cancer, promising discoveries are being made — such as the fact that the disease is actually many different subtypes — that are leading to more and more effective treatments.

A decade ago there was just one standard test for pancreatic cancer — today there are 10 different diagnostic tools available to patients. And what was once a bleak field at BC Cancer is seeing exciting progress: from increased team capacity and advancements in hereditary testing and research to crucial patient support in order to expedite treatment in a disease where time is of the essence.

Donors Can Create Change — The Hager Family’s Story

Prior to 2011, only a small group of researchers in B.C. were focused on this hard-to-treat cancer. Now, BC Cancer is an international leader in pancreatic cancer research and care with a groundbreaking Rapid Access Clinic (designed to reduce the time between diagnosis and treatment) and a hereditary cancer testing program that is the first government-funded program of its kind in Canada.

This is largely due to the courage and tenacity of Bob Hager who — in the four short months between his diagnosis and death — gathered a team of experts from BC Cancer, UBC and Vancouver General Hospital, and invested $1 million, driven by his belief that collaboratively they could do something about this disease.

In 2012, Pancreas Centre BC (PCBC) was launched. Co-directed by BC Cancer’s Dr. Daniel Renouf and VGH’s Dr. David Schaeffer, its mission is to advance early detection and the development of more personalized treatment options to improve outcomes for those diagnosed with pancreatic cancer.

In celebration of PCBC’s 10-year anniversary, the Hager family (Judy Hager and her daughters Leslie Carter and Shelley Ferris) built on what Bob so selflessly started with an incredible $5 million investment (the largest gift to pancreatic cancer research and care in B.C. history), matched by the BC Cancer Foundation and the UBC & VGH Foundation for a total of $10 million.

Creating Timely Access to Care

Since its inception, the PCBC’s Rapid Access Clinic has streamlined patient care and significantly reduced the time between diagnosis and treatment for patients — minimizing stress and improving outcomes.

The clinic supports patients by:

• consolidating specialist consults in a single day;
• expediting testing;
• performing cutting-edge genetic profiling at the time of diagnosis, leading to tailored therapies for each individual patient and;
• creating an invaluable support network of nurse practitioners that guide patients through the process and help coordinate appointments with other specialists.

Increasing Expertise to Support Patients

Thanks to donor investment and Dr. Renouf’s inspiring leadership, pancreatic cancer research and care is now an exciting potential-filled field of focus at BC Cancer. New additions to the team include:

• Medical oncology fellows to lead collaborative clinical research projects.
• A genetic counsellor to support patients and families at risk of inherited pancreatic cancer.
• A biobank technologist to run and maintain the pancreatic biobank, established in 2015 – it contains more than 325 samples to assist studies to better understand genetic changes in the disease.
• A project manager to oversee research and facilitate the development of new projects.

• A Pancreatic Rapid Access Clinic care coordinator to streamline services and provide in-depth patient support.
• A translational nurse to facilitate hereditary cancer testing for patients and ensure they have access to clinical trials.

Innovation and Advancements Right Here at Home

At the forefront of pancreatic cancer research breakthroughs, Dr. Renouf’s team published a study on a deficiency which occurs when the body is unable to repair breaks in DNA. The homologous recombination deficiency (HRD) can be a characteristic of certain cancers and it may have potential as a tool for early detection of pancreatic cancer.

Another discovery occurred when the team identified that KRAS mutations are absent in approximately 10% of the people with the mPDAC subtype of pancreatic cancer — this is informing effective therapies beyond standard chemotherapy, including two new drugs, which could be tested in future clinical trials.

A trial which investigated adding immunotherapy to the treatment of people with mPDAC is showing promise for people with early-stage disease. Dr. Renouf’s team plans to use pancreatic tissue collected from this trial to help identify additional subgroups which may benefit from immunotherapy.

Another trial, MAESTRO, is using genomic sequencing to categorize patients into specific groups based on shared characteristics of their disease. As the team uncovers more pancreatic cancer subtypes, they will help identify the most effective therapies for each person.

“It’s studies such as these that will enable pancreatic cancer to truly enter the era of precision medicine,” says Dr. Renouf.

Leading the Way in Decoding Inherited Disease

A $7.5 million grant is supporting a new initiative to help build a national network for pancreatic cancer research. As part of this grant, BC Cancer – Vancouver’s Dr. Intan Schrader is the lead investigator for the PRECEDE Consortium, a 10,000-patient cohort study which aims to improve early detection and screening for people at high hereditary risk of pancreatic cancer.

By looking into innovative blood and urine detection methods, this research has the potential to change the standard of care.

Assisting discoveries in the hereditary cancer program is a first-in-the-world technology — developed in B.C. — that informs, with a high degree of accuracy, which chromosomes come from the mother’s or father’s side. This information is changing the understanding of hereditary cancer risk and helping determine which family members need to pursue testing.

Thanks to the identification of a BReast CAncer gene (BRCA) mutation, an inherited fault in the gene that creates a higher risk of certain cancers including pancreatic, a BC Cancer patient was offered chemotherapy and drugs specific to their disease and is now alive and well five years after being diagnosed with metastatic cancer.

Progress like this is just the beginning as more expertise, research and advances in hereditary cancer care provide real hope in improving outcomes in this long elusive disease.