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New Treatment For Pancreatic Cancer—The Most Lethal Of Cancers—Offers Hope

Topline

Research combining two different cancer therapies have shown early promise against pancreatic cancer, signaling hope for those living with the often lethal disease and paving the way for future research into treatments that could boost the odds of surviving.

A treatment regimen combining radiation and immunotherapy can help destroy pancreatic tumors and stop the cancer from spreading, according to research on animals published in the journal Cancer Cell on Thursday.

Immunotherapy is a form of cancer treatment that helps a person's immune system fight the cancer and radiation therapy, also known as radiotherapy, deploys high doses of radiation like x-rays to destroy cancer cells and tumors.

Pancreatic cancer does not usually respond well to immunotherapy but researchers said a new type of antibody treatment was able to boost the number of immune cells capable of fighting cancerous ones.

The tumor-fighting effect was magnified when used alongside radiation therapy, said Sana Karam, a cancer specialist at the University of Colorado and the study's lead author, enabling them to focus on eliminating "bad" cells within the immune system.

The approach worked throughout the body—important for cancers that have begun to spread, or metastasize, which is often the case when pancreatic cancer is discovered—Karam said, adding that the immune system was capable of mounting a response when encountering the cancer again in the future.

Karam said the finding could change the way doctors treat pancreatic patients in the "near future" and that "we can stop the disease from coming back."

Crucial Quote

"I've never been more hopeful about the possibility of improving the survival rate for this disease," Karam said. "In just one radiation session, we saw a remarkable immune response that could change how we treat pancreatic cancer patients."

What To Watch For

The study was conducted in animals, meaning it is in very early stages and a long way from widespread use in humans. It is promising, however, and the researchers said they hope to conduct clinical trials using the technique. Though similar research on immunotherapy is underway in Europe, the researchers said their work marks the first time immunotherapy has been combined with radiation therapy and focused on pancreatic cancer tumors.

Key Background

Pancreatic cancer is the 10th most commonly diagnosed cancer in the U.S. And the third-leading cause of cancer-related deaths. It could be on track to become the second-leading cause by 2030. Though some progress in treating the disease has been made in recent years, pancreatic cancer has the lowest survival rate of any group of cancers, with around 12% of people living at least five years after their diagnosis. One of the key reasons for this is that it often goes undetected until it is in its later stages and has started to spread throughout the body. At this point, surgical removal may not be viable and treatments that effectively treat it are very limited, though experts are working on developing new ones and advancing others like immunotherapy. Immunotherapy is not yet as widely used as other forms of cancer treatment like chemotherapy and radiation therapy but they have been able to dramatically boost survival rates for some forms of the disease.

Big Number

49,830. That's how many people died from pancreatic cancer in 2022, according to the National Cancer Institute. It is the third-deadliest cancer, trailing lung and bronchus cancers and colorectal cancers, which respectively claimed an estimated 130,180 and 52,580 lives. In total, cancer killed an estimated 609,360 people in the U.S. Last year, according to NCI, and around 1.9 million people were diagnosed with the disease.

Easing The Way For Thousands Of Patients With Cancer

In fall 2022, a 40-year-old mother of three was brought into a City of Hope Orange County clinic where Kerry O'Neil, B.S.N., RN, OCN, is the nurse manager. Breast cancer had metas- tasized to the woman's brain, leaving her blind. Kerry did not know this when she opened the curtain to check on the woman and ask how she was doing.

"Kerry, I've been listening for your voice," said the woman, who was anxious and in pain. "I knew you were going to be here, and I just needed to hear your voice." Sadly, the young mother later died just before Thanksgiving.

"It was very sad and that was hard," Kerry said. "You know you can't cure everybody, but you can help them. If you can make their journey a little bit lighter and a little bit easier for them, that's what you need to focus on.

In her 40 years as an oncology nurse and supervisor, Kerry has eased the way for thousands of patients with cancer and their families. Patients remember her professional expertise, compassionate listening, comforting touch and calm demeanor — and all the ways big and small that she makes a difference in their lives.

Kerry exemplifies all of City of Hope's values: compassion, service with a sense of urgency, integrity, intellectual curiosity, excellence and collaboration. Hundreds of patients provide feedback on her outstanding care.

Recently, Kerry was walking her dog, Maggie, when she was approached by a woman and her daughter. "You were my mom's favorite nurse 30 years ago," the woman said. Kerry quickly realized who the patient was; she had made Kerry a Christmas ornament. Kerry shared that she thought of the woman every year when she put the ornament on the tree.

The next time Kerry saw the woman and her daughter walking, she gave them the ornament. "And they just broke down in tears," Kerry said, "They said they couldn't believe I kept it. I said, 'Of course. It meant a lot. That's how she showed me that she appreciated me.'"

Reflecting on a career of medical excellence and extraordinary compassion, Kerry says her proudest moments have been when she could gain patients' trust, educate them about their disease, advocate for their care and serve as a healer to ease their journey. Kerry is frequently the voice of her patients.

She remembers a quiet and stoic man with relapsed acute myeloid leukemia who could not bear to tell his wife he wanted to discontinue treatment. However, he trusted Kerry to explain the situation and his difficult choice. Kerry still vividly remembers the difficult conversation and the wife's concern, especially since the couple had a very young daughter. Kerry's calming demeanor helped everyone come to terms with the situation.

Ultimately, the patient was able to pass away at home, with his large extended family surrounding him and all at peace with his decision. Kerry has been successful in gaining patients' trust, often bringing about extraordinary outcomes.

She is particularly proud of her care of a patient who had been thrown a curveball in a difficult situation. When Kerry first walked in the room, he was so upset he barely talked to her. However, Kerry convinced him and his wife that although the road through chemotherapy would be tough, they were "going for a cure."

Months later — and after many difficult treatments — Kerry was proved right. The patient's cancer was in remission, and the couple responded with a note, calling her "an angel sent from heaven."

With her extraordinary talent for compassion and brilliant expertise, it might seem Kerry was destined for oncology nursing. However, as she tells the story, she found this specialty almost by chance. She says she followed a group of Fitchburg State University nursing school peers to California from Massachusetts soon after graduation and quickly found a job.

"They asked me to choose a medical unit, and I was caught off guard until I remembered that oncology was always my toughest class, so I said, 'Put me in oncology. Maybe I'll learn something.'" Of course, Kerry did more than learn something. She excelled.

She says oncology is exciting to her because she enjoys the challenges of understanding nearly every system of the human body. And most of all, she believes that patients with cancer truly appreciate the compassionate care and the connection they build with their nursing team.

She says that joining the infusion team at City of Hope Newport Beach as a nursing manager two years ago was a natural fit, but she made one stipulation upon accepting a managerial role — she still wanted time to care for patients.

Kerry is constantly looking for ways to make connections among patients and ensure they do not feel alone in their journey. During the COVID-19 pandemic, when a group of patients with multiple myeloma came to City of Hope Newport Beach Fashion Island to receive infusions, Kerry introduced them to one another and arranged to have their infusion chairs turned into a circle so they could talk.

The camaraderie and deep friendships among the "Multiple Myeloma Squad" are still going strong. The group dine at each other's houses and plan fundraising events. For Kerry, accommodating and even laughing with the group at times are all part of the exceptional humanity and understanding she brings to her work.

She says that one of the best parts of her job is when patients tell her they aren't scared anymore. Todd Kennedy, a member of the Multiple Myeloma Squad, says, "Kerry O'Neil is an extraordinary healer with deep clinical expertise, a kind heart, a gentle touch and inspired leadership skills. When I was diagnosed, I expected I would dread my time at the infusion center. To my surprise, however, I look forward to the physical and emotional healing I receive during every visit with Kerry and the team she leads."

Another member of the group sent Kerry photos of her daughter's engagement over the holidays. "They feel like we're part of the family and if we didn't help them, they wouldn't have accomplished this. She was afraid she wouldn't see her daughter become engaged," Kerry said.

It is no wonder that Kerry inspired her youngest daughter into nursing. In her nursing school application, her daughter wrote words that might have come from Kerry herself: "Medicine only treats the illness, but nurses treat the person behind the illness."

She also spoke to constantly running into her mother's patients around town and having them greet her with hugs and "enormous gratitude."

"It is clear to see that the impact of a single nurse is far greater than that of the disease," her daughter wrote. Kerry, who raised five children, embodies the best of oncology nursing.

I am proud to nominate Kerry O'Neil for the Extraordinary Healer Award for Oncology Nursing because she sets the bar higher every day to do more for her patients. She prides herself in demonstrating an exceptional level of both expertise and compassion. We need more people like Kerry to be role models for the next generation of cancer care nurses, and I truly hope more nurses will follow in her footsteps.

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Will A Radiation Treatment For Cancer Help Patients With Irregular Heartbeats?

© (Huy Mach/Washington University in St. Louis via Associated Press) Jeff Backus is fitted with a vest of electrodes to map how his heartbeat goes awry. Doctors are zapping the heart with radiation normally reserved for cancer, a bid to better treat people with life-threatening irregular heartbeats who've exhausted other options. ((Huy Mach/Washington University in St. Louis via Associated Press))

Doctors are zapping the heart with radiation normally reserved for cancer, a bid to better treat people with life-threatening irregular heartbeats who've exhausted other options.

While it's highly experimental, surprising early research suggests it may reprogram misfiring heart cells to control heartbeats more like younger, healthier cells do.

"It may actually rejuvenate sick tissue, and that's pretty exciting," said Dr. Stacey Rentschler of Washington University in St. Louis.

An irregular heartbeat called ventricular tachycardia is a major cause of sudden cardiac arrest, blamed for about 300,000 U.S. Deaths a year. Treating it with radiation is a radical approach — cancer doctors are trained to avoid radiating the heart at all costs for fear of collateral damage.

Now researchers are about to begin the first rigorous study to prove if a quick, one-time dose to fight this irregular heartbeat really works well enough — and is safe enough — for more patients like Jeff Backus, who relapsed after standard care.

The Louisville man already had undergone an hours-long invasive procedure to keep his heart beating properly, and had a defibrillator implanted as a backup. Then this winter, twice in about a month, Backus briefly passed out and awoke feeling like he'd been kicked in the chest. The defibrillator had had to save him, shocking his heart back into rhythm.

"You're always in the back of your mind thinking, 'Is it going to happen?' " Backus said. Out of other options to prevent another scary episode, he chose the experimental radiation in February — and so far is doing well. "It gave me some hope."

The heart's electrical system normally makes it beat with a steady lub-DUB, 60 to 100 times a minute. Ventricular tachycardia is a super-fast heartbeat, unable to properly pump blood. It happens when those electrical signals short-circuit in the bottom chambers, the ventricles, often because of damage from a prior heart attack.

The main treatment: Doctors thread catheters inside the heart to identify and burn the misfiring tissue, creating scars that block bad signals. Some patients are too sick for this "catheter ablation" and for others, like Backus, the problem eventually returns.

Dr. Phillip Cuculich, a heart rhythm specialist at Washington University, came up with the idea for a no-incision alternative.

It takes a lot of upfront testing. Patients get a souped-up EKG, donning a vest covered in about 250 electrodes instead of the usual dozen to measure the heart's electrical activity. Adding that to detailed medical scans gives Cuculich a three-dimensional map pinpointing where the heartbeat goes awry.

How to reach it? Cuculich teamed with Dr. Clifford Robinson, who specializes in precisely focused radiation to attack cancer while avoiding nearby healthy tissue.

Aiming at the heart "wasn't on my radar at all. My goal was to miss the heart," Robinson said. After all, some lung and breast cancer survivors experience heart disease years later from tumor radiation that reached and inflamed heart tissue.

But he agreed to try, warning patients about possible long-term risks. His very first arrhythmia patient responded, "You're concerned about something that might happen 10 or 20 years from now? I'm worried about tomorrow," Robinson recalled. "That was really eye-opening."

Patients lie in the same machine that normally blasts cancer, held in place and listening to music while customized beams hit just the right spot. It can take as little as 15 minutes.

Cuculich and Robinson reported the first successes in 2017 and 2019, experiments with small numbers of desperately ill patients who showed dramatic improvement. They say some are doing well up to six years later.

Although it's not approved by the Food and Drug Administration, the duo has since gotten permission to treat about 80 more people on a case-by-case basis, some, like Backus, not as sick as the earlier patients. And the St. Louis team has taught the technique to dozens of other hospitals in the U.S. And abroad that are cautiously trying it.

But the FDA requires stronger evidence for more routine use — and the more hospitals offer "off-label" radiation to these heart patients, the harder it will be to get that proof.

Now in an international study, sponsored by device maker Varian, nearly 400 patients will be randomly assigned to either radiation or another catheter ablation to directly compare how they fare. Washington University just began recruiting potential participants; additional sites are set to open soon.

The bigger mystery: How the radiation prevents arrhythmias. Cuculich thought it would work by simply copying catheter ablation's scarring but was stunned when scans showed "we weren't actually causing a new scar — and that's a big deal."

Rentschler, a developmental biologist who also treats heart patients, took a closer look. Tests with donated human hearts and mouse hearts suggest the one-time moderate dose of radiation was prompting the misfiring cells to repair themselves.

In areas that got zapped, heart muscle cells temporarily switched on certain genes that normally are dormant in adulthood. Among them: a signaling pathway called "Notch" that helps a developing heart form its electrical system.

Reactivating that pathway "is perking up those areas" so they conduct electrical signals more like when they were younger, Rentschler explained. "We've never had any treatment that could do that."

That's very different from how repeat radiation doses can obliterate tumors. Now Rentschler's research team is testing human heart cells in lab dishes, measuring exactly how they conduct electrical impulses — in hopes that even lower radiation doses might work.

"It's really important that we get this right ... That we figure out what the safe doses are and if there's areas that we should be worried about," Cuculich said.

This story originally appeared in Los Angeles Times.

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