A group of the nation's premier cancer researchers led by the Baylor Scott & White Research Institute (BSWRI) and the Translational Genomics Research Institute (TGen) -- has secured a $5.13 million federal grant to develop an early detection system for pancreatic cancer, the nation's third-leading cause of cancer-related death.
Because it displays no overt symptoms or pain in its early stages, pancreatic cancer often is not diagnosed until it has spread to other organs, especially the liver and the lungs -- a point when surgical removal is often no longer an option. This research has the potential to profoundly transform early detection of pancreatic cancer by creating a non-invasive, rapid, accurate and inexpensive blood test.
"Early detection of this disease is essential to reducing its mortality rate," said Dr. Ajay Goel, BSWRI's Director of the Center for Gastrointestinal Research, and the Center for Epigenetics, Cancer Prevention and Cancer Genomics, and the study's Principal Investigator.
"We need a mammogram for the pancreas. Just like breast cancer, if pancreatic cancer is detected early, we can provide better outcomes for patients, and eventually have cures," said Dr. Daniel Von Hoff, TGen Distinguished Professor and Physician-in-Chief, and one of the world's leading authorities on pancreatic cancer.
Because pancreatic cancer often is undetected until late in the disease process, the natural history of the disease is not well known. The five-year, $5.13 million grant (known as a U01 grant) was awarded by the National Cancer Institute's Pancreatic Cancer Detection Consortium, an initiative dedicated to bringing researchers together to better understand the disease and to develop and test new molecular and imaging biomarkers. The common goal is to identify high-risk precancerous lesions and early-stage pancreatic cancer in patients who could be candidates for surgical or other types of early intervention.
"It would be a powerful contrast to the way things are," said Dr. Sunil Sharma, TGen Deputy Director of Clinical Sciences and another of the project's investigators. "By the time a cancer becomes obvious, when it becomes symptomatic and a patient comes to a clinic, by that point the cancer is already a moving target. It makes little sense to guide treatment of a moving target using tests with a traditional biopsy because that biopsy is static in time and space."
Median survival for those with advanced pancreatic cancer was, until recently, less than six months, and the five-year survival rate was less than 10 percent. Survival rates are improving with the development of new therapeutics. Still, more than 43,000 Americans will succumb this year to this aggressive disease, a number eclipsed only by lung and colon cancers.
The BSWRI-TGen led project has three initial objectives:
- Collect matched blood and tissue from a series of patients with pancreatic ductal adenocarcinoma (PDAC, the most common form of pancreatic cancer); precancerous neoplasms (PN, abnormal growths of the pancreas); pancreatitis (an inflammation of the pancreas); and normal pancreas cells and use these samples to identify "signals" characteristic of the conditions being studied.
- Combine multiple signals into a testing panel capable of distinguishing patients with PDAC from those with either PNs or pancreatitis.
- Through clinical trials, use the optimal testing panel prospectively to identify patients with PDAC and PNs.
These efforts come together to create the BSWRI-TGen early-warning system for pancreatic cancer. It will consist of a test that would require only a small blood sample -- a liquid biopsy rather than an invasive tissue biopsy -- to detect pancreatic cancer. Successful development of a liquid biopsy for pancreatic cancer would allow physicians to monitor their patients consistently and safely every month, every week or even every day. A test such as this could also alert a physician to recurrence of cancer before it would be detectable otherwise.
"What we are working on here, it's not going to be one or two markers, but a panel of markers -- a full mixture of DNA, proteins, RNA, microRNA, DNA methylation markers," Dr. Goel said. "This panel would be a more reliable, more sensitive, and more specific pancreatic screening than anything that's available in medicine today."
"Eventually, this method could be adopted for detecting and monitoring other cancers," said Dr. Von Hoff. "We would know very soon if a particular drug or drug combination is working, or not."
Other participants in this project include: HonorHealth Research Institute; University of Southern California and Hoag Memorial Hospital; Ochsner Health System; Medical College of Wisconsin; University of Arizona; Nagoya University; Samsung Medical Center; Prairie View A&M University; and Harvard Medical School.
For more than 30 years, BSWRI has remained focused on accelerating medical breakthroughs through its portfolio of bench, clinical and translational activities across more than 60 specialties. With more than 2,000 clinical research trials, BSWRI serves over 800,000 people at Baylor Scott & White Health medical centers. The goal of this TGen collaboration is to align the best science, technology and minds across both institutions to drive the discovery of new insights and the development of new therapies to treat this deadly disease.
This project is one of three precision-medicine initiatives proposed under a 2015 BSWRI-TGen partnership that also included: advanced genomic sequencing, which maps out the billions of chemical base pairs that comprise the human genome; and development of new clinical trials, which enable patients to receive the newest therapeutics tailored to the genetics of the individual patient's tumor.