A personalized approach to treating pancreatic cancer

Video Credit: Weill Cornell Medicine

It's not surprising that pancreatic cancer is often referred to as a silent killer. With few early symptoms and an aggressive nature, it has one of the lowest survival rates of all cancers.

By the time people are diagnosed with pancreatic cancer, most are not candidates for surgery because the tumor is too extensive. Too often, I see patients succumb to cancer due to a lack of effective treatment options."

Dr. Despina Siolas, assistant professor of medicine at Weill Cornell Medicine and an oncologist at NewYork-Presbyterian/Weill Cornell Medical Center

The first line treatment for most pancreatic tumors is chemotherapy, a one-size-fits-all approach that does not work for everyone. "We are trying to personalize treatment for this disease and develop new therapeutic regimens, so we can save more patients," Dr. Siolas said.

Dr. Siolas is focusing on the KRAS gene, which is mutated in 93% of pancreatic cancer cells and promotes uncontrolled cancer cell growth and tumors. But not all the mutations are equal.

Last year, she and her colleagues published a highly cited paper that analyzed over 1,300 patients with pancreatic ductal adenocarcinoma. The study showed that specific KRAS alterations were associated with disease onset, distinct molecular features and specific survival patterns. For instance, about 20% of patients have a KRAS mutation called G12R, and they tend to live longer than others with different KRAS mutations.

The findings suggest that not all KRAS-mutated pancreatic cancers behave the same way and understanding the biology of KRAS variants may help in personalizing treatment. Dr. Siolas hopes to explain the differences in prognosis by determining how common KRAS mutations modulate the tumor microenvironment and interactions between cancer cells and the immune system.

Her career and perspective have been shaped by experiencing cancer firsthand at age 16. "My mother was diagnosed with colon cancer, and we were fortunate in that she recovered after having surgery, chemotherapy and radiation treatments," she said. "When treating a patient with cancer, I really try to put myself in their shoes and understand the mix of emotions—fear, anxiety, pain—associated with a medical diagnosis. At the same time, I'm working on the biological rationale behind this cancer and finding the best treatment for each patient."

She sees these patients in the clinic on a weekly basis and feels a sense of urgency to find more personalized therapies to help them.

"Academic research at places like Weill Cornell is very important because we are allowed to do more cutting-edge studies that may transform patient care in bigger leaps and bounds," Dr. Siolas said. "We need to keep innovating and investing in research because that's the only way we're going to make real progress for patients."