Pancreatic cancer is one of the most complex and difficult cancers to treat. Unlike many other common cancers, there isn’t an effective way to screen for and detect pancreatic cancer early. Oftentimes, patients present at the metastatic stage when the disease can’t be cured since the symptoms associated with it can be rather vague.
Pancreatic tumors can also require several different kinds of treatment. But current research and trials are moving the needle closer to effective medication, earlier diagnosis and treatment. Dr. Mandana Kamgar is an associate professor at the Medical College of Wisconsin and a medical oncologist working in this field.
Kamgar's work as an oncologist is focused on finding biomarkers of response to treatments in pancreatic cancer and also exploring the molecular makeup of tumors in each patient.
"Previously, let's say some decades ago, we had no understanding of what drives the cancer in each individual, what made the cancer develop in their body, what are the drivers, strengths, and weaknesses of the cancer. Now, with the advancement in technology ... we can really identify what caused the mutation or the cancer or what combination of mutations in a patient is driving the tumor," she explains.
Kamgar adds that these advancements are crucially important because it also allowed for advancement in medical medications and drug discoveries. Now there are drugs available that can target the genetic mutations, such as Daraxonrasib.
The KRAS mutuation is a genetic drive found in approximately 90% of pancreatic cancers according to Kamgar. While Daraxonrasib is not the first drug to be a KRAS inhibitor, "it opens a new era."
"Think of the KRAS as a growth switch turned on, and basically this drug is trying to turn that switch off," Kamgar explains. "This is the first of many drugs that will come, different mechanisms of action, different specificity about, are they going to target all mutations? Are they going focus on only one mutation? So I think that was the excitement about this drug."
After years of being in the phase three study, Daraxonrasib is approved by the FDA, and there are about 60 patients being treated by the drug at the Medical College of Wisconsin in the past 4-5 months.
"This is a rather reasonably well tolerated medication. It's an oral drug [so] patients don't need to come to infusion center to get it. Also, like any other medication for pancreatic cancer, unfortunately, not everybody will have a response or everybody will have a prolonged response. But definitely we have seen some promising responses: biochemical tumor markers going lower by imaging, the cancer looks shrinking in our patients that are treated so far with that," says Kamgar.
"Now with the [FDA] approval, we have programs that we are looking into combinations of the drugs as part of the trials that are designed at our center," she adds. "So our hope is that we would be able to get deeper and more prolonged responses with drugs."
There's also a new clinical trial in the works for a future pancreatic cancer vaccine, and Kamgar notes that there are actually many different vaccines that are ongoing.
"Some of them are personalized vaccines, many of them or mRNA vaccines [with] early promising results. Now, further trials are ongoing [and] the other is what we call off the shelves, like a peptide vaccine. [This means] that knowing KRAS mutation is the driver in majority of patients they have already produced peptide vaccines that are directed in a way that they can try to activate the immune system against these mutations in the tumor," she explains.
With such developments like the approval of Daraxonrasib, vaccine development and ongoing trials, Kamgar believes that we are now moving closer to precision oncology medicine with this more informed approach to learn how each individual's cancer is presenting.
"I would say that now more than any time if a promising clinical trial is available, I think the best option for our patients would be to try and participate."Dr. Mandana Kamgar
Her advice if you are currently dealing with pancreatic cancer is to see if you are eligible to participate in a clinical trial.
"I can tell you that, and it's not just reflective of all ongoing studies, but at the moment there are at least four phase three studies in the first ever diagnosed pancreatic cancer that are looking at different KRAS targeting drugs," Kamgar notes. "I would say that now more than any time if a promising clinical trial is available, I think the best option for our patients would be to try and participate in clinical trials ... They will be hopefully getting access to medications that they wouldn't have access otherwise, and with the hope that this will improve their outcomes, and maybe the outcomes for future patients."
An additional resource for people navigating pancreatic cancer is the Seena Magowitz Foundation. It holds virtual meetings regularly to offer tailored support for the newly diagnosed as well as caregivers and our broader community of patients and survivors. Additionally, the foundation hosts the Power of Us Conference annually - with the last two years hosted in Milwaukee.
"I think it's very unique because first of all, it's one of the largest population of patients, survivorship, and their families that they gather within the country ... The other thing is that it is really patient-focused," says Kamgar. "It brings patients to our basic scientists. They have a tour of the labs to understand what research is going on for pancreatic cancer at our Medical College in Wisconsin. [Specialists can] give the patients [information] in a way that we hope is clear, understandable, the advances that are going on. And more importantly, it allows the patients to interact with those specialists, ask them questions. Sometimes it leads to second opinions, sometimes it leads to really connecting the right patient to the right treatment that they didn't have any knowledge of that before."
