Exciting Developments for Pancreatic Cancer Care

**By Flavio G. Rocha, MD**

After successful treatment for pancreatic cancer, one of our patients shared her story. Life after cancer is not normal, she said, it’s better than that. She talked of being inspired by the dedication of the Virginia Mason team. As a member of this team, a cancer surgeon and a clinical researcher, I am inspired by the progress we and other organizations are making toward better treatments for this disease. Working together to discover new therapies and the potential for early detection, the future of treating pancreatic cancer has never felt more hopeful.

Today Virginia Mason sees almost a third of all pancreatic cancer patients in Washington state, with decades of experience delivering care as a multidisciplinary team. This collaboration across specialties – along with advances in imaging, surgical techniques, specialized treatment and safety protocols – contributes to a doubling of the overall survival of our patients compared to the national average, as reported by the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program.

researchVirginia Mason is also invested in world-renowned medical research with Benaroya Research Institute (BRI), offering patients access to clinical trials investigating new therapies for all stages of pancreatic cancer. As a BRI affiliate investigator, I see a new wave of disease-fighting possibilities ahead, based on the latest research involving cancer cell microbiology, genetic testing and immunotherapy.

Reach Goal: Early Detection

Despite improvements in treatment, an estimated 46,000 people in the U.S. will die of pancreatic cancer this year. That’s because 90 percent of cases are diagnosed in later stages, when the cancer has already spread to other tissues or organs or requires preoperative therapy to reduce tumors. Virginia Mason, in partnership with BRI and other research collaboratives, is focused on looking inside the pancreatic cancer cell to identify biomarkers that signal a precancerous condition.

A specific protein, for example, was found in a clinical trial to be significantly elevated in the pancreatic fluid of patients known to have premalignant lesions. These results suggest that testing the fluid for this biomarker could detect disease in patients at increased risk, before becoming pancreatic cancer. Other research around early detection focuses on developing special blood tests, diagnostic imaging and other screening tools to find disease at its earliest stages.

Hereditary Cancer Testing

In July 2018, the National Comprehensive Cancer Network (NCCN) issued a new guideline that all individuals with a diagnosis of pancreatic cancer must meet criteria for hereditary cancer testing. Studies suggest up to 10 percent of pancreatic cancer is caused by an inherited mutation in BRCA1 or BRCA2, the so-called breast cancer genes. Other genetic mutations have been linked to an increased risk of pancreatic cancer as well.

Is there a benefit in genetic testing if the patient already has pancreatic cancer? Yes, for two reasons:

  • Knowing about an inherited genetic mutation may help direct treatment decisions. BRCA-associated cancers, for example, are known to respond to certain treatments, including specific types of chemotherapy. This concept of “personalized medicine” is expanding through clinical trials of other agents that target cancers linked to genetic mutations.
  • Identifying a mutation can be valuable knowledge for family members, who can choose to be tested and learn if they are at higher risk for developing certain cancers. That’s because the same mutation that is linked to pancreatic cancer is also associated with breast, ovarian and other cancers. Family members who test positive can engage in screening or risk-reducing strategies for other forms of cancer, as available.

Boosting the Body’s Immune System

Leveraging the power of the body’s own immune system to fight cancer is the science behind immunotherapy, variations of which are already prescribed by oncologists to treat a variety of cancers. While success has been limited using immunotherapies in the treatment of pancreatic cancer, ongoing clinical trials are testing multiple forms of the therapy, including pancreatic cancer vaccines (designed to “program” the immune system to attack cancer cells), and immune checkpoint inhibitors (shown to reactivate immune cells shut down by cancer cells). Other forms of immunotherapy utilize modified viruses to infect tumor cells, or modifications of the body’s own cells to disrupt cancerous activity.

The Future of Research is Now

Virginia Mason is one of 12 clinical trial sites selected nationwide by Precision Promise, the Pancreatic Cancer Action Network’s groundbreaking initiative to improve patient outcomes and double the pancreatic cancer survival rate by 2020. Starting this year, patients will be able to enroll in Precision Promise through the participating sites, accessing trials of multiple novel therapies alongside standard care approaches.

Through Precision Promise, clinical outcomes data will be continuously tracked and analyzed, accelerating findings that can be shared across the trial sites. Analysis methods, including the use of genomic data, will be matched to patients’ responses to therapy to quickly identify effective treatment options. As breakthroughs emerge, Precision Promise will adapt clinical programs to help get successful therapies out to patients faster than traditional research models.

What Keeps Us Going? Our Patients

The pancreatic cancer survivor who shared her story described the joy of seeing her daughter graduate, and teaching her son how to drive. As physicians we are privileged to not only treat disease with our best skills and knowledge, but to nurture hope in our patients that they will return to the lives and people they love. We have seen the pancreatic cancer survival rate increase 3 percent during the last three years, and momentum is building. The time for changing everything we know about diagnosing and treating this disease starts now.


Flavio Rocha, MD
Flavio G. Rocha, MD, has advanced training in surgical oncology and specializes in liver, biliary tract and pancreatic cancer. He is director of research in the Digestive Disease Institute at Virginia Mason and an affiliate investigator at Benaroya Research Institute. Dr. Rocha practices at Virginia Mason Hospital and Seattle Medical Center.

Surviving Pancreatic Cancer: Kris’s story

KrisMy name is Kris and I’m happy to say I turned 63 in April 2015. When I was diagnosed with pancreatic cancer on Jan. 6, 2011, it was a very, very dark day. At that time, I had a teenage son and daughter, two Bichon Frises, a bunny and a wonderful husband I’d been with for 27 years.

I also had two aunts who had died of pancreatic cancer, one that I was particularly close to. I remember very clearly when my primary care physician called to tell me the results of a CAT scan she had ordered. I told her, “Don’t tell me this! This is a death sentence!” I was horrified.

I immediately contacted my sister, a trauma surgeon at Cook County Hospital in Chicago. They say that the Lord works in mysterious ways. At that time, my sister was studying for another board certification. She had just read a paper written by a Virginia Mason oncologist about the team approach to treating pancreatic cancer.

She asked if I was aware of Virginia Mason and I responded that I had been getting my care there for more than 20 years! She urged me to talk with the physician who had written the article she had read because “he totally gets it” — that cancer has to be looked at holistically. His protocol and the Virginia Mason approach, she said, appeared to be quite unique in the treatment of pancreatic cancer.

I met this oncologist for the first time in a joint meeting with my surgeon. I loved him right away. He has twinkly eyes, a very honest, straightforward manner and a sense of humor. That trust was confirmed when he came in to my hospital room at 9:30 at night, the day after my surgery. The diagnosis of stage 2 pancreatic cancer had just been confirmed and my husband and I were both having a good cry.

This doctor introduced himself again and then sat down on the foot of my bed. He said, “What information can I give you that will help you sleep tonight?” He then proceeded to patiently answer our zillion questions. But the answer that meant most to me was when my husband asked him, “What do you consider to be your role in this proposed treatment?” He answered, “My role is to be Kris’s spiritual cheerleader. Anyone can write a script for chemotherapy. But if I can help keep her spirit strong, she will win.”

He proceeded to talk about how cancer was perceived to be a battle waged by the human body. But it was also a battle being waged by the human spirit. I knew I had found the right doctor. Oh, I checked out the competition — but it wasn’t even close.

It is still difficult to talk about the one year of adjuvant therapy. I was very sick and the physical toll it took was a mighty one. But I had the best team in the world. All the oncology nurses were the most compassionate, lovely people. They always gave me a boost, helped me to laugh, and worked so hard to alleviate the terrible side effects. This started even before I got to the treatment room, with the wonderful ladies at the front desk on the second floor who checked me in.

But as awful as 2011 was, it was also a year of many blessings. I developed an extraordinarily close relationship with my daughter. I learned to be a gracious recipient of help. I tell my children and everyone who asks, that my survival was not due to some special effort from me.

Rather, it was the prayers, compassion and kindness of a village. From the neighbors who snuck in at night to fill my garden with tulip bulbs, to the “soccer moms” who brought dinner to my family, every night, for months in a row, to my two best friends, who sat with me every day for an entire year, and to my Virginia Mason “team” — I am here because of you.

I saw my daughter graduate and head off to college. I taught my son how to drive (now there is a challenge!) I went back to work full time — something even the Social Security office had a hard time believing. My life has been changed irrevocably. I laugh more. I spend more time with the people I love. My faith has deepened.

I truly believe that Virginia Mason gave me the means to live a full and complete life. Having such a serious illness leaves a shadow. It is always there, flitting around the edges. I don’t dwell on it. I’ve been very fortunate to be invited to work with Virginia Mason to improve the patient experience, through workshops and participating in process improvement sessions.

The dedication I see from the Virginia Mason team is an inspiration. Life after cancer is not “normal.” It’s better than that. Continuing my relationship with Virginia Mason is part of that “better.” Whatever I can do to give back is such a small price to pay for the amazing care I received and continue to receive. Thank you, thank you. As my son would say, “You totally rock!”

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This story originally appeared on VirginiaMason.org. Meet other patients who bravely shared their stories of fighting cancer, and get the latest information on cancer treatment outcomes and wellness and support at Virginia Mason.