“Jeopardy!” host Alex Trebek has responded well to treatment for stage 4 pancreatic cancer, giving hope to others with this difficult-to-treat disease.
Just months after being diagnosed with stage 4 pancreatic cancer, “Jeopardy!” host Alex Trebek told People magazine that his doctors say he is in “near remission.”
The 78-year-old TV personality told the magazine that some of his tumors have shrunk by more than 50 percent.
Although Trebek’s response to his treatment is good news, he will still require several more rounds of chemotherapy, with no guarantee of complete remission.
The American Cancer Society says stage 4, or distant, pancreatic cancer has a 5-year relative survival rate of 3 percent.
This advanced stage is when the cancer has spread to other parts of the body, such as the lungs or bones.
In contrast, early stage, or localized, pancreatic cancer has a 5-year relative survival rate of 34 percent.
The American Cancer Society estimates that about 45,750 people will die in 2019 from pancreatic cancer.
Dr. Timothy Donahue, chief of surgical oncology at the UCLA Jonsson Comprehensive Cancer Center in Los Angeles, said that over half of patients with pancreatic cancer have stage 4 disease at the time of diagnosis.
Pancreatic cancer is difficult to detect early because people usually don’t have symptoms until the cancer is in a more advanced stage. This makes it more difficult to treat.
“The prognosis for patients with stage 4 disease is worse than those with an earlier stage,” said Donahue. “For the most part, patients with stage 4 disease are not considered curable.”
The main treatment for metastatic pancreatic cancer is systemic chemotherapy, which targets cancer cells throughout the body. At this stage, surgery to remove the cancer is usually not an option.
Chemotherapy drugs may shrink or slow the growth of the cancer. This can help people live longer, but is unlikely to eliminate the cancer entirely.
Pancreatic cancer is “relatively resistant to chemotherapeutic agents probably due to aggressive biology of the disease, further contributing to its high mortality,” said Dr. Wasif Saif, deputy physician-in-chief and medical director of the Northwell Health Cancer Institute in Lake Success, New York.
But he pointed to two “significant advances” in the treatment of pancreatic cancer over the past decade — gemcitabine, which may be used alone or with other drugs, and a combination of four chemotherapy drugs called Folfirinox.
Research into how to prevent, detect and treat pancreatic cancer is ongoing. In 2017, the National Cancer Institute provided more than $178 million in funding in this area.
Donahue said treatment options for patients with pancreatic cancer have expanded over the past 10 years, with more drug regimens being shown to improve survival.
Other types of treatments are also being explored, with some success.
“Exceptional responses to immunotherapy have been reported in small subsets of [certain] patients,” said Saif.
Immunotherapy is a type of treatment that helps your immune system fight cancer.
As with other types of cancer, genetic approaches — such as genomic deep sequencing — are also being used to understand the role of genes in pancreatic cancer.
Mutations in one group of genes — known as RAS genes — are involved in 95 percent of pancreatic cancers.
Genetics may also enable doctors to target treatments to patients who will benefit the most.
“There are a few mutations that have been shown to be associated with improved response to targeted therapies,” said Donahue.
For example, some research has shown that patients with certain genetic mutations respond well to chemotherapy drugs containing platinum.
Last year the National Comprehensive Cancer Network (NCCN) recommended that all patients newly diagnosed with pancreatic cancer undergo genetic testing for mutations linked to cancer.
While genetic testing may one day enable doctors to know which treatment is best for a patient, right now there is still a bit of trial-and-error involved.
“I often recommend that patients try chemotherapy to see if they have a so-called responsive tumor,” said Donahue. “If so, then there will be benefit of the treatment. If not, then it is a better time to re-evaluate the pros and cons of the chemotherapy and their goals of care.”
Other research is aimed at trying to catch pancreatic cancer much earlier, when existing treatments are more likely to work.
These screening tests are promising, but are a long way from being used in the clinic.
How well patients do after a pancreatic cancer diagnosis depends not only on being first in line for cutting-edge treatments. It’s also about accessing ones that already exist.
In a recent Canadian study in the journal CMAJ, researchers found that many patients with advanced pancreatic cancer miss out on treatment that can extend their survival. One-third didn’t even have a consultation with a medical oncologist.
Dr. Julie Hallet, one of the study’s authors and a surgical oncologist at the University of Toronto and Sunnybrook Health Sciences Centre in Toronto, said patients with pancreatic cancer may be discouraged when they hear words like “advanced,” “inoperable,” or “metastases.”
This can lead them to think that the cancer is “not worth treating.” But that is not always the case.
“Advanced pancreas cancer treatment can lead to better survival, delaying of clinical deterioration and improvement in symptoms,” said Hallet.
This study was based in Canada — which has a publicly-funded healthcare system — so there may be other barriers to people accessing cancer treatments.
But Hallet said studies in the United States and Europe have found similar levels of stigma and fatalism surrounding pancreatic cancer.
To counteract this loss of hope, Hallet encourages patients diagnosed with pancreatic cancer to seek information about the disease and talk to a medical oncologist.
“While treatment may not be feasible for everyone and may not align with the wishes of all patients,” said Hallet, “it is important that everyone has the opportunity to be assessed and receive the information.”