Pancreatic cancer does not give up. It is an aggressive tumor that, when detected, in most cases (80%), it is too late because it is in advanced stages. 93% of just over 8,000 patients diagnosed each year die within a few months. The only strategy is to investigate, to know its causes and its behavior to develop more effective treatments and an early diagnosis. Núria Malats, a 60-year-old Barcelona woman and head of the Genetic and Molecular Epidemiology Group at the National Cancer Research Center (CNIO), is involved in this crusade. The scientist promotes the Pancreatic Cancer Research Alliance (Alipanc), to which she managed to add 45 teams of researchers from all walks of life who are trying to avoid a fateful record: pancreatic carcinoma is the second cause of death from cancer.
To ask. How did the alliance come about?
To respond. Several teams interested in investigating pancreatic cancer began to gather in Madrid. During the pandemic, activity plummeted and then exploded. Today we are 45 multidisciplinary groups: half carry out clinical research and the other half carry out basic research. This is the richness of the alliance, we complement each other well. We are aware that if we do not join efforts and resources in research, we will not position ourselves or advance in the knowledge of this disease. We want to advance as much as possible in knowledge so that we can later transfer advances to clinical practice and also because it is a matter of public health, to reduce the incidence and mortality and to improve the survival and quality of life of these patients.
Q. Why is there less research on pancreatic cancer than other tumors?
R. There are many reasons. Although it ranks second in mortality after lung cancer, it is not as frequent in incidence. The number of patients with pancreatic cancer is smaller than that of patients with breast, colon, prostate, lung or bladder tumors, for example, who receive more attention from national health systems. Another reason is because, as pancreatic carcinoma is so aggressive and patients have such a short survival, there is not much room for treatment and makes research difficult. Before, there was the perception that nothing could be done and patients with a poor prognosis – only 20% could be operated on – did not receive treatment. Furthermore, 64% of the European population, five years ago, had never heard of pancreatic cancer. I didn’t even know where it was or the symptoms to spot it in its early stages or the risk factors to prevent it. It has always been the great overlooked one. But this attitude has changed a lot due to the increase in cases and because we are all pressing at all levels. There is more awareness among the population. Primary care physicians, whose role is very important, are increasingly active. Also in the political sphere, in health services and in research funding. It’s the moment when we’re all moving and that also helps to bring about this alliance.
Q. Why are cases increasing?
R. Until now, pancreatic cancer was very uniform in men and women with an average age of 67 to 70 years. It is now being seen more in younger people, as is the case with colon cancer. The proportion of women is also slightly higher. We don’t know what’s behind it. It is thought to be related to the rise in obesity and diabetes. But there are certainly other factors that we have not identified. There may be a dysbiosis [desequilibrio microbiano] in the colon due to antibiotic abuse. We also investigated genetic predisposition. We know there are risk factors, but they don’t explain everything. There is not a single element and testing all hypotheses is not so easy. It is true that all the identified cases point to a problem of chronic inflammation of the pancreas and this gives some clue.
We know there are risk factors, but they don’t explain everything
P. Why is he so aggressive?
R.. Pancreatic cancer has been called catastrophic because of its evolution. While the period from initiation and development for other cancers until it is diagnosed is 15 or 20 years, for pancreatic cancer it is much shorter. Even very small tumors of one centimeter can be metastatic. This is due to the characteristics of the gland, as it has no barriers and has a lot of irrigation. There are many challenges.
Q. Are there formulas for an early diagnosis?
R. We’re looking into it, although we’re not about to move it. The potential of liquid biopsy is very high. If there is a way to identify pancreatic cancer in the very early stages, it is with a liquid biopsy and with all the artificial intelligence technology applied to the images. It will be an important field in terms of early diagnosis markers, but we also need to define the population in which to apply these biomarkers. It cannot be for the entire population because the incidence is not high enough. We need to go to the highest risk population. Until now, screening programs are being done for those who have hereditary or familial chances of pancreatic cancer. But it only represents 10% and we lost 90%. And they are not as efficient either. When pancreatic cancer appears between two or three scans, it is already advanced and nothing has been seen before. This is certainly because the imaging tools that are used without artificial intelligence are not sensitive enough, because the window of opportunity should be smaller between one exam and another and also because of the characteristics of this tumor, which we can see. difficult.
Screening programs are being run for those who have a chance of hereditary or familial pancreatic cancer. But it only represents 10% and we lost 90%
Q. When could we reach an optimal level of early diagnosis?
R. I would say, very willingly, between five and 10 years. Let’s see if we can do this as soon as possible. We are joining efforts with major international projects to achieve it in five years.
P. In addition to the population with a family history, what would be the population at risk?
R. That’s what we’re trying to identify, integrating a lot of information about well-established risk factors, but also with genomic markers, microbiome, metabolome, immunome… -population at risk so that the screening program is profitable and makes sense. We know that they are over 60 years old, that diabetes is important, that obesity, tobacco and alcohol are also important, or if there are potentially malignant lesions. But my dream is to have an application on our cell phones, like the ones that exist for cardiovascular monitoring, with which we could estimate the risk and, those that were above a threshold, which we have to determine, would go to the national health system .to enter screening programs based on a battery of biomarkers that we are investigating.
My dream is to have an application on our cell phones, such as those for cardiovascular monitoring, with which we can estimate risk
Q. It doesn’t seem too difficult.
R. We are working on it, developing the algorithm so that it can be used by the population. Where it gets harder is the other unnamed part: the markers that actually play a role in defining high risk. But we have to keep checking whether it discriminates not only when they are already diagnosed or in early cases, but also before the diagnosis and how long before it.
Q. As for treatments, there is talk of nanoparticles, immunotherapy, viruses… Are there any that are promising?
R.. Someone told me recently that you have to attack by land, sea and air. With only one type of treatment we will not succeed and I believe that it will be the combination of several that will finally help us to control this disease. In primary care, we must know how to prevent development; then getting an early diagnosis to 80% of the population at risk, and then offering the whole battery of innovative treatments.