By Eric Lefkofsky, Co-Founder and CEO @TempusLabs and Kevin White, President @TempusLabs
This year roughly 50,000 people will be diagnosed with pancreatic cancer in the United States. With the beginning of Pancreatic Cancer Awareness Month, we have an opportunity to take a look at what needs to be done in order to give the men and women living with pancreatic cancer a fighting chance to survive. According to American Cancer Society statistics, in 2016 pancreatic cancer will claim close to 42,000 lives and it will be the third most lethal cancer (behind lung and colon cancer). With a five year survival rate of less than 8% overall, and a survival rate of less than 2% for people diagnosed with stage 4 disease, a diagnosis of pancreatic cancer gives a patient extraordinarily long odds.
But there is is reason to be optimistic.
In recent years, thanks to the tireless activism and fundraising among pancreatic cancer advocacy groups and research sponsoring foundations, this situation has begun to change. Simultaneously, new technologies such as next-generation genome sequencing have allowed us to catalog the genetic mutations and molecular abnormalities that drive pancreatic cancer. Optimization of protocols for developing patient-derived xenografts and organoids have allowed us to grow a patient’s own tumor in a mouse or in engineered synthetic environments, and to study how it behaves when exposed to drugs or to natural conditions it might encounter in its own ‘microenvironment.’ Meanwhile, advances in immunotherapy and targeted therapeutics have begun to transform the treatment of other forms of cancer, and there are high hopes that at least some of these advances will migrate into the treatment of pancreatic cancer.
In response to this change in climate, our understanding of pancreatic cancer has accelerated at an impressive pace. Last year alone there were nearly 6,000 new scientific references registered in the National Library of Medicine’s PubMed catalog; by comparison this is more than double the number published a decade ago in 2005. At the same time, clinical trials have also surged. A search of ClinicalTrials.gov reveals over 700 open studies this month that involve pancreatic cancer, with many of the studies exploring novel therapeutics that harness the immunological or molecular state of the tumor.
The advances happening, driven in part by new technologies, have the potential to be transformative. For example, in 2016 we have learned from genomic analyses that there are at least four molecular subtypes of pancreatic ductal adenocarcinoma (the most common and lethal form of pancreatic cancer) (Bailey et al. March 3, 2016 Nature), and that the accepted model of pancreatic cancer development may need to be significantly modified (Notta et al. October 20, 2016 Nature). These findings could have profound effects on how we diagnose, categorize and treat this disease.
The refinement of our molecular understanding of pancreatic cancer has implications for how we might conduct and interpret clinical trials. Recently a new type of clinical trial in pancreatic cancer was announced that matches each patient’s molecular profile to their treatment and that can evolve over time based on the data. The Precision Promise trial has been organized by the Pancreatic Cancer Action Network (PanCAN) who is investing $35M across 12 major cancer centers in the United States. Our company Tempus is excited to have been chosen by PanCAN to support this revolutionary effort, using our technology platform for the production and analysis of genomic and clinical data associated with Precision Promise.
For most of the modern world there are algorithms, cutting-edge analytics and sophisticated software systems that help us communicate and navigate in our daily lives, that manage massive financial networks, or that optimize complex industrial workflows. However, this kind of technology has not permeated healthcare, and in particular cancer care, in the same way. We need a new set of technology tools that unifies all of the disparate systems that clinicians and research rely on to collect and analyze data.
To utilize these tools a sufficient number of patients is needed with deep clinical and molecular data, tying therapy to genomic profile and ultimately to outcome. Precision Promise anticipates enrolling thousands of patients in the next few years. If the technology we have at our fingertips holds the key to advancing our understanding of treatment outcomes and extending survival, Precision Promise (and other trials like it) may be the beginning of the end for pancreatic cancer.
Do we have the technology to cure pancreatic cancer, or to at least improve outcomes so that patients with this dire diagnosis can survive longer than they do now? The answer is maybe, which means there is hope. Many think we are on the precipice of a new age in the treatment of all cancers, including pancreatic cancer. While time will tell, time is unfortunately not something pancreatic cancer patients have to spare. That is why we are teaming up with other like-minded organizations and individuals to see how fast we can learn from the technologies we have in hand today. We need more innovative initiatives like Precision Promise across more cancer types. And if our current technology is going to put a dent in pancreatic cancer, let’s figure that out fast. The month of the November is a time to remind ourselves of the urgent need for progress toward conquering this deadly disease.