Donna Gustafson a few years ago was feeling much more tired than usual after a flight to Australia from her home in Florida, and her skin suddenly turned yellowish. He went to an emergency room thinking he needed IVs or intravenous hydration. But doctors told him he had pancreatic cancer.
“They were very clear, they said there was practically no doubt that this was the diagnosis,” says Gustafson, now 72 years old and living in Delray Beach, Florida, remembering that moment. She and her husband immediately returned to Florida to explore treatment options.
Less than 13% of people diagnosed with pancreatic cancer live more than five years. Almost all of the patients in this clinical study have already been alive for six years
Gustafson underwent surgery to remove parts of his pancreas, whose disease was in stage 2 (when tumors or cancers are already enlarged but still located in a specific area).
Before he started chemotherapy, his doctors told him there was a new clinical study to measure the possible effect of using messenger RNA vaccines that can generate a “personalized” immune response.
It was February 2020, just before messenger RNA coronavirus vaccines became highly sought after amid the pandemic, and before long Gustafson was among the first people to receive such a vaccine developed against pancreatic cancer.
“I didn’t have to think about it,” Gustafson said, about joining the clinical study, “because “I knew the odds were against me.”
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Less than 13% of people diagnosed with pancreatic cancer live for more than five years, making it one of the deadliest types of this disease. There are no routine screenings that can detect it, such as colonoscopies or mammograms, and there are usually no symptoms until the cancer is advanced. Once it is detected there are few treatment options; only one in five cases is operable, and the fact that it is is a requirement to join the clinical studies of vaccines like the one Gustafson received.
These vaccines are a form of immunotherapy, which uses each patient’s immune system to fight cancer cells. The goal is not to eliminate existing tumors, but to eradicate any undetected cancer cells and others that may form before they multiply.
Patients still need to have surgery to remove the tumors. After that, messenger RNA technology vaccines are personalized for each individual based on genetic material taken from biopsies of the tumors in question. Clinical study patients like Gustafson also receive chemotherapy, a standard treatment for those who have undergone surgery for pancreatic cancer.
(For some cancer patients, immunotherapy may be a way to avoid surgery and chemo)
Pancreatic cancer has long been one of the most difficult cancers to treat with traditional immune therapies, according to Vinod Balachandran, who runs a center for cancer vaccines and is the doctor at Memorial Sloan Kettering Cancer Center in New York who led the clinical study that Gustafson joined six years ago.
For a long time, specialists believed that people with pancreatic cancer could not mount an immune response against their own tumors. But Gustafson, who has received nine doses of the personalized vaccine, is one of eight people who achieved it in the clinical study, developing an “army” of T cells that are dedicated to destroying tumor cells.
Balachandran and his team published initial results of the study last year, based on phase 1 data that only took into account the first three years of treatment. But now there is new data, compiled over the total six years since the clinical study began, and The results suggest that the immune response is not only successful at the beginning: its success would last such that patients can prolong their lives.
The latest results will be released for the first time on April 20 at the annual conference of the American Association for Cancer Research. The data was provided to our sister network NBC News.
“People who respond to the vaccine have lived longer than those who did not have that response.”
william freed-pastor, doctor
They show that Gustafson and six other people who had a strong immune response to the vaccines are still alive. Two of the eight people who did not have a strong immune response are also still alive.
“The most important finding is that people who respond to the vaccine have lived longer than those who did not respond,” said William Freed-Pastor, a doctor at the Dana Farber Cancer Research Institute who was not involved in the clinical study. He stressed that more research is still needed because the first group of patients is small and the results cannot be extrapolated.
Balachandran and his team have just launched the next clinical study, phase 2 (which focuses on evaluating efficacy in a larger group of patients), for their vaccine.
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Robert Vonderheide, the incoming president of the American Association for Cancer Research, said the results to be presented Monday at the group’s conference open several promising avenues.
Previous mRNA vaccines had been tested in people who had more advanced or metastatic cancers, and the patients’ immune response was not very promising. “So for a while we thought the vaccines weren’t going to work,” says Vonderheide, who was not involved in Balachandran’s study.
But the results from patients like Gustafson suggest that vaccines that have now worked with those with less advanced cancer could be reformulated to perhaps generate an immune response in more serious patients.
“Now that we know better the mechanisms of how they work we may be able to go back and see how we can make them work for those who have more advanced cancers,” Vonderheide said.
(This is the third most diagnosed type of cancer in both men and women)
The association specialist, who is also the director of the cancer center at the University of Pennsylvania, said that the results of the phase 1 study with Gustafson still need to be taken with some caution, because there are some people with pancreatic cancer who in any case could have already survived more than the five years of life prognosis for those who suffer from it and it remains to be seen if the vaccine alone will offer that possibility to more people.
But both he and Freed-Pastor emphasize that it is very important for the field of treatment research that there are already immune responses to a vaccine when there were none before.
In addition to Balachandran’s, there is another team developing a possible vaccine against pancreatic cancer that focuses on attacking a protein called KRAS that is present in up to 90% of cases of this type of cancer, and in very initial results in a few patients 85% had an immune response to combat that protein and, subsequently, part of the cancer.
Vonderheide said it is encouraging that there are several lines of research at once.
“As soon as we have something that we believe can be effective, cancer cells tend to find a way to survive despite it, and then it is a great possible solution for us to develop several tools to combat them,” he said.
