Alex Trebek was quick to point out that he is one of a huge number of people who are dealing with a cancer diagnosis. The initial diagnoses can be a very fearful time, with a lot of different anxieties.
“How do we talk to a patient that’s just been diagnosed with pancreas cancer?” asks Dr. Daniel Labow, Chair of Surgery at Mount Sinai St. Luke’s and Mount Sinai West, and the Assistant Chief of Surgical Oncology. “Everyone knows it’s a tough diagnosis, and patients come in feeling very vulnerable and scared. So I think the first point is to give them information and find out, well, what do we have?”
Read MoreTrebek wanted to make sure that there was no misinformation about his diagnosis. “Hi everyone, I have some news to share with all of you, and it’s in keeping with my long time policy of being open and transparent with our jeopardy fan base. I also wanted to keep you from reading or hearing some overblown or inaccurate reports regarding my health. So therefore, I wanted to be the one to pass along this information.”
He made sure to mention that a lot of other people are going through the same thing. “Just like 50,000 other people in the United States each year, this week I was diagnosed with stage four pancreatic cancer,” said Trebek.
Then he got to the part about how difficult a diagnosis stage pancreatic cancer is, but he stayed positive the whole time, saying he’s going to keep working and plans to fend off the disease. “Now, normally, the prognosis for this is not very encouraging. But I’m going to fight this, and I’m going to keep working. And with the love and support of my family and friends, and with the help of your prayers also, I plan to beat the low survival rate statistics for this disease. Truth be told, I have to! Because under the terms of my contract, I have to host jeopardy for three more years! So help me. Keep the faith, and we’ll win. We’ll get it done. Thank you.”
“And the fact of the matter is everyone who treats this disease, though it’s serious, has patients that have great responses, or have patients that have great responses. And therefore we need to see how that individual pancreas cancer is going to respond to the treatment we have,” says Dr. Labow. “And so what we need to do is first assess the extent of disease, and then come up with a treatment plan and say, you know, ‘We’re going to get through each of these steps along the way, and time will tell how sensitive your tumor is.'”
Usually one of the major steps in figuring out treatment for pancreatic cancer is understanding whether surgery is an option. “So our first step in figuring out how best to treat pancreatic cancer is to decide can the patient have surgery or not,’ says Dr. Ocean. “If we feel that the patient is appropriate for surgery, even nowadays we are giving chemotherapy before surgery to shrink the tumor down, to make the surgery easier.”
The best option, according to Dr. Ocean, is chemotherapy both before and after surgery, if surgery is possible. “It’s also been shown that giving chemotherapy before surgery, followed by surgery, followed by more chemotherapy, gives patients the best chance of a longer term survival,” says Dr. Ocean. “So we actually even in patients who can have surgery from the get to, we’re usually giving them chemotherapy first, shrinking it down, treating the bloodstream also because there may be microscopic cells in the bloodstream. Then, we proceed with surgery and then chemotherapy after surgery too.”
And where immunotherapies, therapies that activate the body’s own immune system to fight cancer, can have application for some type of cancer, there aren’t that useful yet for pancreatic cancer. “Immunotherapy in pancreatic cancer it’s the same really for any other form of cancer. We need to find out if there are a lot of mutations in the tumor or if the tumor is MSI high, because those are the tumors that will respond to immunotherapy,” says Dr. Ocean. “For the most part pancreatic cancer is not a cancer that responds to immunotherapy. There are a lot of clinical trials that are going on now combining chemotherapy with immunotherapy to try to improve outcomes in pancreatic cancer, but certainly not a mainstay of therapy. And very, very few patients can successfully get immunotherapy for pancreatic cancer.”
When people respond well to treatment for pancreatic cancer, the reason is usually genetic. “The people that beat pancreatic cancer usually are the people that we consider exceptional responders to therapy. They are exceptional responders usually because they have a mutation in their cancer that is actionable and responds well to chemotherapy and to targeted therapies,” says Dr. Ocean. “So we need to do genetic sequencing of every patient with pancreatic cancer so we can figure out the best drugs to use. The ones that usually beat the five year survival statistic with metastatic disease are the ones usually that have an actionable mutation that we can target with therapy.”
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