Understanding Pancreatic Cancer
- A new study has linked blockbuster weight loss drugs, like Ozempic (generic name: semaglutide), to a major reduction in rates of pancreatic cancer, a disease Alex Trabek passed away from after a year and a half of battling the aggressive form of cancer.
- Semaglutide is a GLP-1 receptor agonist, meaning that it mimics the effects of GLP-1 in the body. Given as weekly subcutaneous injections, it is normally prescribed to manage blood glucose levels in diabetic patients. It also leads to a significant amount of weight loss in these patients.
- Pancreatic cancer is a type of cancer that forms in the pancreas. It is more challenging to treat because symptoms usually don’t present themselves until the cancer has spread or metastasized. Symptoms may include weight gain, back pain, and jaundice.
- Early-stage pancreatic cancer tumors don’t appear on imaging scans, and people typically don’t experience symptoms until the disease has progressed. The pancreas’ location in the abdomen makes it harder to find tumors.
- Treatment options for pancreatic cancer may include surgery, radiation, chemotherapy, and targeted therapy.
Semaglutide is a GLP-1 receptor agonist [GLP-1RAs], meaning that it mimics the effects of GLP-1 in the body. Given as weekly subcutaneous injections, it is normally prescribed to manage blood glucose levels in diabetic patients. It also leads to a significant amount of weight loss in these patients.
Read MoreAccording to Oncology News Central, Dr. Khaled Alsabbagh Alchirazi, MD, of Aurora Health Care, said during the study’s presentation, “GLP-1 RAs have gained attention due to their unique mechanisms of action, and this study explored the relationship between GLP-1RAs in T2D patients and the incidence of pancreatic cancer.”
The findings—which looked at the TriNetX multi-institution database on more than 4.9 million patients with type-2 diabetes taking antidiabetic drugs for 15 years, between 2005 and 2020—concluded that the 245,532 people taking the GLP-1RAs were 53 percent less likely to get pancreatic cancer, than those who had been taking insulin instead.
Additionally, those taking these popular weight loss drugs had 20 percent reduced risk of getting pancreatic cancer than those who were taking DPP-4 inhibitors. The study also showed a 22 percent reduced risk when compared with SGLT2 inhibitors, and a 16 percent reduced risk compared with sulfonylureas.
SGLT2 inhibitors and sulfonylureas are also among a class of drugs used to treat type 2 diabetes.
The authors explain in the study’s abstract, “Our study compared GLP-1RAs with other antidiabetics medications: insulin, metformin, alpha-glucosidase inhibitors, dipeptidyl-peptidase 4 (DPP-4) inhibitors (from 2006), sodium-glucose cotransporter-2 (SGLT2) inhibitors (from 2013), sulfonylureas, and thiazolidinediones.”
How Does Semaglutide Work?
Semaglutide is a GLP-1 receptor agonist, meaning that it mimics the effects of GLP-1 in the body. It is taken as subcutaneous injections and often prescribed to manage blood glucose levels in diabetic patients. It also leads to a significant amount of weight loss in these patients.
Although semaglutide has been approved for blood sugar control in people with type II diabetes, under the brand name Ozempic, and for weight loss under the brand name Wegovy, it has not been approved for use as an immune booster and cancer preventative. Thus, it should not be prescribed for that purpose. Those taking it to control their diabetes or weight, however, can expect the additional benefit of improving their immunity. as per a recent study, and lowering their cancer risk, as a link between weight and cancer does exist.
RELATED: What You Need to Know About Obesity
Integral to blood sugar control, GLP-1 is a hormone released by the gut in response to food. It causes the pancreas to release insulin. A rising blood insulin level causes all the body tissues to start absorbing glucose (blood sugar) from the bloodstream, thereby lowering blood glucose levels. GLP-1 also prevents the release of glucagon, which is a hormone that raises blood sugar levels by stimulating liver cells to release glucose and helps people feel full for longer. These effects can also cause people to lose weight.
Modern studies on GLP-1 have shown that it has a role beyond glucose control. It modulates the immune system cells, including NK cells, in a way necessary for weight loss.
Obesity & Cancer Risk
It’s important to understand that obesity increases an individual’s risk of developing a range of dangerous health conditions, including several types of cancer. In addition to increasing the likelihood of developing certain cancers, obesity is associated with worse treatment outcomes.
In a previous interview with SurvivorNet, Dr. Stephen Freedland of Cedars Sinai Medical Center said, “Some of the best data we have is that obesity increases the risk of not just getting prostate cancer, but actually dying from prostate cancer. Obese men are 35 percent more likely to die from prostate cancer.”
While obesity or a person’s high weight will not always cause them to develop cancer, other conditions associated obesity, like diabetes and heart disease, can lead to complications from cancer treatment if a person already has cancer. In addition, these conditions can sometimes prevent patients from receiving the recommended first-line therapies, as well as increase a patient’s risk of undergoing surgery.
Sugar, The Western Diet And Cancer Prevention
Dr. Andrea Tufano-Sugarman of NYU Langone Health explained to SurvivorNet the benefits of losing weight.
“While all cancers cannot be prevented,” she said, “losing weight is a great way to reduce one’s risk.”
Dr. Tufano-Sugarman said that this is especially true for women; they lower their risk of developing breast cancer and endometrial cancer when they lose weight and keep it of.
Even without losing weight, adopting a more nutritious diet can help. “Food choices, independent of weight loss, may also help to reduce risk,” Dr. Tufano-Sugarman said. “Research has shown that the Mediterranean diet (rich in fruits, vegetables, nuts and legumes, fish and olive oil) is associated with a decreased risk of cancer. Whereas diets rich in red meat may be associated with an increased risk of colorectal and prostate cancer.”
All About Alex Trebek’s Health Battle & Pancreatic Cancer
Alex Trebek died of pancreatic cancer after a year and a half of battling pancreatic cancer, an aggressive form of cancer. While some celebrities choose to keep their cancer battles private, the “Jeopardy” star openly spoke about his treatment process with the public, and in doing so, educated millions on the disease.
While hosting an episode of “Jeopardy!” in March 2019, Trebek shared with fans that he had been diagnosed with stage 4 pancreatic cancer, and would immediately start pursuing treatment.
Despite the difficult journey, he remained the host of the TV trivia show and would keep viewers up to date on his progress periodically. At the time of his diagnosis, the one-year survival rate of pancreatic cancer was just 18%, but in June 2020 he made a special announcement that he’s “beating the odds” by surpassing the one-year-survival rate.
In addition to sharing good news, Trebek was also extremely open about the side-effects he experienced as a result of chemotherapy, and how it affected his mental state significantly at times. He later turned to an experimental therapy, developed by Dr. Patrick Soon-Shiong, which attempts to use multiple parts of the immune system to destroy tumors.
Trebek’s transparency made a huge impact in educating the public on pancreatic cancer, and made people more vigilant in spotting symptoms early.
In fact, one “Jeopardy!” viewer said Trebek “saved his life” when the TV show host shared symptoms he experienced before his diagnosis, and the viewer realized he was also experiencing these symptoms. As a result, the viewer’s pancreatic cancer was caught at an early and treatable stage.
Pancreatic cancer is an aggressive disease that is difficult to detect because symptoms, including jaundice and weight loss, typically present at a later stage in the cancer’s development. In a previous interview with SurvivorNet, Dr. Anirban Maitra, the co-leader of the Pancreatic Cancer Moon Shot at MD Anderson Cancer Center, explains what he typically sees when patients develop this disease.
“Because the pancreas is inside the abdomen often doesn’t have symptoms that would tell you that something is wrong with your pancreas,” he says. “By the time individuals walk into the clinic with symptoms like jaundice, weight loss, back pain or diabetes, it’s often very late in the stage of the disease.”
Detecting Pancreatic Cancer Early Is Crucial
Parents, siblings and children of someone with pancreatic cancer are considered high risk for developing the disease because they are first-degree relatives of the individual. PGVs (pathogenic germline variants) are changes in reproductive cells (sperm or egg) that become part of the DNA in the cells of the offspring. Germline variants are passed from parents to their children, and are associated with increased risks of several cancer types, including pancreatic, ovarian and breast cancers. Germline mutations in ATM, BRCA1, BRCA2, CKDN2A, PALB2, PRSS1, STK11 and TP53 are associated with increased risk of pancreatic cancer.
Jessica Everett, a genetic counselor at NYU Langone’s Perlmutter Cancer Center, encourages people in this category to look into possible screening options.
“If you’re concerned about pancreatic cancer in your family, start by talking to a genetic counselor to learn more about your risk and what options you have,” Everett said.
Additionally, note that up to ten percent of pancreatic cancer cases are caused by inherited genetic syndromes. So, if two or more members of your family have had pancreatic cancer, or if you have pancreatic cysts, it’s worth asking your doctor to check for pancreatic cancer since you’re at high risk.
Progress in Pancreatic Cancer
Progress has been made over the last few years in the world of pancreatic cancer treatments. One clinical trial recently found that the drug Onivyde, in combination with chemotherapy in the so-called Nalirifox regimen, helped patients live longer compared with chemotherapy in previously untreated patients with metastatic pancreatic ductal adenocarcinoma (mPDAC), according to Ipsen, the pharmaceutical company that bought the drug.
“The prognosis for people diagnosed with pancreatic cancer is extremely poor and we plan to submit these new findings to the regulatory authority as, if approved, we believe this regimen could offer up an important new treatment option for people living with an aggressive and hard-to-treat cancer,” Howard Mayer, Executive Vice President and Head of Research and Development for Ipsen, said. “We thank the patients who participated in the study, their families and their healthcare teams.”
The drug is currently approved in the U.S., Europe, and Asia in combination with fluorouracil and leucovorin as a treatment for mPDAC after disease progression and following gemcitabine-based therapy.
Expert Resources On Pancreatic Cancer
- Detecting Pancreatic Cancer Early Is Crucial
- 3 Key Pancreatic Cancer Red Flags to Look Out For; Some Were Present in Alex Trebek & Patrick Swayze
- Immunotherapy Offers New Hope for Fighting Pancreatic Cancer
- Pancreatic Cancer Treatment Just Became a Lot More Accessible; New Platform Is Designed to Test Multiple Therapies at the Same Time
Another example of progress being made comes in the form of immunotherapy, a type of cancer treatment that uses your own immune system to fight cancer.
“Up until now, immunotherapy hasn’t had a big role,” Dr. Allyson Ocean, a medical oncologist at Weill Cornell Medical Center, previously told SurvivorNet.
Dr. Allyson Ocean explains why pancreatic cancer is so hard to treat.
A clinical trial led by researchers at the Perelman School of Medicine at the University of Pennsylvania, and sponsored by the Parker Institute for Cancer Immunotherapy, found “combination of chemotherapy with an immunotherapy meant to unleash the anticancer capacity of the immune system was effective against one of the hardest targets in cancer care, pancreatic cancer,” said Penn Medicine.
“The researchers found that in 34 patients with advanced pancreatic cancer randomized to receive the immunotherapy nivolumab with two chemotherapy drugs, nab-paclitaxel and gemcitabine, had a one-year survival rate of 57.7 percent, significantly greater than the historical average of 35 percent with chemotherapy alone,” the institution said.
Dr. Benjamin Musher, the director of medical oncology at the Dan L Duncan Comprehensive Cancer at Baylor St. Luke’s Medical Center, recently said there were currently multiple “home-grown clinical trials testing novel immunotherapies in all stages of pancreatic cancer studies underway at Baylor St. Luke’s.” But only about 5 percent of patients with pancreatic cancer participate in such studies.
“We know that we are not going to improve outcomes without more patients enrolling,” Musher said.
In addition, there are immunotherapy clinical trial innovations being made to allow for multiple immunotherapeutic approaches to be tested and compared to one or several standard-of-care options within trials. In other words, “investigational treatments can be added or dropped from the trial over time, depending on preclinical and clinical evidence.”
“We’re encouraged by the trend toward more innovative clinical trial designs to improve the drug development process and ultimately lead to better patient outcomes,” PanCAN Chief Science Officer Lynn Matrisian said in a recent article from the Pancreatic Cancer Action Network.
Clinical trials, in general, are research studies that compare the most effective known treatment for a specific type or stage of a disease with a new approach.
Dr. Beth Karlan, a gynecologic oncologist with UCLA Health, previously told SurvivorNet that clinical trials can play an important role for some patients’ treatment, but they also serve a larger purpose.
“Clinical trials hopefully can benefit you, but it’s also providing very, very vital information to the whole scientific community about the effectiveness of these treatments,” Dr. Karlan said. “We need everyone to be partners with us if we’re ever going to truly cure cancer or prevent people from having to die from cancer.”
That being said, there is no guarantee you’ll receive more effective treatment than the standard of care, and clinical trials certainly aren’t right for everyone. You should always talk with your doctor(s) before getting involved in one. Some risks to consider are:
- The risk of harm and/or side effects due to experimental treatments
- Researchers may be unaware of some potential side effects for experimental treatments
- The treatment may not work for you, even if it has worked for others
But if you’ve already decided that a clinical trial is right for you or you’re just beginning to explore your treatment options, you should know that SurvivorNet has a tool for you. The SurvivorNet Clinical Trial Finder: an A.I. driven tool for patients to find clinical trial options for treatment.
The tool is built on top of clinicaltrials.gov, a database maintained by the U.S. government that compiles privately and publicly funded clinical trials conducted around the world, and gives access to more than 100,000+ individual clinical trials, updated daily.
“Clinical trials are critical to the development of new therapies, and as we live through this extraordinary revolution in genomics, immunotherapy and targeted therapy, it’s clear that one of the most pressing needs for patients, clinical trials sponsors, and researchers is simply a better way to find patients,” SurvivorNet CEO Steve Alperin said.
“Even one percent more people successfully enrolled in clinical trials can change the world.”
Contributing: SurvivorNet Staff
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