Francisco X. Real, researcher at the National Cancer Research Centre (CNIO). / Christian Esposito. Madmoviex. CNIO
“For the first time in 40 years, there are new experimental drugs for pancreatic cancer. The talk about a cure is still far away, but the situation is one of hope.”
“We must pay attention to possible increases in cases of pancreatic cancer among young people.”
“We want to study whether already approved drugs could prevent pancreatic cancer in specific groups.”
The Pancreatic Cancer Research Alliance (ALIPANC) encompasses nearly 60 groups throughout Spain currently working "to bring basic discoveries closer to clinical trials and to improve patient management."
Francisco X. Real heads up the Epithelial Carcinogenesis Group at the Spanish National Cancer Research Centre (CNIO) and is the President of ALIPANC, the Pancreatic Cancer Research Alliance in Spain. The latest research by Real’s group has pinpointed the mechanism by which a genetic variant increases the risk of pancreatic cancer. It is a step towards an ambitious goal: the prevention of a tumour that too often is only diagnosed when it is no longer operable, because it has already spread to other organs.
According to Real, research needs to advance simultaneously in identifying at-risk populations, in early diagnosis and in treatment. With that approach, “the impact in 10 years will be significant,” he states.
Is pancreatic cancer increasing among young people? If so, why?
It might be increasing in people under 55, although the data are not conclusive, so we must be cautious. But we must certainly pay attention to the problem, because it is an aggressive disease and it cuts life very short.
Less progress has been made in the treatment of pancreatic cancer than in other tumours. Is this starting to change?
The most important thing is that the first drugs specifically targeting the main oncogene involved in pancreatic cancer, which is KRAS, are already being tested. This is the first breakthrough in almost 40 years in terms of treatment, and it is going to change the therapeutic outlook for patients. I’m not talking about a cure, but finally we are going to have more specific drugs than chemotherapy. So we could say that this is the least bitter moment in the history of pancreatic cancer.”
Data reported informally by companies suggest that these new drugs double life expectancy. But still, it’s a matter of months…
We still do not have a cure for pancreatic cancer. That is the first point. What we have are new drugs that are more effective than the chemotherapy we’ve had so far, drugs that are still in the experimental phase. That is to say, in order for them to be available to all patients, clinical trials still need to be completed. They must also be approved by the US and European regulatory agencies, as well as national administrations. But we have never had such good drugs, so the situation is one of hope.
What is the current situation for pancreatic cancer patients?
20% of patients can undergo surgery to cure the disease. But the remaining 80% are diagnosed with inoperable and often metastatic disease (cancer has spread to other organs). Over the past 50 years, the only treatment available to these patients has been chemotherapy, which is not very effective against pancreatic cancer.
“One challenge is to identify the population at highest risk
to diagnose the disease early or even prevent it”
What kind of progress is being made in early diagnosis?
Progress is slow, but steady. As with therapy, there are some major challenges. For example, in pancreatic cancer, liquid biopsy is more complex and less effective than in other cancers, and we don’t really know why. The first challenge, of course, is to identify the population at highest risk, in order to intervene with early diagnosis or even with chemoprevention treatment.
How do you define the at-risk population, the people who need to be monitored more closely?
One group consists of patients with a family history of pancreatic cancer, which accounts for between 5% and 10% [of all pancreatic cancer cases]. Also patients diagnosed with diabetes, and those with chronic pancreatitis. And smokers; smoking doesn’t greatly increase the risk of pancreatic cancer, but it does have an influence.
Is there a specific habit associated with the risk of developing pancreatic cancer?
No, there is no single fundamental risk factor in pancreatic cancer, such as smoking in lung cancer. However, there are many factors that become important as a whole, as they interact with each other.
Regarding chemoprevention, is there, or will there be, any medication that can prevent pancreatic cancer in high-risk groups?
This is what I’m particularly interested in, and we are working on this in our lab. It is an area where animal models that reproduce pancreatic cancer in humans are proving very helpful. We want to study whether drugs that have already been approved, and which we know have low toxicity, could prevent cancer in specific groups.
“More and more research groups
are interested in pancreatic cancer”
Should we prioritise research in treatment, early diagnosis, or prevention?
The important thing is to make progress in all these areas. If we identify high-risk subjects, improve early diagnosis, detect patients who will go on to develop metastatic disease, and advance treatment around surgery, the impact will be significant, I’m sure. We won’t see it tomorrow, but we will in 10 years’ time.
As the president of ALIPANC, the Pancreatic Cancer Research Alliance in Spain, have you seen an increase in research precisely due to the arrival of new treatments in clinical trials?
ALIPANC was launched before the pandemic and in a few years has created a network of clinical and translational researchers for pancreatic cancer in Spain. We have around 60 groups and we are growing, because there are indeed new groups interested. We are working to bring basic discoveries closer to clinical trials, and to improve patient management. The latest ones we have incorporated are working on pancreatic cancer immunotherapy.
Your group, and others at CNIO, also participate in large international research projects on pancreatic cancer.
Yes, we have a very dense international network of partnerships. In Europe, especially, we have significant collaborations in France and Germany, particularly. The groups led by Núria Malats and Héctor Peinado are involved in projects related to the use of liquid biopsy, for example.
What does artificial intelligence bring to pancreatic cancer research?
It’s no different than in other tumours, it’s just that when you’re very behind, any progress has a high impact. In this sense, we have a lot of progress to make. But, from a conceptual point of view, it’s the same as in other tumours, and it’s true that AI is going to revolutionise the way we work: from designing new treatments to how we conduct experiments.