PERSONALIZING PANCREATIC CANCER TREATMENT
I knew little about pancreatic cancer when I was diagnosed in May of 2014. I just knew I was not going to accept the often-ineffective standard treatment being offered to me. Rather, I spent precious weeks and days doing research to find a promising, innovative approach to treating this difficult cancer. That research drew me to Dr. William Isacoff in Los Angeles and Dr. Allyson Ocean at New York Presbyterian Hospital/Weill Cornell Medical Center in New York City.
Over the past two years, I have done well and have been treated with several different kinds of chemotherapy combinations developed by my doctors. My treatments have changed, based on the view of my doctors that my tumor continues to change.
One of the ways that Dr. Isacoff and Dr. Ocean shape my treatment is through the investigational research of Dr. Mark Ricigliano, a pioneering scientist who has developed a process for analyzing the circulating tumor cells in the blood.* Through a simple blood test, his process determines which medications could have the most impact on my tumor. The resulting tumor sensitivity profile enables Dr. Isacoff and Dr. Ocean to shape my protocol and continue to test and see if it’s effective. And it has been!
Unquestionably, Dr. Ricigliano and his work have positively impacted my quality of life, and I am grateful everyday for the commitment of researchers like him.
And his work is just a small slice of the science-driven treatment options pancreatic cancer patients and their families can learn about on Let’s Win.
Following is an excerpt of an article about circulating tumor cell analysis that first appeared on Let’s Win.
The genetics of circulating tumor cells provide therapeutic clues. So believes Dr. Mark Ricigliano who has devoted much of his career to developing and designing diagnostic tests to personalize chemotherapy treatments for pancreatic cancer patients.
The research falls under the umbrella-term “pharmacogenomics,” meaning scientists study how specific genes — those short segments of DNA that tell your cells how to function and what traits to express, like straight or curly hair, for example — affect an individual’s specific response to medications. The hope, of course, is to develop treatments that are geared to an individual’s genomic makeup.
“Patients with pancreatic cancer are hoping for some type of breakthrough that can not only make current treatments more effective, but also technologies that can provide information as to whether a treatment is actually working for them,” says Ricigliano, founder and director of Germantown, MD-based Adera BioOncology, which develops assays and companion diagnostics for pancreatic cancer. “It’s rewarding to work on research that can ultimately go from our lab to these patients and, hopefully, positively affect them.”
Ricigliano’s work is focused on so-called circulating tumor cells, basically rogue cells that break away from a primary tumor, enter the blood stream and eventually invade other organs. Once this process of metastasis begins, treatment becomes much more difficult.
Predicting The Best Approach to Treatment
In his lab, Ricigliano maps, or profiles, specific genes being expressed by these circulating tumor cells. It’s this profile that may be able to help doctors predict whether a patient with pancreatic cancer is responding to treatment well before that patient would receive a CT scan to determine the treatment’s effectiveness. The tests may also be able to determine what specific regimen may be better for a patient, and if that patient is becoming resistant to a current regimen.
So far, Ricigliano has found seven pancreatic cancer biomarkers that can be evaluated in his lab. “All a patient needs to do is to have a blood sample taken,” he explains, adding that biomarkers are simply genes in the cancer cell and the expression or mutation of these genes may provide biological information to doctors.
“Each biomarker can provide us different information,” explains Ricigliano. “It’s actually incredible and very powerful.”
For example, one biomarker gene called ALDH1A1 provides information on the extent of pancreatic circulating tumor cells. When the expression of this gene is elevated it could signal active metastatic disease. Another biomarker called BCRP is a multi-drug resistance gene. If there are elevated levels of BCRP it can be associated with drug resistance.
While a blood test is a relatively easy process for the patient, the evaluation of these biomarkers relies on highly sophisticated computer modeling programs to determine potential treatment options, to see if the disease has progressed, or to figure out if a person is responding to treatment.
Anne Glauber has a deeply personal experience with pancreatic cancer, and, with the support of her team and fiscal sponsors, has created Let’s Win to make a meaningful impact in the lives of pancreatic cancer patients.
*Another element of Dr. Ricigliano’s work was touched on in the previous post by Dr. Allyson Ocean called “In the fight against pancreatic cancer, power is knowledge.”
