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Fungal Invasion May Drive Some Pancreatic Cancers

By EJ Mundell
HealthDay Reporter

FRIDAY, Oct. 4, 2019 (HealthDay News) — Fungi living in the gut can move into the pancreas, triggering changes to normal cells that can result in cancer, a new study suggests.

The finding could advance the prevention and treatment of pancreatic cancer, which is usually fatal because it’s often detected too late. The disease has been in the news lately because “Jeopardy!” host Alex Trebek is waging a battle against an advanced form of the illness.

The new research focuses on a particular form of the cancer, called pancreatic ductal adenocarcinoma, which can be fatal within two years.

While the exact causes of pancreatic cancer remain unclear, the American Cancer Society has long recognized that viruses, bacteria and parasites can help spur pancreatic tumors, the authors of the new study noted.

But fungi haven’t been shown to play a role — until now.

“While past studies from our group have shown that bacteria travel from the gut to the pancreas, our new study is the first to confirm that fungi, too, make that trip, and that related fungal population changes promote tumor inception and growth,” study co-author Dr. George Miller said in a news release from NYU Langone Health.

Miller is co-leader of the Tumor Immunology Research Program at Perlmutter Cancer Center at NYU Langone Health, in New York City.

Pancreatic ductal adenocarcinoma is cancer of the tube in the pancreas where digestive juices drain into the intestines. This exchange causes fungal populations in the gut and pancreas — the “mycobiome” — to become abnormal, the NYU team explained. That change may cause pancreatic cells to turn malignant.

In the new study, the researchers first looked at fungal transfer from the gut to the pancreas in mice that already had pancreatic tumors.

In those experiments, the researchers found that treating the rodents with an antifungal drug shrunk the weight of tumors from between 20% to 40% over 30 weeks.

Investigating further, the team catalogued the species of fungi in the poop of mice with or without pancreatic cancer. They even tagged the fungi with “glowing” proteins to watch the microbes travel from the gut to the pancreas.

Continued

Certain patterns emerged, with some populations of fungal species increasing at a far higher rate in the cancerous pancreases versus the non-cancerous ones.

One such cancer-linked species is called Malassezia.

“We have long known that Malassezia fungi — generally found on the skin and scalp — are responsible for dandruff and some forms of eczema, but recent studies have also linked them to skin and colorectal cancer,” study senior co-author Deepak Saxena noted in the news release.

“Our new findings add evidence that Malassezia is abundant in pancreatic tumors as well,” said Saxena, who is professor of basic science and craniofacial biology at NYU College of Dentistry. Pancreatic cancers in the mice grew about 20% faster when Malassezia was allowed to grow unchecked, the team noted.

The researchers theorized that fungi spur growth of the cancer by affecting immune system mechanisms that lead to abnormal tissue growth.

Study co-first author Smruti Pushalkar, a research scientist at NYU College of Dentistry, added, “Moving forward, one goal for our team is to determine which species are most relevant to cancer, as doing so could guide future attempts to slow tumor growth with targeted antifungal medications, and to avert side effects.”

The results of the study add evidence to the theory that fungi increase the risk for cancer by activating an ancient part of the immune system, the researchers said. This immune response fights infections but also increases cell growth as the infection is cured. Past studies have shown that aggressive tissue growth can cause cancer when it’s combined with genetic flaws.

The report was published Oct. 2 in the journal Nature.

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Sources

SOURCE:Nature,  news release, Oct. 2, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Justice Ruth Bader Ginsburg Treated for Pancreatic Cancer

By HealthDay staff
HealthDay Reporter

FRIDAY, Aug. 23, 2019 (HealthDay News) — Justice Ruth Bader Ginsburg has just finished treatment for pancreatic cancer, the U.S. Supreme Court announced Friday.

After the tumor was first diagnosed in late July, Ginsburg was given a three-week course of focused radiation at Memorial Sloan Kettering Cancer Center in New York City, the court said in a statement. A bile duct stent was placed and the justice tolerated treatment well, the statement added.

“The tumor was treated definitively and there is no evidence of disease elsewhere in the body,” the statement said. “Justice Ginsburg will continue to have periodic blood tests and scans. No further treatment is needed at this time.”

This is the fourth time Ginsburg has battled cancer. She had surgery in 1999 to treat colon cancer, and was treated for early-stage pancreatic cancer in 2009. Late last year, she had two cancerous nodules removed from her left lung.

A history of bouncing back from health setbacks hasn’t eased the nerves of liberals who worry about how much longer Ginsburg can serve, as the balance of the Supreme Court shifts to the right with President Donald Trump’s two recent appointees, Brett Kavanaugh and Neil Gorsuch.

Ginsburg was first appointed to the Supreme Court in 1993 by former President Bill Clinton. She is the oldest justice on the court.

Ginsburg has consistently fought for women’s rights. In 1971, she helped launch the Women’s Rights Project of the American Civil Liberties Union (ACLU). She served as the ACLU’s general counsel from 1973 to 1980.

In recent years, Ginsburg gained social media popularity with her own nickname, “Notorious R.B.G.” She was also the subject of a recent documentary, and a movie has been made about her life.

Ginsburg was born in Brooklyn, N.Y., in 1933, according to the U.S. Supreme Court website. She married Martin Ginsburg, and together they had a daughter and a son. She received her undergraduate degree from Cornell University, and attended Harvard and Columbia law schools.

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Sources

SOURCES: Aug. 23, 2019, statement,U.S. Supreme Court

Copyright © 2013-2018 HealthDay. All rights reserved.

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A New Way to Fight a Previously ‘Inoperable’ Pancreatic Cancer

THURSDAY, May 30, 2019 — A new treatment protocol for locally advanced pancreatic cancer can enable surgical removal of previously inoperable tumors and improve survival rates, according to a new study.

“Locally advanced” pancreatic cancer is confined to the pancreas, but the tumor still involves major abdominal blood vessels and usually cannot be removed by surgery.

It’s one of the worst forms of an already deadly cancer, the Massachusetts General Hospital researchers explained.

However, the results of their clinical trial could offer such patients new hope.

The trial included 49 patients with previously untreated locally advanced pancreatic cancer who received a combination of intensive chemotherapy and radiation therapy, as well as the blood pressure drug losartan.

Use of the combo therapy allowed 34 of the 49 participants to go on to have their tumors surgically removed, the team reported May 30 in JAMA Oncology.

And in 30 (61%) of the patients, surgery (“resection”) removed all evidence of cancer around the tumor.

The treatment protocol also significantly improved survival rates, the research team said.

As study co-lead author Dr. Janet Murphy explained, “around 40% of pancreatic cancer patients have either locally advanced or borderline resectable disease, with historically poor rates of successful surgery.” She works in the hospital’s hematology/oncology division.

“To be able to successfully remove the primary tumor in 61% of patients sets a new benchmark and offers much hope,” Murphy said in a hospital news release. “A key part of the success of our approach was our surgeons’ willingness to attempt an operation even in patients who had the appearance of cancer at or near their blood vessels.”

She said that prior research had suggested that tumor spread (as evidenced on CT scans), and the ability of surgeons to remove the tumor after chemotherapy and radiation “are no longer clearly correlated.”

That could give surgeons the green light to proceed.

“While we did not see total blood vessel clearance in 61% of patients, 61% achieved a complete removal of their cancer [anyway],” Murphy said.

“Locally advanced pancreatic cancer has been generally considered an incurable disease, so these results mark a dramatic improvement with respect both to rates of conversion to surgical resectability and to long-term disease outcomes,” study co-lead author Dr. Jennifer Wo said in the news release. She’s from the hospital’s department of radiation oncology.

“Based on these results we have launched a new, multi-institutional clinical trial that will also include the immunotherapy drug nivolumab, since losartan treatment has also been shown to activate several immune system pathways,” Wo said.

One specialist not involved in the trial agreed that the approach could be a new option for these patients.

“Of utmost importance, the results showed that they were able to successfully remove the primary tumor in 61% of patients, which definitely sets a new benchmark,” said Dr. Wasif Saif. He’s deputy physician-in-chief and medical director of the Northwell Health Cancer Institute in Lake Success, N.Y.

More information

The U.S. National Cancer Institute has more on pancreatic cancer.

© 2019 HealthDay. All rights reserved.

Posted: May 2019

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Pancreatic Cancer Survival Odds Linked to Weight Before Age 50

SUNDAY, March 31, 2019 — Need another reason to stay slim? People who are overweight have a greater risk of dying from pancreatic cancer, especially those who are carrying extra pounds before age 50, a new study suggests.

“No matter what the age, there was some increase in pancreatic cancer deaths associated with excess weight. But the association was stronger for excess weight measured in people’s 30s and 40s,” said the study’s lead author, Eric Jacobs, senior scientific director of epidemiology research at the American Cancer Society (ACS).

“We’re not completely sure why this is. Weight gain later in life may simply have less time to cause cancer,” he said.

Between 2000 and 2015, the rate of pancreatic cancer rose about 15 percent, he said. It’s now the third-leading cause of cancer death in the United States.

One reason pancreatic cancer is so deadly is that it often isn’t discovered until it has reached an advanced stage. The disease rarely causes noticeable symptoms, and there are no effective screening tests, according to the cancer society.

But a few risk factors for pancreatic cancer can be changed. Smoking, weight and exposure to workplace chemicals are the three known risk factors that can be modified.

In the new study, researchers looked at data for almost 1 million U.S. adults with no history of cancer. The participants were enrolled in a nationwide study that began in 1982, and were followed through 2014.

The study participants reported their weight and height once — at the start of the study. This information was used to calculate each person’s body mass index (BMI), an estimate of body fat based on height and weight. A BMI from 18.5 to 24.9 is normal, while 25 to 29.9 is overweight. Over 30 is considered obese.

When BMI rose by five units — equivalent to about 32 pounds for someone who is 5 feet 7 inches tall — the risk of dying from pancreatic cancer rose:

  • 25 percent for those between 30 and 49 years old.
  • 19 percent for people between 50 and 59.
  • 14 percent for people in their 60s.
  • 13 percent for those between 70 and 89.

As newer generations who are heavier than past generations reach older ages, Jacobs said he expected pancreatic cancer deaths to rise.

About 28 percent of that risk for people born between 1970 and 1974 comes from BMIs in excess of 25. That’s about double the risk people born in the 1930s face, the investigators found.

Dr. Matthew Weiss, deputy physician-in-chief of surgical oncology at Northwell Health Cancer Institute in Lake Success, N.Y., reviewed the findings.

He said, “This study shows a clear association between obesity in patients under 50 years old and an increased risk of dying from pancreatic cancer. Interestingly, this phenomenon does not seem as impactful at older ages.”

Weiss pointed out that the study doesn’t prove a cause-and-effect relationship. It only shows an association.

“It may be that some of the factors that are important in the development of obesity also increase the risk of pancreatic cancer, which is a highly lethal disease,” Weiss said.

It’s also possible that both conditions are on the rise, but for different reasons, he said. However, Weiss added, obesity has been linked to other cancers as well.

Dr. Rishi Jain is an assistant professor of hematology/oncology at Fox Chase Cancer Center in Philadelphia. He urged people who are overweight to do something about it, to reduce their cancer risk.

“When lifestyle modification — such as diet and physical activity — are insufficient in promoting weight loss, patients may seek additional support from a weight management program, which may incorporate other interventions including weight-loss medications or bariatric [weight-loss] surgery procedures,” Jain suggested.

Jacobs is scheduled to present the findings Sunday at the American Association for Cancer Research meeting, in Atlanta.

Findings presented at meetings should be viewed as preliminary until they’ve been published in a peer-reviewed journal.

More information

Learn more about pancreatic cancer from the American Cancer Society.

© 2019 HealthDay. All rights reserved.

Posted: March 2019

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‘Jeopardy’ Host Alex Trebek Has Pancreatic Cancer

March 6, 2019 — Jeopardy host Alex Trebek’s voice was calm and determined on Wednesday’s YouTube video, announcing his grim news in just over a minute. “Just like 50,000 other people in the U.S. each year, this week I was diagnosed with stage IV pancreatic cancer.”

“Normally the prognosis is not very encouraging,” he continued, “but I am going to fight this. I plan to beat the low survival rate statistics for this disease.”

He told fans of his long-running hit game show he was going to continue working — adding playfully that he had no choice, his contract runs another 3 years.

A Surgeon’s View

Trebek’s cancer is likely the type known as pancreatic ductal adenocarcinoma, says Timothy Donahue, MD, a professor of surgery and chief of the division of surgical oncology at David Geffen School of Medicine, UCLA. He spoke in generalities about pancreatic cancer because Trebek did not release more details about his condition.

“The other type of pancreatic cancer is a pancreatic neuroendocrine tumor, which is what Steve Jobs had,” Donahue says, referencing the late founder of Apple.

The median survival rate of people with stage IV pancreatic cancer, he says, is about 18 months, with half surviving longer and half dying sooner.

“Patients who have stage IV usually do not undergo surgery,” Donahue says. “Stage IV means the cancer has spread to other organs, and surgery is almost always not possible.”

Pancreatic cancer often spreads to the liver, he says.

Typically, the cancers are treated with systemic chemotherapy, Donahue says, usually using multiple drugs. For these patients, he says, he would typically look for mutations in the tumor that can be analyzed to find the best treatment. Experts are learning more about the genetics of the disease, he says, and ”actionable mutations” within the tumor, which are mutations that can be targeted with specific treatments to get a better result.

Pancreatic Cancer: The Grim Reality

In his blog posted on the American Cancer Society site, Len Lichtenfeld, MD, interim chief medical and scientific officer for the Society, praised Trebek’s decision to share the news. “Announcements such as Mr. Trebek’s remind us that together we give one another strength to face an uncertain future with dignity and hope,” Lichtenfeld wrote.

“The fact is, pancreatic cancer is a difficult disease to treat effectively. That is due in no small part to the fact that — as the case with Mr. Trebek — pancreatic cancer is usually diagnosed at a later stage, remaining undetected until it causes difficulties and symptoms by its spread.”

The pancreas lies deep within the body, so doctors cannot easily feel it.

“The reality is that for most people, pancreatic cancer is too advanced to be treated with surgery and is not very responsive to currently available chemotherapy and targeted therapy medications,” Lichtenfeld wrote.

But Donahue says the newer treatments that use multiple agents have shown more promise than the single agent chemotherapy.  

Still, Lichtenfeld wrote, “newer forms of treatment such as immunotherapy and CAR-T haven’t shown particular success at this point.”

Pancreatic Cancer Statistics and Outlook

This year, the American Cancer Society expects more than 56,000 people to be diagnosed with pancreatic cancer and more than 45,000 to die from it. The cancer almost always strikes after age 45, with 71 the average age at diagnosis. Trebek is 78.

Family history and genetics play a role in risk of the cancer. Tobacco use, obesity, and workplace exposure to certain chemicals used in dry cleaning and metal working industries raise the risk as well. Chronic pancreatitis also  makes the cancer more likely, and some research shows that late onset diabetes, especially in the elderly, could lead to pancreatic cancer.

Blood tests can be done to detect certain proteins that may go up in the presence of pancreatic cancer, but the proteins aren’t always elevated. If they are, the cancer is often already advanced, the American Cancer Society says.

Sources

YouTube: “A Message From Alex Trebek,” Jeopardy!

American Cancer Society: “Pancreatic Cancer.”

Timothy Donahue, MD, professor of surgery and chief of the division of surgical oncology, David Geffen School of Medicine, UCLA.

American Cancer Society blog.

Len Lichtenfeld, MD, interim chief medical and scientific officer, American Cancer Society.

© 2019 WebMD, LLC. All rights reserved.

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Teenage Obesity May Raise Pancreatic Cancer Risk Years Later