Why is pancreatic cancer so deadly?

Nearly 16,000 new cases of pancreatic cancer are recorded each year in France, almost equally between men (8,323 cases) and women (7,668 cases). “Between 1990 and 2023, the incidence rate increased by more than 300% in France and this trend will only continue. It is one of the only tumors for which we observe a clear increase in Currently, pancreatic cancer represents the 4th leading cause of cancer mortality and it is estimated that by 2030, it will be the 2nd leading cause.notes Dr Alice Boilève, medical oncologist specializing in digestive cancers at the Gustave Roussy Institute. At the same time, we are observing a rejuvenation of the affected population, even if pancreatic cancer occurs mainly in subjects aged over 50. A real public health issue, research is moving forward to try to explain this increase in the number of cases and discover how to reduce it, in particular through the YODA project, led by our contact at Gustave Roussy.

Ductal adenocarcinoma of the pancreas is the main form of pancreatic cancer. It develops on the cells of the ducts of the pancreas, responsible for carrying digestive enzymes to the digestive tract. By unknown mechanisms, some of these cells will begin to mutate and become cancerous. Patients diagnosed with pancreatic cancer have a life expectancy of approximately 1 year. Two factors explain this poor prognosis. “The pancreas is an organ that is surrounded by many other essential organs such as the duodenum, stomach and blood vesselsexplains the medical oncologist. In other words, all it takes is a not very large but poorly placed mass for the vessels to be affected and we can no longer operate. It is also a type of cancer that is easy to metastasize, that is to say, to migrate to other places in the body. In either case, the cancer will be difficult to treat.”

Chemotherapy is not very effective, although studies have shown that it is more effective than doing nothing. It helps delay the onset of symptoms and improve quality of life by reducing pain. “It is one of the tumors for which the survival prognosis is the worst. The 5-year survival rate is less than 10%. Recent revolutions such as immunotherapies and targeted therapies are important for moment a marginal place in the management of pancreatic cancer”deplores the specialist. The development of KRAS inhibitors, drugs that could improve the prognosis for a large proportion of pancreatic cancer patients, provides hope. Phase 1 and 2 clinical trials are underway in the United States and should begin in France at the end of 2024.

Another approach to progress: the personalized vaccine, developed from the patient’s cancer cells cultured in the laboratory. The goal of this treatment is to enable the immune system to recognize cancer cells and destroy them. “Promising results have been obtained, not at the metastatic stage, but in patients who have undergone surgery and who are offered adjuvant treatment” finally emphasizes Dr Alice Boilève.

Thanks to Dr Alice Boilève, medical oncologist specializing in digestive cancers at the Gustave Roussy Institute