Projections indicate that pancreatic cancer could become the second most common cause of cancer death by 2030.
William Hawkins, M.D., deputy director of MUSC Hollings Cancer Center and a pancreatic cancer researcher and surgeon, said recently that pancreatic cancer's rise up the ranks of deadliest cancers is not because it's getting worse but because prevention, screening and treatment are getting better for other types of cancer – and that type of progress can be made with pancreatic cancer, too.
"I fully expect that we will be able to improve survival in pancreas cancer, and that we will double it in the next five to 10 years," he said. "And I am absolutely determined it will not be second."
Hawkins spoke to a full house at the Talbot Pancreatic Cancer Awareness Reception at Hollings on Nov. 21, World Pancreatic Cancer Day.
Jane Talbot, widow of the Hon. Francis F. Talbot, who died of pancreatic cancer in 2010, two-and-a-half years after his diagnosis, also spoke.
"He had a slogan, and his slogan was 'Where there is research, there is hope.' I see him sitting on the edge of the bed, looking at me, and saying 'Do something' about research," she said.
For Jane Talbot, part of "doing something" was founding the South Carolina chapter of the Pancreatic Cancer Action Network and raising money for research at Hollings, the only National Cancer Institute-designated cancer center in the state.
The Talbot family knows firsthand how important research is. Francis Talbot wasn't eligible for surgery because of the location of his tumor. But he entered a clinical trial testing chemotherapy before surgery, instead of the typical protocol of chemotherapy after surgery. Under the clinical trial protocols, the tumor shrank enough that he became eligible for surgery.
"That was at a time when I would say to people that my husband had pancreatic cancer and we were doing a trial, and I got two responses: 'Oh, pancreatic cancer. That's a death sentence.' And the other one was, 'Oh, trials. You do a trial as a last resort.'
"And certainly, we know that both of those things aren't true. As we've watched the survival rate increase and as we know now that the first thing you should do is look for trials so you get the very best of what's out there," she said.
In fact, trials are at the top of Hawkins' to-do list for 2025. He's set goals to launch two clinical trials for pancreatic ductal adenocarcinoma, the most common form of pancreatic cancer, and to hire more pancreatic cancer researchers.
Basic science research will be key to improving pancreatic cancer survival, he said, and, in fact, one can look at the improvements over the last 30 years and see how increases in survival rates parallel increases in research funding.
Pancreatic cancer now has a five-year survival rate of 12-13%, compared to a five-year survival rate of 7% in 2017, and Hawkins said that targeted therapies will increase the rate even more.
"I fully expect that we will be able to improve survival in pancreas cancer, and that we will double it in the next five to 10 years."William Hawkins, M.D.
Today, there are two FDA-approved drugs to target KRAS gene mutations, even though for decades KRAS was considered "undruggable."
Though the two FDA-approved drugs are for uncommon KRAS mutations, there are two all-KRAS mutations drugs in late-stage clinical trials and more than 50 KRAS-targeting inhibitors in the pipeline.
"And nobody expects we're going to cure pancreas cancer with one drug. So we make progress, but then we have to combine these in a safe way. Novel combinations are the future," he said.
Hawkins pointed out that there's room for progress on the early intervention and prevention side as well. Traditionally, pancreatic cancer hasn't been been thought of as preventable because there's no screening test aimed at the general population, like mammograms or colonoscopies, and because it seems to progress so quickly once diagnosed.
But researchers now understand that pancreatic cancer takes years to develop, just like other, more common cancers.
"From a normal duct to carcinoma in situ to high-grade dysplasia to active carcinoma was a five- to 10-year journey. It was not different than breast cancer," he said. "It provides us with a longer timeline in which we can intervene."
A recent study showed that many people harbor some KRAS-mutations in their pancreas.
"But most of us will never get pancreas cancer. So the body is doing something in the background that says, 'That shouldn't progress,'" Hawkins said. Figuring out that messaging and exploiting it is an opportunity to prevent progression.
Promoting healthy habits can also reduce the risk for pancreatic cancer. Smoking and obesity are both risk factors, and research is also looking at alcohol and diet as factors.
"We don't eat well in South Carolina – the food is too good. We don't exercise enough in South Carolina." But, he added, behaviors can be changed, and spreading information about healthy habits is part of what the Office of Community Outreach and Engagement does.
"Instead of talking about therapy and then death, we're now talking about therapy to survivorship."
