November is Pancreatic Cancer Awareness Month and I want to mark this event by saying that, for the first time in 30 years, I am feeling positive about the progress being made with this notoriously hard-to-beat disease.

There are a number of reasons for my hope. The first is that we are starting to see more effective chemotherapy drug combinations, with almost a doubling of response rates. The second reason is fuelled by the first, and we are seeing a long overdue move away from ‘surgery first’ to ‘chemotherapy first’ treatment strategies. With more effective chemotherapy drugs delivered as a first step in treatment, we will see more patients having their cancer removed and living longer.

The third reason is because we are seeing breakthrough research into the genomics of pancreatic cancer (that is gene differences specific to the disease) which helps explain why all pancreatic cancers do not behave the same way. We can now recognise different sub-types with different genetic mutations. Although not yet available in routine clinical practice, this offers the opportunity to tailor different treatments to different sub-types.

In the meantime some centres have introduced another way of selecting the best drug treatments for an individual patient’s pancreatic cancer. From a biopsy of the cancer, cells can be grown and tested against a whole array of chemotherapy drugs, singly and in combination, to see which ones are the most effective for that specific cancer. We are on the threshold of a new era of personalised treatment for pancreatic cancer treatment. 

These positive developments have been driven by high-quality international research. But to be honest, much more research is needed.

In New Zealand, we need to take stock because recent data is showing that pancreatic cancer is becoming a more common cause of cancer death. This is not only because it is becoming more prevalent, but also because the survival from other cancers has improved to a greater extent. It is expected that in New Zealand, pancreatic cancer will become the second or third most frequent cause of cancer death, up from fourth or fifth. A recent study placed New Zealand lowest for five-year pancreatic cancer survival in a study of countries including Australia, Canada, Denmark, Ireland, Norway and the UK. And to further underline why research is imperative, data shows that the disease has lower survival rates in our Māori population.

So while we continue to provide expert care for patients with pancreatic cancer in this country, we also need a greater commitment to pancreatic cancer research. The funds from the Hugo Charitable Trust has recently enabled us to create a PhD scholarship in pancreatic cancer research which has been awarded to Hossein Jahedi. He will be supervised by Professor Lai-Ming Ching from Auckland Cancer Society Research Centre, Professor Cris Print and myself.

Hossein will investigate how pancreatic cancer walls itself off, making it harder for chemotherapy drugs to penetrate and do their work. This characteristic is a reason why pancreatic cancer is one of hardest cancers to treat.

Another reason is it is uniquely aggressive, almost always systemic from the outset, meaning that it spreads around the body very quickly. It doesn’t help that the disease has few specific symptoms to raise suspicions and allow early diagnosis. We know that adult-onset diabetes can precede the diagnosis of pancreatic cancer in a fifth of patients, and we know that the risk is greater if a person has two or more first degree relatives who have had pancreatic cancer. Screening patients with these indicators may allow earlier diagnosis. The risk of pancreatic cancer can be reduced by limiting alcohol consumption, stopping smoking, reducing obesity and eating a healthy diet.     

Limitations of effective and available treatments has resulted in a fear and pessimism about pancreatic cancer. But as I have outlined, this is changing. Progress is being made but we need more high-quality data about the situation in New Zealand. To that end we are launching two important projects. The first is to define the clinical and economic burden of pancreatic cancer in New Zealand. The second is to determine the best way to measure (‘quality indicators’) how well we are doing with the treatment of pancreatic cancer. The funding from Hugo Charitable Trust has helped us make a start on these important projects through the support of a post-doctoral scientist.

The Hugo Charitable Trust also funds two postdoctoral scientists in the field of pancreatic diseases. Dr Jiwon Hong is a senior scientist in the Applied Surgery and Metabolism Laboratory and Dr Sayali Pendharkar is a scientist in the Surgical Trials Unit, both within the Surgical and Translational Research (STaR) Centre, designed to accelerate the introduction of new treatments. 

We also need more support to make treatments developed overseas available to our New Zealand patients. For example, we do not yet have access to the personalised treatment that I have mentioned above, but with the right support (better awareness, more funding and a commitment to lift our pancreatic cancer survival rate out of its shameful placing) it could be.

The progress we are making means the time is right to make this commitment and the National Pancreatic Cancer awareness month is the perfect time to make that message heard.  

Professor John Windsor is a Pancreatic Surgeon and Director of the Surgical and Translational Research Centre at the Faculty of Medical and Health Sciences at the University of Auckland.

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