Cancer interception, a phrase coined by Nobel Laureate Elizabeth Blackburn, PhD, a member of the SU2C Scientific Advisory Committee (SAC), has great potential to improve the lives of patients who may have a higher risk of developing pancreatic cancer. Cancer interception is defined as actively blocking cancer at its earliest, pre-invasive stages with drugs, vaccines or screening. This phrase was meant to distinguish active versus passive intervention (e.g., not smoking), but does not suggest importance of one over the other. Unfortunately, pancreatic cancer is typically diagnosed after it has metastasized, and there is no suitable screening test to apply to the general population.
Seminal studies by members of our Dream Team have helped define clinical subsets who are at higher risk for developing pancreatic cancer than the general population for example, individuals with an inherited predisposition (germline mutation carriers); patients with pancreatic cysts; and adults with new-onset diabetes. These individuals may, therefore, greatly benefit from cancer interception.
The overarching goal of this Dream Team is to intercept pancreatic cancer in high-risk cohorts through a multidisciplinary effort spanning six institutions: The University of Texas MD Anderson Cancer Center, Johns Hopkins University, Dana-Farber Cancer Institute, Mayo Clinic, University of California, San Diego, and MIT. Through our combined volume of patients, we will test 2,000 pancreatic cancer patients for heritable mutations, and screen the immediate family members of mutation carriers for their own pancreatic cancer risk. Cancer-free relatives that are mutation positive (and therefore at high risk) will be invited to enter one of our active screening protocols, tied to computer-based “deep learning” imaging algorithms that can detect smaller cancers missed by the human eye.
An important, practice-changing deliverable of these studies will be to make universal germline testing a standard of care for all pancreatic cancer patients. A subset of 50 mutation-positive, high-risk individuals who are currently cancer-free, but who, based on imaging, harbor pre-cancerous lesions in their pancreas, will also be invited to participate in the first-ever trial of a vaccine to prevent pancreatic cancer. Our vaccine will attempt to induce the body’s immune system to act against abnormal KRAS, the earliest and most common genetic aberration found in pancreatic cancer, with the aim of eliminating the precancerous lesions. The success of this pioneering trial will set the stage for future immune-based cancer interception paradigms in such genetically defined, high-risk cohorts.
Our team will also develop a “blood test” for diagnosis of pancreatic cancer when it has still not clinically manifested itself, as this window of opportunity presents the best shot at intercepting the cancer and prolonging survival. This blood test will be applied to high risk settings such as new-onset diabetes.