Editor’s note: The “Research Spotlight” series is written by Dr. Anna Berkenblit, PanCAN’s Chief Scientific and Medical Officer. Each month, Dr. Berkenblit shares her insights into the latest news and research in pancreatic cancer. Follow Dr. Berkenblit on X and LinkedIn.
Precision medicine is gathering momentum in pancreatic cancer.
Precision medicine refers to using specific features of a patient or their tumor to direct their cancer care. This personalized approach can have a significant impact on the effectiveness of treatments and patient outcomes.
In order to determine if a patient’s tumor has any “actionable” alterations – features that align with certain treatment options – a tissue sample from the tumor needs to undergo biomarker testing. Patients can access biomarker testing through their treating institution or PanCAN’s Know Your Tumor precision medicine service.
The most common alterations in pancreatic adenocarcinoma tumors – the most common form of pancreatic cancer – are mutations in a gene called KRAS. After decades of being considered “undruggable,” we are now on the verge of powerful therapies that can directly target KRAS. Research is underway to determine the safety and effectiveness of investigational drugs that target KRAS in pancreatic cancer.
One challenge with precision medicine for patients with pancreatic cancer is that, with the exception of KRAS, many of the molecular alterations found in patients’ tumors can be quite rare. In fact, there are some alterations that are typically found in the small subset of patients’ tumors that do not have KRAS mutations (these are called KRAS wildtype). One example is FGFR2, which stands for fibroblast growth factor receptor 2. In tumors, sometimes the FGFR2 gene gets mixed up with a piece of another gene, resulting in what’s called a gene fusion. Gene fusions are best detected by RNA sequencing, which looks for changes in the intermediary genetic material, RNA, that is coded from DNA and then gets translated into proteins. Gene fusions in FGFR2 can cause constant activation of the protein, which leads to uncontrolled cellular growth and tumor formation and progression. It’s thought that gene fusions in FGFR2 and other activating mutations occur in about 1.5% of pancreatic adenocarcinoma tumors. FGFR2 gene fusions are also known to occur in a cancer type called cholangiocarcinoma, an aggressive cancer of the bile ducts. For patients with FGFR2 gene fusions in their tumors, there is an investigational drug that targets FGFR2 and may be able to stop its cancer-promoting activities.
When I was at the American Society of Clinical Oncology (ASCO) meeting last month, I had the privilege of meeting Dr. Sameek Roychowdhury, an oncologist at the Ohio State University Comprehensive Cancer Center. Dr. Roychowdhury is taking an exciting and novel approach to conducting a clinical trial to determine the effectiveness of an investigational FGFR2 inhibitor in patients with FGFR2 gene fusions in their pancreatic tumors. Instead of patients needing to travel to a predetermined clinical site, Dr. Roychowdhury designed his clinical trial to be available to patients at the institution where they’re already receiving their cancer care. The clinical trial investigators at Ohio State University will ensure the patient is screened, enrolled, and treated according to the clinical trial protocol without having to leave the facility where they’re already being treated. They will collaborate with the patient’s local oncologist to coordinate standard of care CT scans and blood work.
For families affected by cancer, travel to clinical trials can create a significant burden – cost, transportation, missed work, etc. – so the concept of being able to participate without having to travel and switch medical centers is very attractive and may set a precedent for future trials.
I believe that the future of pancreatic cancer care will involve a rigorous precision medicine strategy whereby each patient’s treatment will be personalized to them and their disease. I commend Dr. Roychowdhury and his team’s innovative approach to designing a telemedicine-based clinical trial and look forward to the results.
If you or your loved one has pancreatic cancer, we strongly recommend biomarker testing and genetic testing for inherited mutations. Contact PanCAN Patient Services or any questions about testing or the diagnosis and treatment of pancreatic cancer.