Professor Andrew Biankin
Right now, the outlook for pancreatic cancer is bleak. Despite heartfelt efforts by researchers, survival has barely shifted over recent decades. Fewer than three in every 100 people diagnosed with pancreatic cancer can expect to make it to five years.
It’s a situation that urgently needs to change, and one that we’re particularly focusing on as part of our new research strategy.
Someone who’s trying hard to alter the outlook for patients with the disease is pancreatic cancer expert Professor Andrew Biankin, who works at our research centre in Glasgow.
Last year we tempted him away from the sunny weather of Sydney, Australia, to pursue his pioneering work in Scotland’s cooler climes.
The decision to tackle such a hard to treat cancer in the first place might seem a little puzzling. So why did he do it?
Determination and change
“It was in the final year of my surgical training in Sydney that I first thought about turning to research. I was working pretty hard, treating patients with diseases of the liver, pancreas, stomach and so on, and felt that I wanted to do something different,” he told us.
And for the patients he saw with pancreatic cancer, things were dismal. In particular, the memory of one patient in particular has always stuck with him – a 39 year old woman with pancreatic cancer.
“She was one of the first patients I treated as a consultant and had the tiniest tumour in her pancreas, about a centimetre across,” he recalls. “The surgery to remove it went well and I was so proud of that operation – I think it was the best operation I’ve ever done.”
Nine months later he saw her again, and all was well.
“But six weeks after that I got a call from the hospital saying the disease had come back. Two months later she died.
“At that point I realised we really didn’t know anything about pancreatic cancer, and throughout my career I’ve been determined to change that,” he says.
And that means understanding why pancreatic cancer develops so quickly.
“It boils down to the biology – it’s an inherently very aggressive disease,” says Biankin. “Often it’s diagnosed so late it makes clinical trials very difficult to do.
“It’s also very diverse – there are probably many types of pancreatic cancer that we haven’t managed to properly distinguish yet. The old model of ‘one size fits all’ is no good if you’re looking at maybe 20 distinct diseases, that all respond in different ways to treatment.”
But back in the 1990s, nobody in Australia was doing research into understanding the disease, not even at Sydney’s prestigious Garvan Institute of Medical Research.
“So I went across the road to the Institute and had a chat with Rob Sutherland, who was director of cancer research there.”
Biankin proposed teaming up to try to make a difference for these patients.
Sutherland’s reaction was memorable. “He looked at me and said: ‘Well, we’ve got a bit of a problem because I don’t know anything about pancreatic cancer, and you don’t know anything about research!’”
That situation was about to change.
Starting from scratch
Biankin started a PhD, and then spent two years at the Johns Hopkins University in Baltimore before returning to Sydney to focus on a particular puzzle in pancreatic cancer research – the faulty genes that cause the disease, and the underlying differences between patients’ tumours.
In particular, Biankin set out to understand why patients respond to treatment differently, as well as looking for new targets for future therapies.
A key player in all this was DNA researcher Sean Grimmond – “My sequencing super-guru”, as Biankin calls him – who pioneered a lot of the DNA sequencing technology in Australia.
In Sydney, Biankin and Grimmond put in a bid to run the pancreatic cancer arm of a large collaborative project called the International Cancer Genome Consortium (ICGC) – and set up the Australian pancreatic cancer genome initiative.
The pair oversaw the mapping and uploading of the complete DNA read-outs for around 400 pancreatic cancers to the ICGC project, making it one of the largest sets of whole genome sequences for any cancer type.
“Thanks to our efforts it’s gone from one of the least genetically characterised cancers to one of the best, which is fantastic because the need is so desperate.”
But there’s some way to go to use this knowledge to help patients. Biankin’s next focus was to try and move these cutting edge DNA analysis techniques out of the lab and into hospitals, to try to work out how genetic variations are linked to response to therapy.
And that’s what brought him all the way to the other side of the world, to Glasgow.
Assembling a top team
“We’re now hunting for new targets for treatments, working closely with colleagues at the Cancer Research UK Beatson Institute to develop new ideas into potential future therapies, or even use existing drugs in a better way,” he says.
And it’s this proximity – having basic scientific researchers so close to the patients in the clinic – that made the UK such an attractive place to move.
“Obviously it wasn’t the weather that drew me here,” he quips. “The critical mass here is amazing and we’re recruiting from all over the world. More and more people are starting to work on pancreatic cancer using the lab models we’ve created from samples taken from patients’ tumours”.
A recent addition to the Glasgow team has been DNA technology guru Grimmond, who’s setting up a new DNA analysis facility to mimic the set-up back in Sydney. And access to local hospitals is vital for providing tumour samples and clinical information about how well patients are doing.
“It’s great being able to work within the NHS more generally – the NHS is fantastic for doing this kind of research!”
But in Biankin’s view, there needs to be a complete shift in how the health service views pancreatic cancer.
A clinical emergency
“We need to treat pancreatic cancer as a clinical emergency. Someone with a diagnosis should be fast-tracked through a rapid assessment and into treatments or a clinical trial,” he says.
“With other types of cancer that are slower growing, it might be OK not to rush it and wait a week or so for a scan. But with pancreatic cancer you want to get all the information in front of you as soon as possible.”
One big problem is that the disease progresses rapidly and has multiple effects on the body – such as wasting and fatigue (known as cachexia) – so many patients don’t get any therapy at all as they’re too sick to handle it.
Faster diagnosis and assessment could give every patient the best opportunity not only to get therapy but also to get on a clinical trial. “Everyone should have the opportunity to be on a trial,” Biankin points out, “as what we’re doing now to treat them really doesn’t work.
“We need to hit the disease hard and fast with new approaches – right now we don’t truly have a standard of care. The drugs we do have probably work in a handful of people and we don’t know who, so we give them to everybody.
“And we must get the patients involved as well – get them to understand the cancer more when they get diagnosed, and give them the option of trying the latest therapies in a clinical trial setting.”
But that means being faster in clinical systems to get to that point, including taking tumour samples and discussing with the patient about what’s on offer.
“We need to get that worked out within two to three weeks, rather than four to six weeks,” he says.
Into the future
Despite these frustrations, Biankin is optimistic about where all this could lead, and points to promise of matching patients’ individual cancers to the new generation of ‘targeted’ cancer treatments.
“What I’d like to see even within a year’s time is a UK-wide clinical trial like Cancer Research UK’s Lung Matrix Trial, where we take samples from patients’ tumours, run genetic tests on them and then give them appropriate targeted drugs.
“We’d also like to take more tumour samples if the cancer comes back to see how it’s changed,” he says – something that will allow them to go back to the lab and do further investigation into possible treatments.
In five to 10 years he hopes that this will lead to therapies that work at least in a subgroup of patients, and to begin to understand how pancreatic tumours evolve in the body and develop resistance to treatment.
“Even if we can just use the drugs that we already have in better ways, I would anticipate that we could make a significant step forward.”
At the moment, says Biankin, there’s a bit of a nihilistic attitude towards pancreatic cancer treatment and research.
“I’d like to see a “We can do this!” attitude, where we try and enthuse more people to get in there and dedicate themselves to pancreatic cancer research.”
We couldn’t agree more.
Genome image from Flickr
CORRECTION: Andrew works at the Cancer Research UK Glasgow Centre, not the Beatson Institute, as originally stated.