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Giving pancreatic cancer patients better opportunities to join clinical trials

by Emma Smith | Analysis

24 March 2017

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A photo of three nurses.

There has been little improvement in survival for pancreatic cancer over the last 40 years, making it one of our top priorities.

Fewer than 3 in every 100 people diagnosed with pancreatic cancer in the UK survive for 5 years or more – a figure that’s barely budged in decades.

It’s time to change this bleak statistic.

Back in 2013 Professor Andrew Biankin, a world-leader in pancreatic cancer research, moved to Glasgow after successfully applying for Cancer Research UK funding.

His vision is to revolutionise how we treat pancreatic cancer. And thanks in part to a new injection of funding from us announced today, change is on the horizon.

Biankin will be leading a newly funded project, called PRECISION Panc, to increase opportunities for patients with pancreatic cancer to join clinical trials.

And the project’s ultimate aim is to match patients to treatments most likely to work for their type of pancreatic cancer.

The right treatments for the right patients

“Some treatments work, but not many,” says Biankin. “And we can’t predict who they will work for ahead of time. The good news is that more and more drugs are becoming available to try, but we simply don’t know which patients to give them to.”

Andrew Biankin crop

It can take a long time to get patients through the current system and into a trial. By that time, it’s often too late – Professor Andrew Biankin

Pancreatic cancer is usually aggressive, which means many patients only have time for one course of treatment. If this doesn’t work, it’s often too late to try something different. This is why, according to Biankin, it’s vital that doctors have a better chance to “get it right first time”.

There are 2 ways Biankin thinks we should tackle this.

“First, we need to be able to better use the drugs we already have,” he says. But to do this scientists and doctors need to understand the biology of different types of pancreatic cancer better. They also need to figure out how to predict the treatments each type is most likely to respond to.

“Second, we need new drugs targeting specific weaknesses in different types of the disease, and smarter clinical trials to test them in patients likely to benefit,” says Biankin.

Because pancreatic survival is poor, many patients would like to try experimental treatments and join a clinical trial. But the aggressiveness of the disease poses a huge challenge.

“It can take a long time to get patients through the current system and into a trial. By that time, it’s often too late, because the patient is no longer well enough,” says Biankin.

“We urgently need to speed up this process, to enable more patients to join trials and try experimental new treatments, which could offer them more benefits than the current standard of care.”

A ‘menu’ of trials

Biankin’s vision is to change the way new treatments are tested in pancreatic patients and make the process quicker so more patients are well enough to join a trial.

What will PRECISION Panc do?

  • 3 clinical trials opening later in 2017, including one testing immunotherapy
  • Collecting and analysing tumour samples from patients
  • Test if DNA analysis could predict which groups of patients might benefit from a particular treatment

PRECISION Panc will kick off with 3 trials later this year, including a trial testing an immunotherapy treatment. Up to 658 people can join the trials, and there’s potential for expansion in the future.

“There will be an option for all patients who want to join a trial, regardless of their type of pancreatic cancer or how advanced it is,” says Biankin. He added that a clinical trial is the best option for some patients, because their cancers don’t respond to standard chemotherapy drugs.

The first step will be setting up ways to collect and analyse tumour samples collected from patients.

Biankin and the rest of the researchers involved in PRECISION Panc want to find out if analysing the DNA from tumour samples could group patients into different genetic types to predict what treatment might work best. If this works it could then guide the decision about which trial is most suitable for each patient.

“Instead of focusing on the clinical trial and working out if a patient is suitable, we want to flip this round – analyse the patients’ cancers first then match the best trial to them, putting the patient at the heart of the process,” says Biankin. “It’s how we’ll find the right trial for the right patient.”

Biankin also wants PRECISION Panc to be used to help patients join clinical trials that are already up and running. Their goal is to be able to offer all pancreatic cancer patients a ‘menu’ of possible clinical trials to discuss with their doctor and decide upon together.

“It’s about finding the best opportunities to offer patients – they will be a central part of the decision making process,” Biankin says.

Making research work in the NHS

One of the big challenges that Biankin wants to overcome is the delay in getting patients enrolled in trials.

By raising the subject of clinical trials shortly after their diagnosis, we hope we can speed up enrolment for patients who do wish to take part

– Professor Biankin

He hopes a ‘menu’ of trials at local cancer clinics will mean that patients can be offered the opportunity to join a research trial at an earlier stage.

“By raising the subject of clinical trials shortly after their diagnosis, we hope we can speed up enrolment for patients who do wish to take part,” he says.

One of the problems Biankin believes needs fixing to make precision medicine trials run more smoothly is the ability of the NHS to combine research and routine care for patients.

“Reading the genetic sequence of tumours is a piece of cake nowadays because we have a laboratory dedicated to processing samples,” he says.

“But the hard part is actually getting the sample sent to us quickly. At the moment it’s not a priority for the doctors and nurses taking care of the patient. It’s frustrating that we can be held up for months by logistics, operational procedures, forms and red tape.”

He adds that the trials he’d like to run will need support from doctors in hospitals and better information for patients in order to be successful.

Benefits for patients now and in the future

Biankin sees PRECISION Panc as a vital step towards giving patients more opportunities to join trials, and matching each patient to the best trial for them.

The trials he has planned aren’t yet open. But later in the year he hopes to see those patients taking part being given access to new experimental treatments. And if the plans hold true, these ‘smarter’ clinical trials could improve care for all pancreatic cancer patients in the future.

Collecting and studying tumour samples will play an important role in improving our understanding of the biology of pancreatic cancer, which in turn will support new treatments.

“We aim for PRECISION Panc, and Glasgow, to become a world-leading hub of pancreatic cancer expertise,” says Biankin. “We’re hopeful that this is the first step towards changing the way we develop and test treatments for these patients.”

And this moves us towards our goal of creating a brighter future for people with pancreatic cancer.

PRECISION Panc is still in its infancy. It remains to be seen if it’s possible to match pancreatic cancer patients to trials based on the genetics of their tumour, or boost the number of patients given the opportunity to join a trial.

But this project will find the answers.