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World Pancreatic Cancer Day 2019

On November 21, people around the world united to demand better in the fight against the world’s toughest cancer. The World Pancreatic Cancer Coalition, consisting of more than 80 organizations from over 30 countries and six continents, raised global awareness and inspired action, bringing greater attention, awareness, and better outcomes to this deadly disease.

Thank you to everyone who participated in World Pancreatic Cancer Day 2019. With your support, we turned the world purple, raising awareness for a disease that desperately needs more attention and progress to help patients fight and survive.

Please mark your calendar and save the date for World Pancreatic Cancer Day 2020 – Thursday, November 19, 2020

Click here to find out more about what happened on WPCD 2019.

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Does Type 2 Diabetes Increase the Risk of Pancreatic Cancer?

Pancreatic cancer is a form of cancer that occurs when cells are produced in the pancreas in an uncontrolled manner. Like all cancers, the earlier a diagnosis is made, then the better the prognosis. Pancreatic can is one of the hardest of cancers to diagnose and has a low 5-year survival rate of around 6-9%.

There have been reports that the onset of diabetes or the worsening of an existing diabetes condition could be a warning sign for pancreatic cancer. Alternatively, diabetes could be a consequence of pancreatic cancer. A recent paper published by a researcher at the Ivano-Frankivsk National Medical University in Ukraine has investigated the role of diabetes in the development of pancreatic cancer.

A chicken and egg situation

The pancreas is a small organ that is part of the digestive system and sits just behind the stomach. It also plays a role in keeping blood sugar levels within acceptable levels by producing insulin. The link between pancreatic cancer and type 2 diabetes has been shown to be there - but researchers have not been able to fully determine the relationship.

When higher levels of insulin are circulating in the blood stream, there is an increased pressure on the pancreas to produce insulin. Some researchers have suggested that this could lead to a higher risk of pancreatic cancer. Alternatively, some researchers believe that pancreatic cancer may lead to insulin resistance by increasing the quantity of insulin produced in the pancreas and that pancreatic cancer could lead to a reduced ability to produce insulin leading to an increased risk of diabetes.

Both a marker and a risk factor

To investigate the link between type 2 diabetes and pancreatic cancer, the researchers from the Ukraine studied 42 participants in four groups. A healthy control group, patients with type 2 diabetes, patients with pancreatic cancer but no diabetes and patients with pancreatic cancer and type 2 diabetes. Blood samples were taken and analysed using chromatography among other techniques. The ability of chromatography to process samples efficiently is discussed in the article, Increasing HPLC / UHPLC Sample Throughput: Doing More in Less Time.
The team reported that patients with pancreatic cancer that had a background of type 2 diabetes did not have some of the usual diabetes conditions like obesity, elevated IGF-1 levels and hyperinsulinemia which they conclude leads to conclusion that the patients have secondary diabetes - diabetes caused by another illness, in this case pancreatic cancer. They also state that patients with a new diagnosis of pancreatic cancer should be advised to screen for pancreatic cancer as diabetes can be both a marker and a risk factor for pancreatic cancer.

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Adults 85 years and older fare well after CRC operations

Preliminary study results show many older patients receive a colon cancer diagnosis and operation at the same time, and that a surgeon's experience may be an important component in how surgical treatment should be delivered.

As people are living longer, more elderly patients are being diagnosed with age-related colon cancer, making it of increasing concern to the medical community. Another related issue is whether an operation should be suggested as a form of treatment for this vulnerable population.

However, results from a preliminary research study reveal the vast majority of surgical patients over 85 were still alive in the short-term after undergoing an operation (called colectomy) to remove a portion of the colon for stage II and III colon cancer. Researchers presented their findings at the American College of Surgeons Clinical Congress 2019.

Using the New York State Cancer Registry and Statewide Planning Research & Cooperative System, lead study author Roma Kaur, MD, a research fellow in the department of surgery, University of Rochester Medical Center, N.Y. and colleagues analyzed data on 3,779 patients age 85 and older who underwent colectomy between 2004 and 2012. They looked at short-term outcomes (30 and 90 day) among patients with Stage II or Stage III colon cancer.

"We were interested in this topic because we know from CDC data that patients 85 and older have the highest incidence rate of colon cancer and according to the U.S. Census Bureau this is the fastest growing segment of the geriatric population. Given the burden of colon cancer in this cohort, we were hoping to identify and better understand factors that were associated with survival in these patients," said Dr. Kaur.

The survival rates of all patients were evaluated from the time of the operation. After 30 days, 89 percent of patients were alive, and after 90 days, 83 percent of patients were still alive. Factors associated with worse survival were having an operation during an unplanned admission, having an open operation, and preoperative complications like perforation, bleeding, and a serious infection called sepsis.

There were several noteworthy findings in the study. Nearly half of the patients received a diagnosis of colon cancer and surgery performed during an unplanned hospital admission, a factor found to be independently associated with worse survival. Additionally, the study suggested being treated by an experienced surgeon who performs a large number of colon cancer resection procedures annually reduced the risk of dying in this population.

Regarding the number of non-elective procedures, Dr. Kaur said, "It seems a large number of patients are coming into the hospital with a problem that is severe enough to require admission?--sometimes a complication from their cancer?--and then getting diagnosed with cancer and undergoing an operation during that same hospitalization. We found that 80 percent had an open operation, as opposed to a minimally invasive one, so these patients are being subjected to open operations because, in part, it's taking place in an acute setting."

During an open operation a surgeon makes a larger incision; whereas, for a minimally invasive operation, a few small incisions are made, and surgeons use laparoscopic instruments to perform the procedure. Generally, minimally invasive surgery is favored due to outcomes like less pain, shorter hospital stays, and faster recovery times.

"When patients have surgery in a nonelective setting it makes it nearly impossible for these patients to be adequately optimized before their operation. If we are able to find these patients earlier, we may be able to do a comprehensive geriatric assessment, prehabilitation before surgery, and perhaps even a minimally invasive operation," Dr. Kaur added.

While colonoscopy is considered a gold standard procedure for preventing death from colon cancer, screening older adults is controversial. According to the U.S. Preventive Services Task Force, adults age 76 to 85 should consult with their doctor before getting this diagnostic test.* Results from the study corroborate the idea that perhaps screening guidelines should not be solely based on chronological age, but rather be more individualized, and incorporate the patient's life expectancy, health status, and ability to tolerate the screening procedure into account. The role of less invasive screening alternatives and identifying the "right" patients to screen will require further study, according to the researchers.

To improve care among older adults, factors yielding favorable outcomes need to be identified. This study found that two factors--discharge to another health care setting and higher surgeon colon cancer resection volume--were associated with improved survival.

"Postoperatively, we need to consider the full breadth of resources available to patients--physical and occupational therapy needs, nursing needs, and to evaluate if they would benefit from being discharged to another health care facility," said Dr. Kaur.

About 42 percent of these patients were discharged to a skilled nursing facility after their operation. The move reduced the odds of dying by 89 percent at 30 days, and by 58 percent at 90 days.

When the the operation was performed by a highly experienced surgeon, it also reduced the risk of death. The researchers reported a nearly 59 percent reduction in the odds of mortality in the short-term associated with surgeons who performed a higher volume of colon resection procedures per year.

"The decision to operate on an older adult must take many factors into account," Dr. Kaur said.

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Exercise Can Now Be Prescribed Like Medicine for Cancer Patients

It is well known that regular exercise can help prevent and treat many forms of heart disease, but less commonly known are the benefits of physical activity for cancer patients.

A new initiative called Moving Through Cancer — led by Dr. Kathryn Schmitz, professor of public health sciences at Penn State College of Medicine, and an international team of health practitioners and researchers — is hoping to change that.

According to the researchers, exercise is important for cancer prevention, as it can lower the risk of developing colon, breast, endometrial, kidney, bladder, esophagus and stomach cancers.

Exercise during and after cancer treatment can also help improve fatigue, anxiety, depression, physical function, and quality of life and can also help increase survival rates after a breast, colon or prostate cancer diagnosis.

In their new paper published in CA: A Cancer Journal for Clinicians, Schmitz and her team outline new exercise recommendations for people living with and beyond cancer.

“With more than 43 million cancer survivors worldwide, we have a growing need to address the unique health issues facing people living with and beyond cancer and better understand how exercise may help prevent and control cancer,” said Schmitz, who is also a member of the Penn State Cancer Institute.

“This esteemed, multidisciplinary group of leaders on the forefront of exercise oncology aimed to translate the latest scientific evidence into practical recommendations for clinicians and the public and to create global impact through a unified voice.”

Depending on each patient’s activity levels and abilities, the researchers generally recommend 30 minutes of moderately intense aerobic exercise three times a week and 20 to 30 minutes of resistance exercise twice a week.

But, Schmitz said health care professionals can also customize exercise prescriptions to individual patients.

“Through our research, we’ve reached a point where we can give specific FITT exercise prescriptions — which means frequency, intensity, time and type — for specific outcomes like quality of life, fatigue, pain and others,” Schmitz said.

“For example, if we’re seeing a head and neck cancer patient with a specific set of symptoms, we could give them an exercise prescription personalized to them.”

Schmitz said the recommendations will help with one of the premier goals of Moving Through Cancer: raising public awareness about the benefits of exercise for people living with and beyond cancer by 2029.

“Currently, an average person on the street will know that exercise is good for preventing and treating heart disease, but not for melanoma,” Schmitz said. “We want to change that. When researchers in the 1950s built an evidence base for exercise and heart disease, there was a shift in public knowledge about that connection. It’s now time for the same thing to happen with exercise and cancer.”

Schmitz said the second piece of the initiative is resources and programs to help get cancer patients moving. The Moving Through Cancer website has an exercise program registry that can help patients, families, health care providers and others find programs near them.

The final piece is policy, Schmitz said, which could be used to increase the chances that health care professionals will talk to their patients about exercise and that patients will be adequately referred as they move through cancer.

“This is the center of my professional heart,” Schmitz said. “My mission for a decade now has been that I want exercise to be as ubiquitous in cancer care as it is in cardiac disease care, only better. The new recommendations and guidance are a tool that can help make that a reality.”

Source: Penn State

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Pancreatic cancer drug reaches Phase III status

A pancreatic cancer drug discovered in professors Paul Bingham and Zuzana Zachar’s lab in the Department of Biochemistry and Cell Biology at Stony Brook University has now entered Phase III, or multi-center testing stage.

During the multi-center testing stage, the drug will be tested among qualifying patients in clinical research centers nationwide, including Stony Brook Cancer Center. The trial will use a combination of FOLFIRINOX and CPI-613 — a partial inhibitor of the tricarboxylic acid (TCA) cycle, a pathway used in the mitochondria for glucose metabolism — in metastatic pancreatic cancer patients. Dr. Minsig Choi, an attending physician who specializes in gastrointestinal medical oncology, is the principal investigator of the trial.

FOLFIRINOX is a chemotherapy regimen that uses multiple drugs to kill cancer cells. The use of CPI-613, a lipoate analog — a chemically equivalent compound similar to one of the intermediates in the TCA cycle — may increase the vulnerability of cancer cells to traditional chemotherapy regimens by inhibiting cancer cells’ almost “addictive” use of the TCA cycle, Choi explained. Thus, combinational therapy may improve life expectancy for patients.

“While normal cells can use other pathways when the TCA cycle is inhibited, cancer cells are more sensitive to changes in the TCA cycle,” Choi said.

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European Society of Medical Oncology Congress Presentations Show B-Cell Vaccine Combinations

(ASX:IMU), a clinical stage immuno-oncology company, today announced two presentations by medical investigators at the European Society of Medical Oncology in Barcelona Spain showed combining its HER2 vaccines with PD1 vaccines reduced cancer growth in a number of standard preclinical models.

The findings were detailed in posters presented by Dr Tanios Bekaii-Saab from the Mayo Clinic Phoenix USA and Dr Joshua Tobias from the Medical University Vienna, Austria.

Dr Bekaii-Saab’s poster presentation was entitled ‘Antitumor activity and safety of a novel PD-1 vaccine (PD1-Vaxx) alone and in combination with two chimeric HER-2 peptide vaccine (B-Vaxx) in syngeneic Balb/c mice and canines.’

The presentation detailed how Imugene’s PD1-Vaxx combined with B-Vaxx was more effective in reducing tumour growth in a model of HER2 positive colon cancer compared to either the PD1-Vaxx vaccine alone, or the positive control standard anti-mouse PD-1 monoclonal antibody.

The vaccine combination was found to be safe and did not appear to exhibit toxicity or autoimmunity. Imugene is working to evaluate PD1-Vaxx and its potential efficacy in a range of human cancers.

Dr Joshua Tobias’ poster presentation was entitled ‘Active immunization with immune checkpoint inhibitors-mimotope elicits strong in vivo anti-tumor effect against Her-2/neu-expressing tumors.’

The presentation showed active immunization with a PD1-derived mimotope vaccine combined with Imugene’s HER-Vaxx increased the anti-tumour effect of the combination vaccine compared to each vaccine alone in a model of HER2 positive breast cancer.

Active immunisation with the PD1-derived mimotope vaccine increased cancer cell death and anti-proliferative effect of the HER2 positive cancer cells in breast cancer tumours.

Imugene will initiate a Phase 1 trial of PD1-Vaxx as a monotherapy in 2020. In addition to safety and efficacy, a focus will be to assess the vaccine when combined with Imugene’s immunotherapy pipeline and other immunotherapies on the market.

Imugene Managing Director and Chief Executive Officer Leslie Chong said, “The global medical community is actively seeking inmuno-oncology combination treatments which do not increase toxicity and demonstrate improved response rates and efficacy at minimal cost.”

“The promising new B-cell vaccine data presented at this year’s ESMO congress and other major cancer research conferences has helped raise the profile of our promising anti-cancer pipeline and its potential clinical value when used in combination with other immune-oncology therapies.”

“These latest presentations of comprehensive vaccine combination results help further demonstrate the significant value of Imugene’s B-cell vaccine strategy and the strength of our pipeline,” she said.

All the Imugene related research posters presented at ESMO are available on the company website.

Dr Bekaii-Saab’s poster presentation was entitled ‘Antitumor activity and safety of a novel PD-1 vaccine (PD1-Vaxx) alone and in combination with two chimeric HER-2 peptide vaccine (B-Vaxx) in syngeneic Balb/c mice and canines.’

Dr Joshua Tobias’ poster presentation was entitled ‘Active immunization with immune checkpoint inhibitors-mimotope elicits strong in vivo anti-tumor effect against Her-2/neu-expressing tumors.’

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COLOSSUS project which we are supporting has published a new video

Colorectal cancer is the third most common cancer in Europe. COLOSSUS is an EU-funded Horizon 2020 project that aims to provide new and more effective ways to classify patients with a specific type of colorectal cancer (microsatellite stable RAS mutant metastatic colorectal cancer or MSS RAS mt mCRC) and to develop better treatments for them. Our ultimate goal is to deliver a personalised medicine approach for patients with MSS RAS mt mCRC that is currently not available.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 754923. The material presented and views expressed here are the responsibility of the author(s) only. The EU Commission takes no responsibility for any use made of the information set out.

Click here to view the COLLOSSUS video.

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Digestive Cancers Europe has developed a position paper on the use of biosimilars medicine in colorectal cancer

With the help of the Patient Advisory Committee (PAC) comprising of 7 colorectal cancer patients and carers, Digestive Cancers Europe has developed a position paper on the use of biosimilar medicines in colorectal cancer.

We believe equality of access to medicines is a fundamental right for all patients. Partly due to the disparities in availability of biological medicines, there are wide ranging standards of care for colorectal cancer across Europe, which means that where someone lives is a crucial factor in their prognosis. We passionately believe that all patients with colorectal cancer should have access to the same high standard of care, regardless of where they live.
With this in mind, we believe there is an important role for biosimilar medicines to play in the treatment of colorectal cancer.

Because they are generally less expensive than the reference medicine, the introduction of biosimilar medicines could increase patient access to biologic therapies, without compromising quality. This in turn could generate cost savings that could be redistributed to expand patient access to other biologic therapies, or improve healthcare by providing services and care that are currently not provided.

Patient safety is the main priority and it is vital that biosimilars continue to be evaluated with the same exacting standards as the reference medicines. It is also important that patients are fully informed about the medicines available to be able to make an informed decision themselves. We also acknowledge that the companies that create the reference medicines invest millions into the research and development program of each medicine in extremely thorough clinical trial programs. They have well-established manufacturing processes for these complex medicines and well-established pharmacovigilance in place. The EMA has imposed similar pharmacovigilance programs for all biosimilars.

To see Digestive Cancers Europe position on the use of biosimilar medicines in colorectal cancer, click here.

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Overcoming resistance in pancreatic cancer

In pancreatic cancer cells' struggle to survive, the cells choose alternative routes when their main pathways are blocked by drugs. Researchers recently developed a new cocktail of drugs that shrink pancreatic tumors in mice by blocking both the main and alternative pathways that cancer cells use.

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