It took six months of doctors probing and repeatedly scanning her abdomen to find the cause of Vicky Stinson's jaundice. By the time a doctor uttered the words "pancreatic cancer," Stinson's disease was at Stage III. A doctor warned her she had "months – not years – to live."
"That was really hard," Stinson, a self-proclaimed optimist, admits. "And I decided not to take that prognosis," she says with a laugh.
Two years on, Stinson is defying the odds.
"I have this drive and I want to keep going," says Stinson, 65, a retired landscape architect with the National Park Service who married her college sweetheart and loves water color painting and hiking in Flagstaff, Ariz., where she lives.
Luckily for Stinson, researchers are breaking through with pancreatic cancer — a disease notoriously hard to detect and treat. Stinson herself benefitted from one of them — a new drug called daraxonrasib, a medicine that works by targeting and killing cancer cells that have a common mutation. There are other promising treatments , too, including an individualized mRNA vaccine, and a device that delivers alternating electrical fields to the abdomen.
About 70,000 Americans are diagnosed annually with pancreatic cancer, and about 80% of them are diagnosed at a late stage. Many companies are working on developing better ways to screen for the disease, through blood tests that detect markers for multiple cancers, for example. But for now, the five-year survival rate for pancreatic cancer remains at a dismally low 13%, according to the American Cancer Society. By comparison, immunotherapies, genetics and AI imaging have increased the 5-year survival rate for cancers overall to 70% – even for previously lethal forms like skin and lung.
With similar breakthroughs under way for pancreatic cancers, researchers say treatment could transform within a couple years. So Stinson is hoping science will help her outrun her cancer.
What makes pancreatic cancer so different?
Several factors make cancers in the pancreas especially troublesome. Its location, for one.
The pancreas sits behind many other organs, making it hard to feel, see, scan, or operate on, says surgical oncologist Rajesh Ramanathan, who co-directs the GI unit at Banner MD Anderson Cancer Center in Phoenix. He says it's also difficult for patients to identify the source of their discomfort.
"Part of the problem is that the symptoms of pancreatic cancer are generally very vague — abdominal pain, eating difficulties, new diabetes," Ramanathan says.
Treatment is also tricky, in part because these cancers create what Ramanathan calls a "cocoon," a layer that shields itself from the veins and arteries that allow chemotherapy, for example, to reach tumors.
And the organ sits close to central veins and arteries. It's a part of the midsection that is "like the Grand Central station for your body, so that if cells move from the pancreas, they have easy access to the highways that would take themselves to very distant parts of the body," says oncologist Arif Kamal, chief patient officer for the American Cancer Society.
Kamal says these tumor cells also have a mushy physical quality that makes them disperse easily, and act more like grains of sand than a solid mass. Containing those cells from further spread, therefore, is extremely difficult.
"You're going to miss little kernels of sand, right? That's just what's going to happen," Kamal says. "And pancreas cancer is more like a handful of sand that gets spilled, than it is a tennis ball that gets dropped."
New genetically targeted drugs show promise
Last week, new clinical trial data for a promising new drug was published in The New England Journal of Medicine. It shows a drug, daraxonrasib, outperforming chemotherapy and enabling patients to live three to four times longer, or 8 to 9 months without disease progression, on average. Chemotherapy typically keeps the disease at bay for only 2-3 months.
The drug is in a new class of genetically engineered medicines called RAS inhibitors, which target and kill cells with certain cancerous mutations. Similar RAS treatments have transformed colorectal and lung cancer care.
Researchers believe this could be a transformational development for pancreatic cancers, too, because it gets closer to addressing the root cause of disease.
"We are not going to be stuck with just using chemotherapy — which is not as specific as we would like, doesn't work as well as we would like, has more side effects than we would like — and instead shift now to a more targeted approach where we can really go after the gene mutation that is thought to be the main driver of the disease," says oncologist Brian Wolpin, who directs gastroenterology at the Dana-Farber Cancer Institute and is the study's lead investigator.
Stinson participated in the daraxonrasib trial for 13 months, and says the biggest benefit was ease: It's a single pill, not an hourslong infusion. And it comes with fewer side effects than most chemotherapies.
In the study, about a third of patients experienced moderate to severe side effects like rash and diarrhea, though none discontinued the trial as a result. Former Senator and terminal pancreatic cancer patient Ben Sasse appeared on CBS "60 Minutes" and The New York Times while in the drug trial, and appeared to suffer more severe, sunburned or bloody spots on his face.
In Stinson's case, she developed some milder acne on her face, neck and back.
"Kind of brought me back to my teens," she jokes. But it left her with energy to hike the Dolomite mountains in Italy and do her usual exercise classes. "I mean I had a full year of normalcy."
Daraxonrasib is so promising, the FDA allowed its maker, Revolution Medicines, to expand access to patients, prior to approval. Wolpin says he hopes that means more patients will get the drug within a couple weeks or months.
This technology — RAS inhibition — will likely be the backbone of future treatments which, in combination with other drugs, might result in longer life or even a cure, Wolpin says.
Other treatments also on the horizon
The next question is how to marry the new drug with other therapies or new technologies, he says, because researchers are tackling pancreatic cancer from many fronts.
Last month, one small but promising study showed customized mRNA vaccines, for example, may have promise. It developed individualized mRNA vaccines – designed and manufactured for each patient in Germany, based on the genetic profile of their cancer, then administered to the patient within 9 weeks — activating an immune response in half of a group of 16 patients, extending life for most of them by a whopping 6 years.
"The magnitude of the immune response was very potent," says surgical oncologist Vinod Balachandran, the trial's principal investigator and Director of the Olayan Center for Cancer Vaccines at Memorial Sloane Kettering. "It also has features of exceptional durability," meaning the body's defense system could continue working against the cancer for years. The mRNA vaccine technology has since advanced, and is now being tested more broadly on patients in other trials, Balachandran says.
In addition to those latest experimental drugs, scientists are also looking at ways of changing the microenvironment around cells, which might make it more hostile for them to replicate, or activate the body's immune system to attack the cancer itself.
The FDA recently approved a new device that creates "tumor treating fields." It involves attaching electrodes to the skin and sending high-frequency electrical signals to replicating pancreatic cancer cells to kill them. This electrical signal also appears to help activate the body's immune response — without adding new toxins into the body, like chemotherapies do.
Oncologist Saro Sarkisian at Frederick Health in Maryland began using it on pancreatic cancer patients in March, and will begin evaluating results next month. He hopes for patients it will mean less pain and at least 2-3 months more survival, as it did in clinical trials.
"Unfortunately it's not curative, but it gives them additional time to spend with their families," Sarkisian says.
"Hanging on"
These myriad developments, while exciting, are also nerve wracking for current pancreatic cancer patients for whom these future treatments cannot arrive fast enough.
Arizonan Vicky Stinson is among them. Her cancer returned in late March, after showing no growth on the experimental daraxonrasib pill for 13 months. Discovery of a new growth, now Stage IV in her ovaries, meant stopping that pill, which she says made her really sad.
"My husband's been really sad about it, too, just because it was so easy," compared to the chemotherapy she has since restarted, Stinson says.
She's now trying to help other researchers, hoping they might design a treatment based on the genetic profile of her cancer, for example.
As someone who's always focused on the bright side, Stinson says she's still hopeful for additional breakthroughs in time to help her.
"It feels like it's so close and I kind of feel like a ripe tomato on a vine, and it's like if I can just keep holding on for a little bit longer, this just might work for me."
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