Research and Clinical Trials
Pioneering pancreatic cancer research at the Kimmel Cancer Center includes refinements to the Whipple procedure, a complex pancreatic cancer surgery, and the first genetic blueprint for pancreatic cancer, mapping out all the mutations in known human genes linked to cancer that make proteins that tell cells how to behave. The discovery uncovered an unexpected terrain of diversity in alterations from tumor to tumor. It explained why seemingly similar cancers often responded very differently to the same treatments.
Read on to learn more about our most current discoveries and clinical trials:
More than a decade ago, researchers led by Elizabeth Jaffee, M.D., developed a novel vaccine to strengthen the immune system in pancreatic cancer patients. The vaccine, which is only available in clinical trials, uses irradiated pancreatic cancer cells that are incapable of growing, and have been genetically altered to secrete GM-CSF, a protein the body produces to help increase the number of white blood cells. It supercharges the immune system and causes immune cells to seek out and kill pancreas cancer cells throughout the body. Investigators also are studying the timing of vaccination as well as combining the vaccine with drug and radiation therapies to boost its tumor-killing capabilities, as well as studying peptides to create the first vaccines individualized to the unique molecular characteristics of each patient’s cancer.
Johns Hopkins experts are studying family risk and causes for pancreatic cancer. The National Familial Pancreas Tumor Registry at Johns Hopkins began in 1994 when the importance of familial clustering and pancreatic cancer was recognized. We believe that there is likely to be a genetic cause behind this clustering. With our research in hand, we are working on ways to improve our methods of genetic counseling and screening methods for pancreatic cancer.
We are also on the hunt for additional pancreatic cancer genes through genotyping technology and gene sequencing.
Since lifestyle factors may be important, we collect information from our patients about habits and health history so that we can study all the causes of this disease.
If you have immediate or close family members with pancreatic cancer and would like to learn more about your risk for pancreatic cancer, contact our Cancer Risk Assessment Program to make an appointment. If you are not in the mid-Atlantic region and are seeking genetic counseling services in your area, a directory of professionals can be found through the National Cancer Institute or National Society of Genetic Counselors.
Johns Hopkins experts have developed a Multidisciplinary Pancreatic Cyst Program to evaluate patients with known or suspected pancreatic cysts. The program offers a comprehensive evaluation, incorporating all aspects of care from top experts in the field. In addition, Johns Hopkins scientists have created a gene-based test to distinguish harmless from precancerous pancreatic cysts. The test may eventually help some patients avoid needless surgery to remove the harmless variety. More research is needed before the test can be developed and used for evaluating cysts in patients.
At Johns Hopkins, our surgeons have made significant improvements to the Whipple procedure, the primary surgical treatment for pancreatic cancer that occurs within the head of the gland (also called a pancreaticoduodenectomy). Today, our surgeons perform a high volume of these procedures and have lessened the complications during and after surgery.
We also have minimally invasive or laparoscopic options for certain patients with tumors in the pancreas. Our team can help determine whether you are a candidate for these procedures.
Until recently, pancreatic surgery was associated with a very high risk of surgically related mortality. Johns Hopkins Medicine surgeon honed the Whipple procedure to the point where the mortality rate now stands at 2 percent, when performed by experienced surgeons. Dr. Cameron has performed more than 2,000 of these surgeries -- more than anyone else in the world. He has trained a team of pancreatic surgeons at Johns Hopkins Medicine to carry on his legacy.
Improving Standards of Surgical Care Through Research
With the availability of laparoscopic pancreas cancer removal, Johns Hopkins surgical oncologists are studying whether systemic chemotherapy that is given earlier to patients because of shortened recovery periods with laparoscopy is safe and feasible. Because pancreas cancer is an aggressive disease, the goal is to deliver systemic therapies as quickly as possible, and this study will determine whether laparoscopic procedures may help reach that goal.
Surgical and medical oncologists at Johns Hopkins also are studying the use of experimental vaccines given before surgery to remove the pancreas in an effort to boost the immune system and help it identify and kill cancer cells.
Another study will involve using radiotherapy during surgery for pancreas cancer tumors that are anatomically difficult to remove. With these tumors, there is a good chance that pancreas cancer cells may remain in the margins surrounding tissue that is removed. Radiation delivered externally through the stomach can be given only in low doses, so Johns Hopkins scientists are planning to study whether high doses of radiation in seed implants positioned next to the tumor site during surgery could be more effective than external radiation.
Less is More: A Closer Look at Stereotactic Body Radiation Therapy for Pancreas Cancer
SBRT is an exciting area of radiation therapy that can help advance care for patients with pancreatic cancer. As it only requires five days of therapy, as compared to five or six weeks of traditional radiation therapy, SBRT is more convenient for patients, but it also minimizes time off of chemotherapy and may be more biologically effective against the tumor. One of the difficulties with pancreatic cancer is that the tumors often involve the larger blood vessels around the pancreas. Investigators at the Johns Hopkins Kimmel Cancer Center are learning that SBRT can be helpful in shrinking tumors off of the vessels, allowing surgeons an improved ability to surgically remove the tumor. Studies from our institution, as well as in conjunction with other leading institutions such as Memorial Sloan Kettering Cancer Center and Stanford Cancer Center, have shown with the proper safety checks, this treatment can be safe and efficacious.
Further studies and longer term follow-up are needed to confirm these early results. The next step will be to combine novel drugs and vaccines with stereotactic radiotherapy to try and augment its ability to kill cancer cells.