Fighting Pancreatic Cancer as a Team

Published in Surgery - Winter 2017

Christopher Wolfgang, who directs Johns Hopkins’ Hepato-Pancreato-Biliary Program, says that to win the war against pancreatic cancer in a patient, two battles must be fought. The first battle, he says, is a local one that involves removing primary tumors via complex procedures, such as the Whipple, the modified Appleby, the distal pancreatectomy and others. The second battle is a broader, systemic effort to catch the micrometastases that can spread to distant sites, including the liver, lungs, bone, brain and other organs.

“No one specialty can fight both these battles on its own,” Wolfgang says, “and it’s nearly impossible to win the war unless specialties are functioning as a team.”

That’s why Johns Hopkins started the Pancreatic Cancer Multidisciplinary Clinic in 2007. At the time, says Wolfgang, it was the first clinic of its type nationally, integrating specialists from surgery, medical oncology and radiation oncology, and incorporating the latest research from Johns Hopkins and elsewhere to fight pancreatic cancers.

Nearly a decade later, the program is the most experienced and busiest in the country—factors shown time and again to improve patient outcomes. For example, Johns Hopkins pancreatic surgeons performed 349 Whipple operations and over 500 pancreas operations in fiscal year 2016. The group performs many of the operations using a minimal access approach, such as laparoscopic and robotic, as well as the traditional open method.   

Besides Wolfgang, surgeons on the team include John Cameron, one of the fathers of pancreatic surgery, who has spent nearly five decades performing it. When he began his career at Johns Hopkins in the 1970s, the mortality rate for the Whipple procedure was nearly 30 percent. His efforts brought that rate down to less than 2 percent at Johns Hopkins, and he instructed countless other surgeons in the process to spread his lifesaving technique throughout the world.

Other surgeons on the team include Marty Makary, Matt Weiss and Jin He, who together comprise a premier pancreatic surgery program that includes minimally invasive techniques, an irreversible electroporation program, innovative clinical trials and cutting-edge translational research. 

The medical oncology program is led by Elizabeth Jaffee, who developed a powerful therapeutic vaccine to mobilize patients’ immune systems to combat pancreatic cancer recurrence. Other medical oncologists on the team include Dan Laheru, Lei Zheng, Dung Le, Ana DeJesus and Nilo Asad. Each works to incorporate immune treatments with traditional and innovative chemotherapies to systemically contend with metastatic disease.

In addition, radiation oncologists led by Amol Narang, pain medicine led by Michael Erdek, pathology led by Ralph Hruban, and diagnostic imaging led by Elliot Fishman and Karen Horton round out the team. Each of these individuals is recognized as a leader in his or her field.

Members from all specialties work in concert, discussing each patient to decide on the best course of care. Their experiences in the clinic inform their lab work, Wolfgang says, with new innovations stemming from patients at Johns Hopkins and elsewhere. Physician-scientists, including Wolfgang, are currently working to better understand pancreatic cancer genetics to develop personalized approaches to treatment and early detection. They’re also studying circulating metastatic cells to develop directed therapies and to use the cells as a window into the primary tumor.

“Our goal for all patients who walk into this clinic is a cure,” Wolfgang says. “Sometimes the odds can be stacked against them, but having our team provide every cutting-edge and personalized treatment for every case will give them the best chance.”