Hope has been an emerging theme of our 2023 #TimeMatters campaign. This year, we have focused on the stories of five remarkable individuals who have survived a diagnosis of pancreatic cancer.
Two, including NIPANC Trustee, Ivan McMinn (61) and 79-year-old dairy farmer, William Sproule from the Sperrin mountains are among only 1% of people with the disease to live past ten years. They are living proof people can and do survive pancreatic cancer.
The good news is, new technologies and treatments are on the horizon, yet still the best way of surviving pancreatic cancer is to follow our campaign advice.
If you are a member of the public, please familiarise yourself with the symptoms of pancreatic cancer and be persistent in seeking early diagnosis and treatment.
If you are a GP or medical practitioner, please be vigilant of the complex symptoms which can often masquerade as much less life-threatening health conditions.
But what might the future of pancreatic cancer treatment look like?
In today’s blog, Professor Mark Taylor, one of NI’s leading Hepatobiliary Surgeons and a Trustee of NIPANC is in conversation with Professor John Callan from the University of Ulster talking about the benefits of a novel approach to targeted cancer therapy.
If trials are successful, it has the potential to improve the prognosis for pancreatic cancer patients and for those with other solid organ tumours.
Professor Callan and his research team at the NI based company, SonoTarg have dedicated their careers to developing what is hoped to be a revolutionary new treatment. It is a unique delivery system, combining the power of sonodynamic therapy and chemotherapy to specifically target cancer tumours with pin-point precision.
Professor Callan said: “The simplest way to describe how microbubble technology works is to think of the Fairy bubbles you would have blown as a child and then burst using the pressure of touch. Our technology works in a similar way except we use bubbles that are much smaller, one hundred times smaller than the diameter of a human hair.
“Instead of using the pressure of touch to burst the bubbles, we use the pressure of an ultra-sound wave. So, we load up our bubbles with a combination of drugs and inject a suspension of those drugs into the patient’s blood stream. As they are passing through the pancreatic cancer tumour, we use an ultra-sound focused beam over the abdomen to burst those bubbles, release the drugs and activate the treatment.”
Some of the current challenges with pancreatic cancer tumours is they are hard to reach and there is a very dense protective coating (a stromal barrier) around the tumour This tissue acts like a shield, preventing drugs from getting in.
A major benefit of the new technology is that it is targeted in such a way that the micro-bubbles burst and explode helping to improve the penetration of the drugs into the pancreatic cancer tissue.
The super-oxygenated microbubbles not only achieve a much better effect but also use a lot less toxic chemotherapy. In addition to the improved efficacy of the treatment, it is expected to be much better tolerated by patients.
NIPANC Trustee, Professor Mark Taylor, also the Chief Medical Officer (CMO) for SonoTarg is delighted to be actively involved in the pioneering new research.
He said: “Our recent audit into pancreatic cancer in NI shows the number of people with pancreatic cancer has increased by 86% in the last ten years with approximately 280 people being diagnosed locally each year. Survival of the disease has largely remained static over the last 40-years and despite the advent of new systemic treatments, we have only made marginal progress.
“Novel therapies therefore are a major focus of research at present in trying to address the deficiencies. One such area is the development of microbubbles laced with chemotherapy, that are burst by ultra-sound within the tumour.
“It’s incredible this potentially much more efficient and targeted technology is being developed locally and may provide a wonderful opportunity to improve the experience and length of treatment time for patients as well as change the terrible statistics associated with the disease.
In summary, the two main benefits of the new technology are:
Much lower doses of chemotherapy can be used as more of the drug goes straight to the tumour rather than other healthy parts of the body, therefore reducing side effects
When the bubble bursts, the critical processes that drive that event help carry the drug deeper into the tumour tissue
Mr Taylor explained: “When the chemotherapy is released into the tumour, a response takes place that causes necrosis or death of the tumour. As well as using the microbubbles to zone into the tumour with conventional chemotherapy drugs, John, and his team, have also incorporated a completely new sonodynamic treatment.
“This involves the activation of an otherwise harmless drug that has no effect on the body, but when it comes into contact with ultrasound, it converts the normal oxygen we breathe into a highly reactive form of oxygen, a free radical super oxide that kills cells – in this case cancer cells.”
Mr Taylor said: “The amount of chemo in the bubbles is one tenth of the concentration normally given systemically into the vein which then travels around the body. If you can image, what SonoTarg has created, is a single dart programmed to hit the bullseye.
“As chemotherapy no longer courses throughout the body, the expectation is the novel treatment will reduce systemic side effects such as tiredness, lethargy, nausea, neuropathy, lacerations, and dry skin.”
For those with unresectable or in-operable pancreatic cancer, the new technology has potential to prolong and improve quality of life for patients allowing them to spend more precious time with family.
As the treatment is highly targeted, it is also likely to be better for those with borderline resectable tumours in advance of operations such as the Whipple procedure. Currently, many patients can’t go forward for major surgery because current regimes of chemotherapy make them too sick.
Mr Taylor said: “There is also evidence, the use of the microbubbles with an immune inhibitor can cause reductions to tumours that are not in the direct line of fire of the ultrasound. That means this treatment can be of major benefit for those individuals with metastatic disease decreasing say, the spread of cancer from the pancreas to the liver and lungs. By activating T-Cells in the patient’s own immune system, it could potentially positively impact on secondary tumours.”
Professor Callan said: “We are very excited about this technology. If it works even remotely as well as the laboratory experiments undertaken so far, then we think it offers real hope for pancreatic cancer patients.
“In terms of other emergent treatments, obviously there is a lot of focus in trying to harness our own immune systems to try and seek out and target and destroy the cancer cells. This is known as immunotherapy. A big benefit of our treatment is that it works very well alongside these existing immunotherapy-based treatments.
“But in the absence of a screening programme for pancreatic cancer, as of yet, and the fact surgery is still the only cure for pancreatic cancer, I think we still have to increase awareness of the early symptoms of the disease not just among the general public but also health care professionals. I don’t mean just GPs but other medical professionals including pharmacists.
“They are more likely to see patients on a more regular basis than their GPs and could be able to identify some changes in a person’s appearance or recognise their symptoms that might be indicative that further investigation is needed. It is very important the public become very familiar with the early symptoms and warning signs so they can get diagnosed in a timely manner. That’s why SonoTarg is delighted to be taking part in NIPANC’s #TimeMatters awareness raising campaign.”
Please familiarise yourself about the symptoms of pancreatic cancer here