Marilynn Duker knew her family tree was littered with relatives with cancer. So when a genetic counselor offered to test her to see if she had one of 30 cancer-causing genetic mutations, she immediately agreed.
The test revealed a mutation in the CDKN2A gene, which predisposes carriers to pancreatic cancer.
“They called and said, ‘You have this mutation. There’s really nothing you can do,'” recalls Ms. Duker, who lives in Pikesville, Maryland, and is the chief executive of a residences for the elderly.
She began having regular scans and endoscopies to examine her pancreas. They revealed a cyst. It hasn’t changed in the last few years. But if it turns into cancer, treatment is likely to fail.
Patients like Ms. Duker don’t have many options, noted Dr. Elizabeth Jaffee, deputy director of Johns Hopkins University’s Sidney Kimmel Comprehensive Cancer Center. A person with more advanced cysts could avoid cancer by having their pancreas removed, but that would immediately plunge them into a realm of severe diabetes and digestive issues. Radical surgery might be worth it if it saved their lives, but many precancerous lesions never turn into cancer if they’re just left alone. Still, if the lesions turn into cancer – even if the cancer is detected at an early stage – the prognosis is grim.
But it also provides an opportunity to manufacture and test a vaccine, she added.
In pancreatic cancer, Dr. Jaffee explained, the first change in normal cells on the pathway to malignancy is almost always a mutation in a well-known cancer gene, KRAS. Other mutations follow, six genetic mutations leading to the growth of pancreatic cancer in the majority of patients. This idea allowed the Hopkins researchers to design a vaccine that would train T cells – the white blood cells of the immune system – to recognize cells with these mutations and kill them.
Their first trial, a safety study, involved 12 patients with early-stage pancreatic cancer who had previously been treated with surgery. Although their cancer was detected soon after its onset and despite the fact that they were treated, patients with pancreatic cancer generally have a 70-80% chance of having a recurrence within the next few months. years. When pancreatic cancer comes back, it is metastatic and deadly.
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