Rising to the challenge

Treating pancreatic cancer calls for innovative and aggressive steps

Tom Arai has always lived an active, healthy life. The 65-year-old former commercial real estate agent and Yorba Linda resident is especially fond of cycling. For 25 years, he made a habit of riding upwards of 20 miles per day, pedaling scenic road routes along the Santa Ana River Trail or tackling the riparian canyons and singletrack of the Whiting Ranch Wilderness Park on his mountain bike.

“That changed very quickly once I found out I had pancreatic cancer,” he says. “I’ve been healthy throughout my life, and this was my first serious illness.”

His first serious illness couldn’t have presented a bigger challenge. Pancreatic cancer is a hard-to-cure condition that claims more than 41,000 American lives each year. Divulging a diagnosis of pancreatic cancer to patients has been especially difficult for doctors because, according to the American Cancer Society, 93 percent of patients will die within five years, giving it the highest mortality rate of any major cancer.

However, doctors at the UCI Health Chao Family Comprehensive Cancer Center—Orange County’s only National Cancer Institute-designated comprehensive cancer center—are not content with the status quo. In recent years, they have expanded the treatment options for some patients, developments they hope will begin to gradually boost long-term survival rates.

Meeting the challenge of pancreatic cancer

One reason pancreatic cancer has such a high mortality rate is because it’s very rarely diagnosed in the early stages, when it’s more easily treated, before the tumor can metastasize and move to the liver or the lungs.

“Pancreatic cancer is often not found until it has progressed. Jaundice is a potential early sign, while some people may only have belly pain for months and weeks,” says Dr. John Lee, a UCI Health professor of clinical medicine and gastroenterologist. “The best way to find it early would be endoscopic ultrasound or MRI. But most people just don’t have any risk factors, so there is no good way to screen the general population.”

Once diagnosed, the treatment options for pancreatic cancer are also fairly limited. Lee estimates about 85 percent of diagnosed patients show evidence the cancer has already spread. “For those patients, the only treatment would be chemotherapy,” he says. “The other 15 percent of people may be eligible for surgery.”

Among the 15 percent of patients eligible for surgery, the options depend on the location of the tumor.

“The head of the pancreas is the most common place for the tumors to be,” says Dr. David Imagawa, a UCI Health professor of clinical surgery and chief of the Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation. For tumors in this part of the organ, the patient is likely to undergo a complex and taxing surgery called the Whipple procedure, which UCI Health pancreatic surgeons perform. The surgery was known as extraordinarily risky more than 40 years ago when it was first tried. But today, at high-level medical institutions, the surgery is much safer.

For tumors in the body or tail of the pancreas, doctors can perform a distal pancreatectomy, which, he explains, “is less complicated than the Whipple procedure and easier to recover from.” UCI Health physicians pioneered laparoscopic pancreas surgeries—operations performed through small incisions—which significantly reduce side effects and shorten the recovery time. UC Irvine Medical Center is one of the few U.S. medical centers to offer a laparoscopic alternative for distal pancreatectomy, performing more of these procedures than any other medical center on the West Coast.

Imagawa adds that there are some new options for fighting pancreatic cancer on the horizon, and that UCI Health uses the most advanced procedures and technology available.

“We are certainly one of the places that have been aggressive in doing resections and reconstructions that were traditionally thought unresectable,” he says. “And in the last few years we’ve been an early adopter of NanoKnife ablation technology that lets us kill cancer cells with high-voltage electricity that doesn’t generate any heat. Very few centers in the country have these machines, and we’ve seen excellent results.”

Clinical trials offer hope

Arai’s situation, however, was like the majority of pancreatic cancer cases—vague symptoms leading to a diagnosis of late-stage cancer without a surgical solution. At first, he noticed pain in his stomach that felt like ulcers or acid reflux after he and his wife returned home from a vacation cruise along the Danube River in Eastern Europe.

“We just thought it was all the rich food from the cruise, but I went to my doctor and they ended up finding the tumor with a CT scan,” he says. Even though he sought treatment shortly after experiencing symptoms, his cancer had already reached stage IV, having metastasized and spread to his liver and lungs.

After his CT scan, Arai’s doctor sent him for a biopsy at UC Irvine Medical Center, where he and his wife saw Dr. Tara Seery, a gastrointestinal oncologist, who explained that he would be an ideal candidate for a new clinical trial. “Dr. Seery was so compassionate, kind and transparent,” he says. “In the past when they said you had pancreatic cancer, that was a death sentence, so when she told us about the trial, we were on board right away. Getting a diagnosis of metastatic pancreatic cancer is devastating. However, we knew that we needed to plow through this as best we can.”

The trial—sponsored by a regional coalition of cancer centers that collaborates on clinical trials along with the National Cancer Institute and Halozyme Therapeutics—has participants in 17 cancer centers around the country. UCI Health is among centers with the most patients. Its purpose is to test the side effects and dosages of a drug called PEGPH20, which seems to improve the effectiveness of chemotherapy by disabling parts of a tumor’s built-in defenses.

“We still have a long road ahead,” Seery says. “In advanced cases where the cancer has spread to other organs, chemotherapy is currently the only option for treatment, and if the tumor hasn’t spread, surgery is generally the best choice. But PEGPH20 is a drug everyone hopes will get approved.”

Once accepted into the trial, Arai started a grueling round of chemotherapy along with the PEGPH20 drug. And after 14 sessions, his tumors are shrinking. “It’s quite miraculous,” says his wife, Toni. “The doctors can’t believe his response from chemo. He really tolerates it well, has a good attitude, and compared with others in the trial, he’s had the best results.”

Arai has even managed to get back on his bike, sometimes riding five miles a day. “Riding my bike has become a way of relieving tension, kind of a natural release,” he says. “We just take one day at a time. I never would have thought I could feel as positive as I do, having pancreatic cancer. I found an inner strength I didn’t know I have. And a large part of maintaining such a positive attitude is knowing I have such a great team of doctors taking care of me and the wonderful support of my wife and children. I want to give others hope and to let them know they should not stop fighting.”

Learn more about pancreatic cancer at ucirvinehealth.org/pancreas.

— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Summer 2016