The Sol Goldman Pancreatic Cancer Research Center

What's New 2010

Frailty Score

Surgeons at Johns Hopkins in collaboration with the geriatrician Linda Fried at Columbia University have developed a new "Frailty Score" which predicts how older patients will weather the stresses of surgery. This advance was published in The Journal of the American College of Surgeons and reported on in a recent issue of the New York Times. This new score helps surgeons assess their patients' risks of surgery. Rather than simply relying on a patient's age, surgeons can now use this new tool to balance the risks and benefits of surgery in older patients.



Hopkins Scientist Use Knowledge of Genetic Changes to Guide Therapy

In an advance on-line issue of the journal Molecular Cancer Therapeutics Dr. Villarroel and colleagues from Johns Hopkins report the case of a patient whose successful treatment was guided by the specific genetic changes (mutations) in their pancreatic cancer. The patient described had gemcitabine-resistant metastatic pancreatic cancer. This patient was treated with the drug Mitomycin C based on laboratory studies of his cancer. Dr. Villarroel and colleagues report that the patient had a dramatic long lasting (36+ months) tumor response. Furthermore, Dr. Villarroel and colleagues go on to show that a specific rare genetic change in the patient’s pancreatic cancer, a PALB2 gene mutation, was responsible for their tumor’s responsiveness to Mitomycin C. This work is exciting for two reasons. First, it suggests that inactivation of the PALB2 gene is a determinant of response to Mitomycin C and other chemotherapy treatments that work by initiating DNA damage in tumors. Second, it suggests that sequencing the genes in a cancer can identify new targets for "personalized cancer care."

Disclosure of Potential Conflicts of Interest: Siân Jones, Ralph H. Hruban, James R. Eshleman and Alison Klein are co-authors on this paper and they are also co-inventors on PLAB2- related intellectual property managed by Johns Hopkins University and have the potential to receive royalty payments for the PALB2 invention.

Genetic Study Reveals Large Window of Opportunity for the Early Detection of Pancreatic Cancer

Dr. Christine Iacobuzio-Donahue Pancreatic cancer develops and spreads much more slowly than scientists have thought, according to new research from the laboratory of Dr. Christine Iacobuzio-Donahue M.D. Ph.D., Associate Professor of Pathology, Oncology and Surgery at Hopkins' Sol Goldman Pancreatic Cancer Research Center. Using whole genome sequencing data generated from the cancer tissues of seven patients who underwent a rapid autopsy, Dr. Iacobuzio and colleagues found that it takes at least a decade after the first cancer-causing mutation occurs in a normal cell in the pancreas until the development of a full-fledged cancer cell. After the first cancer cell appears, it takes an average of nearly seven years for that cell to turn into the billions that make up a cancerous tumor diagnosed by imaging methods, after which at least one of the cells within the tumor has the potential and ability to spread to other organs. Patients die an average of two and a half years after this metastasis. The study, published in the October 28th issue of the journal Nature, contradict the idea that pancreatic cancers metastasize very early in their development, and indicates that there is a potentially broad window for diagnosis and prevention of the disease.

"For the first time, we have a quantifiable estimate of the development of pancreatic cancer, and when it would be best to intervene," according to Dr. Iacobuzio, "so there is potentially a very broad window for screening." Right now, however, she adds, "pretty much everybody is diagnosed after that window has closed."

More on the paper can be found at Nature.com.


Laproscopic Whipple Procedure - July 2010

Drs. Marty Makary and Barish Edil recently performed a laproscopic Whipple procedure (laproscopic pancreatoduodenectomy). Instead of performing the surgery through a large incision, Drs. Makary and Edil made three small incisions and performed the surgery using small surgical "scopes." As a result, instead of a large scar patients who undergo a laproscopic Whipple procedure have only 3 small incisions, and the risk as well as the recovery times are reduced. The doctors also use magnification so they can see the organs more clearly. Dr Makary says "by doing operations through minimum invasive techniques, patients can often get on with their lives they have less pain". A laproscopic Whipple procedure is best used on selected patients. Not all patients who need a Whipple are candidates for the laproscopic approach. For a news story click here.




US News and World Report Ranks Johns Hopkins #1 - July 2010

Voted best hopsital in America!Once more — and now for an astonishing 20th year in a row — The Johns Hopkins Hospital has taken the top spot in U.S. News & World Report's annual rankings of American hospitals.

The Johns Hopkins Hospital ranked in the top five in 15 of the 16 specialty categories listed. In addition to landing in the #1 spot on the Honor Roll, the hospital ranked #1 in Ear, Nose and Throat; Gynecology, Neurology and Neurosurgery, Urology and Rheumatology; #2 in Kidney Disorders, Ophthalmology and Psychiatry; #3 in Diabetes and Endocrinology, Gastroenterology (digestive diseases), Geriatrics, Heart and Heart Surgery; #4 in Cancer and Pulmonology (respiratory diseases); #5 in Orthopedics; and #14 in Rehabilitation.

For a complete list of all rankings, see http://health.usnews.com/best-hospitals

We know that rankings and ratings all have their weaknesses and strengths, but as health care choices become increasingly important, independent evaluations continue to interest our patients, the public, referring physicians and insurers.



Pancreatic Cancers Epigenetically Silence SIP1 and Hypomethylate and Overexpress miR-200a/200b in Association with Elevated Circulating miR-200a and miR-200b Levels. - June 2010

Johns Hopkins scientist Michael Goggins reports in the June 15th issue of Cancer Research that most pancreatic cancers overexpress (make high levels of) two small RNA molecules, called miR-200a and miR-200b. This finding is important for two reasons. First, these small RNA molecules control the expression of the e-cadherin protein in cells, and the overexpression of miR-200 in pancreatic cancer may help explain some of the aggressive behavior of this type of cancer. Second, the scientists were able to show that both miR-200a and miR-200b can be detected in the blood, and, importantly, both Both miR-200a and miR-200b are significantly elevated in the blood of patients with pancreatic cancer and chronic pancreatitis patients compared with healthy controls (P < 0.0001). This finding therefore provides insight into the biology of pancreatic cancer, as well as a potential screening test for pancreatic cancer.

PubMED Web site, PMID: 20551052



In vivo and in vitro propagation of intraductal papillary mucinous neoplasms. - May 2010

Scientists at Johns Hopkins recently created cell line in the laboratory from a surgically resected intraductal papillary mucinous neoplasm (IPMN) of the pancreas. In a paper reported in the May 2010 issue of Laboratory Investigation, Drs. Kamiyama, Eshleman and others report that they were able to grow the cells from an IPMN in tissue culture (in dishes in the laboratory). This is an exciting advance because IPMNs are one of the few curable precursor lesions that can give rise to invasive pancreatic cancer. The scientists hope that by studying this new cell line they will be able to develop new approaches to the early detection and treatment of curable tumors in the pancreas.



Congratulations!

The pancreatic cancer research team will receive two prestigious awards at the 2010 meeting of the American Association of Cancer Research (AACR) held April 17-21, in Washington, D.C.

Dr. Ralph Hruban – 2010 INNOVATOR Award recipient
Dr. Hruban will receive the Kirk A. and Dorothy P. Landon Foundation Innovator Award for International Collaboration at the AACR Meeting. Dr. Hruban will receive this award for an international collaboration he has established with Andrew V. Biankin, M.B.B.S., from the Garvan Institute of Medical Research in Sydney, Australia. Together they will use a unique mouse model developed by Dr. James Eshleman at Johns Hopkins to facilitate the sequencing of a large number of human pancreatic cancers.

Zeshaan A. Rasheed, M.D., Ph.D. - PanCan & American Assoc. for Cancer Research Award Grant
Dr. Rashee was awarded one of four innovative grants. This five-year grant totals $600,000 and is designed to ensure the future leadership of pancreatic cancer research by supporting an outstanding early-career investigator beginning a postdoctoral research position and continuing through the successful transition to independence. The 2010 recipient is Zeshaan A. Rasheed, M.D., Ph.D., Johns Hopkins University School of Medicine. Dr. Rashee will study the question: Are cancer stem cells relevant in pancreatic adenocarcinoma?



Johns Hopkins Medicine Magazine on Pancreas Multidisciplinary Cancer Clinic

Johns Hopkins Medicine Magazine recently carried a nice article on the Multidisciplinary Pancreatic Cancer Clinic here at Johns Hopkins (http://www.hopkinsmedicine.org/hmn/w10/feature3.cfm). The story, written by Ramsey Flynn, describes the journeys of several patients through the clinic, and it highlights the potential impact that multidisciplinary care can have on patients with pancreatic diseases. To learn more about the clinic, click here: http://pathology.jhu.edu/pancreas/MDC/index.php


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New National Pancreatic Cancer Research Consortium

Lustgarten FoundationThe Lustgarten Foundation announced today that it has formed a national pancreatic cancer research consortium, a collaborative effort to advance the most promising research initiatives aimed at finding a cure for pancreatic cancer. Scientists participating in the Pancreatic Cancer Research Consortium (PCRC) will share knowledge, information, expertise and technologies in a coordinated effort. We are pleased that two of the four initial grants were awarded to scientists at Johns Hopkins.

Congratulations to the Johns Hopkins Pancreatic Cancer Research team!

To learn more about research into the familial aggregation of pancreatic cancer at Johns Hopkins, visit the NFPTR Web site.


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Congratulations to Zeshaan A. Rasheed, M.D., Ph.D. - January 2010

Zeshaan A. RasheedThe Pancreatic Cancer Action Network and the American Association for Cancer Research have awarded Zeshaan A. Rasheed, M.D., Ph.D., a medical oncology fellow at the Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins, the 2010 Pancreatic Cancer Action Network-AACR Pathway to Leadership Grant. This grant, totaling $600,000 over five years, will support Rasheed’s efforts to examine the relevance of cancer stem cells in pancreatic adenocarcinoma. "This is a critical area of research that will lay the groundwork for new therapies that can effectively treat pancreatic cancer and stem the tide of this devastating, and too frequently fatal, disease," said Margaret Foti, Ph.D., M.D. (h.c.), CEO of the American Association for Cancer Research.

Congratulations Zeshaan!


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Study from the National Familial Pancreas Tumor Registry at Johns Hopkins provides new insight in the risk of pancreatic cancer in families - January 2010

Dr. Alison Klein, Director of the National Familial Pancreas Tumor Registry

When one or more family members develops pancreatic cancer, it is only natural for the other members of the family to wonder what are their chances of getting cancer. This is especially true when a family member develops pancreatic cancer at a young age (less than age 50 years). A new study, published in the Journal of the National Cancer Institute January 12, 2010, led by Dr. Alison Klein, Director of the National Familial Pancreas Tumor Registry (NFPTR: website: http://pathology.jhu.edu/pancreas/nfptr/) helps to answer this question. In this study Dr. Klein and colleagues followed over 1,718 families who had participated in the NFPTR. Families were followed for an average of five years per family. Forty-one of the people being followed developed pancreatic cancer during this time.

The researchers found that individuals with a family history of pancreatic cancer are at a statistically significantly increased risk of developing pancreatic cancer. Having a member of the family with a young-onset pancreatic cancer (less than 50 years of age) increases the risk even more.

This study demonstrates that individuals who have had more than one family member develop pancreatic cancer, especially when one of those family member developed pancreatic cancer at an early age, have a high risk of developing pancreatic cancer themselves. This study highlights the need to develop early detection tests.


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