Something felt "not right." Out of whack.
In late 2015, Bob Minetti started feeling stomach pains that mysteriously came and went and moved to his lower back. Extensive testing led to one of the most dire of diagnoses: pancreatic cancer. And the small tumor was lodged against a key blood vessel, so it couldn't be surgically removed.
Minetti, a retired academic fundraiser from South Natick, Massachusetts, enrolled in a clinical trial at Massachusetts General Hospital that included a powerful newer chemotherapy, called FOLFIRINOX. The tumor, which he thought of as about the size of a hard candy, responded dramatically.
"It's really shrunk like butter in the microwave," he recalls one of his doctors telling him. "It's been unbelievable how it's responded to the chemotherapy."
It dwindled to the point that surgeons could remove it. That was nearly three years ago, and so far, Minetti says, "We're out of the woods."
"Jeopardy!" host Alex Trebek made headlines recently when People magazine reported that some of his tumors had shrunk by more than 50%, and that he was in "near remission" from Stage 4 pancreatic cancer.
"It's kind of mind-boggling," he told People.
It is indeed mind-boggling for a particularly terrifying type of cancer, one that has long been tantamount to a death sentence within months for most patients, to look so treatable.
But pancreatic cancer specialists say it's less surprising than it once would have been, because the last few years have brought significant progress.
The great majority of patients with pancreatic cancer do still die of the disease, says Dr. Brian Wolpin, director of the Dana-Farber Cancer Institute's Gastrointestinal Cancer Center and Hale Family Research Center, which researches pancreatic cancer.
"However, patients are living longer," he says. "Their symptoms are better controlled because the treatment is controlling the cancer better. And there are a larger number of patients who are being cured from their disease."
Advances in chemotherapy are making a big difference, Wolpin says.
"Over the past 10 years, several new chemotherapy programs have been developed, and they clearly are benefiting our patients," he says. "And that seems to be true whether they have earlier-stage disease or later-stage disease."
More broadly, "there are now a host of new treatment approaches that are being tested in the clinic that are taking advantage of our better understanding of the disease," he says.
For example, insights into the DNA alterations that drive pancreatic cancer are leading to the first targeted therapy for the disease, he says. Other treatments tailored to the specific characteristics of a patient’s tumor are also in the works.
The clinical trial that Minetti was part of used not only aggressive newer chemotherapy but also, in a novel treatment twist, an old blood pressure medication called losartan.
The study's findings, published online Thursday in the journal JAMA Oncology, are not conclusive because it was only a small pilot, but they look promising. Among 49 patients whose pancreatic tumors had initially seemed inoperable, 30 — or 61% — ended up being able to have their tumors completely removed. In three, the drug treatment was so effective that the surgery found no detectable cancer.
"In our study, by far the most exciting finding was that we were able to take patients to the operating room in the majority of cases," says Massachusetts General Hospital oncologist Dr. Janet Murphy, the study's lead author. "We know that removal of the tumor is the first step to cure in this disease."
In about one-fifth of pancreatic cancer patients, the tumors can be removed right after diagnosis, Murphy explains. In about two-fifths, the cancer has already spread beyond the point that surgery could help.
The new study means more hope for the remaining two-fifths, who have tumors that are difficult or impossible to remove because they envelop important blood vessels.
"So though it's a terrible disease, and the outcomes need to be improved in all groups of patients, we see an opportunity to potentially cure up to 60% of patients with this diagnosis," she says, "though we cannot say that surgical removal is the singular key to long-term survival. We know it's a huge leap forward — and it's a start.
"Ultimately," she adds, "the removal of the tumor definitely translated into our patients living longer in the study than they would have otherwise. But we still are working on ways to augment the likelihood of outright cure after an operation."
The pilot study's findings have been carried forward to a larger randomized study, Murphy says. Among other elements, it will try to ascertain how much of a difference the blood pressure drug losartan makes.
Pancreatic tumors tend to be encased in a tough rind, and that toughness makes it hard for chemotherapy drugs to penetrate. Losartan is believed to soften the rind and stimulate the immune system, making the tumor more vulnerable. But whether it truly makes a difference will be determined by the bigger study.
Losartan is old and cheap, so no drug company would have been interested in funding a trial of its use in pancreatic cancer, Murphy says. But the National Institutes of Health did fund it, and she says she has visited members of Congress to deliver this message: "We just achieved these remarkable outcomes in this disease, and it's essentially 100% NIH-funded. So this is the poster child for why NIH funding is so critical."
The study found that overall, patients whose tumors could be removed survived a median of 33 months.
Minetti from South Natick says he's been getting follow-up scans every three months, and he recently asked one of his doctors when that schedule could change or end.
"He said, 'Quite frankly, I don't know. We're not used to seeing patients survive like this,' " Minetti says. "And so, he said, we're kind of making it up as we go along."
Minetti does not dare use the word "cure," about himself, but his doctor has told him that the highest risk of recurrence is in the first three years. He's a couple of months away from the three-year mark now.
"So I might talk more optimistically after September," he says. "Because you don't want to jinx it, you know?"
This segment aired on June 3, 2019.