Widespread screening for more common cancers, such as breast, colon and prostate, have come under fire lately for leading to too many false positives and excessive follow-up treatment.
With even rarer diseases, it is much trickier, Saltz points out, and would demand an exceedingly low false-positive rate. Trying new treatments When pancreatic cancer is caught early, doctors will usually try to remove it surgically.
As Saltz points out, however, the chances that it will come back in the next year or two are still relatively high. And the surgery itself is risky. The pancreas is lodged deep within the abdomen, surrounded by—and connected to—other major organs.
If the cancer has already spread, as it had in Steinman's case, the most common approach is chemotherapy, which "for regular pancreatic cancer, is not very effective," Saltz says.
The mainstay is the chemo drug gemcitabine Gemzar , which is one of the treatments Steinman received. In trials, some patients saw no benefit, but for a minority, it extended life by as long as a few years, suggesting that an essential molecular difference exists in their tumors.
Despite initial positive signs from chemo, and even when Steinman was doing better, "he felt like he was living with Damocles' sword over his neck—he never knew when it was going to come back," Schlesinger says.
So he turned to what he knew: the immune system. The only immunotherapy currently approved for general use as cancer treatment is a drug for metastatic melanoma ipilimumab, or Yervoy, approved in March.
Saltz calls that approval good "evidence that it's an important avenue to explore" for other forms of cancer. Scientist as test subject When word spread that Steinman had pancreatic cancer, Schlesinger says, there was an outpouring of offers from fellow immunologists to try treatments they were working on—many having been made possible by Steinman's own discoveries about the immune system's dendritic cells.
Not all the experimental drugs were meant to tackle pancreatic tumors; some were for skin or prostate cancer. In all, Steinman tried eight different experimental therapies, Schlesinger says. But they were not under-the-table, backroom needle jabs, she is quick to point out.
Each drug was already being tested on other patients in phase I clinical trails, and Schlesinger and Steinman went through great pains—and many hours—to ensure all of the proper institutional and government approvals were granted before he got the therapies.
The first treatment he got was a vaccine called GVAX, under development to treat prostate cancer. He also received a novel therapy that worked on a developmental pathway the hedgehog signaling pathway and two that were based on dendritic cells: one in which dendritic cells were created from his own blood cells that were then "pulsed with RNA that had been isolated from his tumor," Schlesinger explains; and another in which the dendritic cells were filled with "peptides that were from his own tumor.
Arlen's group is testing, in a phase I trial, a monoclonal antibody to treat patients with the more common form of pancreatic cancer.
Preliminary data show that the antibody finds its target with some 50 to 60 percent of patients with adenocarcinoma, he says. But that does not mean that it will leave them disease-free. And he hopes that a combination of the new approaches and the more standard drugs will yield even better results—a trial that they plan to start next year.
Treating Jobs's cancer Endocrine cancer, the variety Jobs had, is treated with a different variety of chemotherapy drugs.
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