Núria Malats, oncologist: "Pancreatic cancer is being detected in younger people and in a higher proportion of women"

Pancreatic cancer does not give up.

It is an aggressive tumor that, when it is detected, in most cases (80%), it is too late because it is in advanced stages.

93% of the slightly more than 8,000 patients diagnosed per year die within a few months.

The only strategy is to investigate, to know its causes and its behavior in order to develop more effective treatments and an early diagnosis.

Núria Malats, a 60-year-old Barcelonan and head of the Genetic and Molecular Epidemiology Group of the National Cancer Research Center (CNIO), has been involved in this crusade.

This scientist promotes the Pancreatic Cancer Research Alliance (Alipanc), to which she has managed to add 45 teams of researchers from all walks of life who are trying to avoid a fateful record: pancreatic carcinoma is the second leading cause of cancer death.

Ask.

How did the alliance come about?

Answer

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Several teams interested in investigating pancreatic cancer began to come together in Madrid.

During the pandemic, activity dropped and then it exploded.

We are now 45 multidisciplinary groups: half do clinical research and the other half do basic research.

This is the wealth of the alliance, we complement each other well.

We are aware that if we do not pool efforts and resources in research, we will not position ourselves or achieve progress in the knowledge of this disease.

We want to advance as far as possible in knowledge so that, later, we can transfer the advances to clinical practice and also because it is a matter of public health, to reduce the incidence and mortality and improve the survival and quality of life of these patients.

More information

Pancreatic cancer, the aggressive tumor with which science continues to stumble

Q.

Why is there less research on pancreatic cancer than on other tumors?

R.

There are many reasons.

Although it ranks second in mortality, after lung cancer, in incidence it is not as frequent.

The number of patients with pancreatic cancer is less than that of patients with breast, colon, prostate, lung or bladder tumors, for example, which receive more attention from the national health systems.

Another reason is because, as pancreatic carcinoma is so aggressive and patients have such a short survival, it does not give much room for treatment and makes research difficult.

Before, there was a perception that nothing could be done and patients with a poor prognosis —only 20% could be operated on— were not offered treatment.

In addition, 64% of the European population, five years ago, had not heard of pancreatic cancer.

I didn't even know where it was or the symptoms to identify it in its earliest stages or the risk factors to prevent it.

He has always been the great forgotten.

But this attitude has changed a lot due to the increase in cases and because we are all pushing at all levels.

There is more awareness on the part of the population.

Primary care physicians, whose role is very important, are increasingly active.

Also in the political sphere, in health services and in research funding.

It is the moment in which we are all moving and so this also helps this alliance to emerge.

There is more awareness on the part of the population.

Primary care physicians, whose role is very important, are increasingly active.

Also in the political sphere, in health services and in research funding.

It is the moment in which we are all moving and so this also helps this alliance to emerge.

There is more awareness on the part of the population.

Primary care physicians, whose role is very important, are increasingly active.

Also in the political sphere, in health services and in research funding.

It is the moment in which we are all moving and so this also helps this alliance to emerge.

Q.

Why are cases increasing?

R.

Until now pancreatic cancer was very even in men and women with an average age of between 67 and 70 years.

Now it is being seen more in younger people, as is the case with colon cancer.

Also the proportion of women is a little higher.

We don't know what's behind it.

It is believed that it may be related to the increase in obesity and diabetes.

But surely there are other factors that we have not identified.

There may be an initial dysbiosis [microbial imbalance] in the colon from overuse of antibiotics.

We also investigate genetic predisposition.

We know there are risk factors, but they don't explain everything.

There is not a single element and testing all the hypotheses is not so easy.

It is true that the identified cases all point to a problem of chronic inflammation in the pancreas and this gives some clue.

We know there are risk factors, but they don't explain everything

Q.

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Why is he so aggressive?

R.

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Pancreatic cancer has been called catastrophic because of its evolution.

While the initiation and development period for other cancers until it is diagnosed is 15 or 20 years, for pancreatic cancer it is much less.

Even very small tumors, one centimeter, can be metastatic.

This is due to the characteristics of the gland, because it does not have barriers and it has a lot of irrigation.

There are many challenges.

Núria Malats, in February in Madrid.

Luis Sevillano

Q.

Are there formulas for an early diagnosis?

R.

We are investigating, although we are not at the point of moving it.

The potential of liquid biopsy is very high.

If there is any way to identify pancreatic cancer in very early stages, it is with a liquid biopsy and with all the artificial intelligence technology applied to images.

It will be an important field in terms of early diagnosis markers, but we also need to define the population to which to apply these biomarkers.

It cannot be for the entire population because the incidence is not high enough.

We need to go to the highest risk population.

Until now, screening programs are being done to those who have hereditary or familial chances of pancreatic cancer.

But it represents only 10% and we miss 90%.

And they're not that efficient either.

When pancreatic cancer appears between two or three tests,

It is already advanced and nothing had been seen before.

This is surely because the imaging tools that are used without artificial intelligence are not sensitive enough, because the window of opportunity should be shorter between one test and another, and also because of the characteristics of this tumor, which we can see. it gets very difficult.

Screening programs are being done for those who have a chance of hereditary or familial pancreatic cancer.

But it represents only 10% and we miss 90%

Q.

When could we reach an optimal level of early diagnosis?

R.

I would say, with great desire, between five and 10 years.

Let's see if we can do it as soon as possible.

We are joining efforts with large international projects to achieve it in five years.

Q.

_

Apart from the population with a family history, what would be the population at risk?

R.

This is what we are trying to identify, integrating a lot of information about risk factors that are well established, but also with genomic, microbiome, metabolome, immunome markers... We need to identify those markers that allow us to reach a very high-risk population so that the screening program is cost effective and makes sense.

We know that they are over 60 years of age, that diabetes is important, that obesity, tobacco and alcohol, too, or if there are potentially malignant lesions.

But my dream is to have an application on our mobiles, like the ones there are for cardiovascular monitoring, with which we could estimate the risk and, those that are above a threshold, which we have to determine, would go to the national health system. for,

My dream is to have an application on our mobiles, like the ones for cardiovascular monitoring, with which we could estimate the risk

Q.

It doesn't seem very difficult.

R.

We are working on it, developing the algorithm so that it can be used by the population.

Where it is more difficult is in the other unidentified part: in the markers that actually play a role in the definition of high risk.

But we have to continue checking if it discriminates not only when they are already diagnosed or in early cases, but also before the diagnosis and how long before it.

Q.

Regarding treatments, there is talk of nanoparticles, immunotherapy, viruses... Are there any promising ones?

R.

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Someone told me recently that you have to attack by land, sea and air.

With only one type of treatment, we are not going to achieve it and I believe that it will be the combination of several that will finally help us control this disease.

In primary care, we must be able to find out how to prevent development;

then, achieve an early diagnosis for 80% of the population at risk and, then, offer the entire battery of innovative treatments.

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