Ongoing and Future Directions in Pancreatic Cancer Research

A Conversation with Margaret A. Tempero, MD


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Our Pancreas Center is poised to learn from every patient and to rapidly apply our laboratory discoveries in the clinic. If we understand this disease, we can beat it.

— Margaret A. Tempero, MD

Margaret A. Tempero, MD, is a pioneer in pancreatic cancer treatment and research. She has long been a leader in the research and development of therapeutics for pancreatic ductal adenocarcinoma, particularly in studying investigational antibody-based therapies, developing the fixed-dose-rate concept for gemcitabine, and using effective gemcitabine combinations. Dr. Tempero’s research group has also provided a scientific foundation for using CA19-9 as a surrogate for survival in clinical trials. Currently, groundbreaking research by her group concerns the assessment of molecular subtypes and molecular enrichment in order to select new drugs for clinical evaluation.

Dr. Tempero holds the Rombauer Family Distinguished Professorship in Pancreas Cancer Clinical and Translational Science and is Director of the University of California, San Francisco (UCSF) Pancreas Center at the UCSF Helen Diller Family Comprehensive Cancer Center.

AACR Pancreatic Cancer Conference

In June, Dr. Tempero was one of the featured speakers at a leadership summit on pancreatic cancer sponsored by the American Association for Cancer Research, (AACR). Called Pancreatic Cancer: Progress and Challenges, the conference was held in Lake Tahoe, Nevada. Following the meeting, The ASCO Post spoke with Dr. Tempero about the conference and today’s most promising avenues of pancreatic cancer research.

What were your impressions of the AACR pancreatic cancer conference, and what do you think were the most interesting research questions discussed?

The conference was on point scientifically—there was a lot of energy, goodwill, and great science. I was impressed with a session on the stroma and the immunoregulatory environment. We have made real advances in understanding this biology and the immunoregulatory role of B cells, macrophages, and other myeloid-derived cells. That gives us the potential to change the environment through drugs or vaccines that can aid in tumor control.

Another interesting area is in understanding the genetic mutations associated with this disease and how to interfere with them using new molecules. For example, mutations in ras have been thought to be the most important driver in pancreatic cancer. Previously it was believed that ras could not be addressed by drugs, but the scientific community is coming up with new ways to interfere with activated ras.

Research

What other promising areas of research do you see bearing fruit in the future, and what kinds of research projects are you working with at UCSF?

One very interesting area of research is detection. We would never use imaging to screen the general population for pancreatic cancer. Because there is a much lower incidence of pancreatic cancer, it’s not cost-effective to do expensive testing on everyone. One of the challenges is to find a model that can identify patients at risk.

We have plenty of screening tools for imaging, and we know that they work. We just need to enrich our population through easily testable biomarkers and then apply the imaging screening tools to a selected population.

At UCSF, I lead the Pancreas Center, and our research projects range from those centered on pancreatic cancer biology to those centered on treatment. I’m interested in the fact that this disease causes diabetes. A subset of people with new diabetes harbors an underlying pancreatic cancer. This suggests there are a lot of opportunities to coordinate with the research community that studies diabetes to better leverage our common resources.

Evolving Community

How has the research community that studies pancreatic cancer changed over the years?

When I first started my career as a researcher in pancreatic cancer, it was hard to find other researchers in the same discipline with whom to talk. When we led the first Progress Review Group and Think Tank in 1999 and 2000, I was astounded at what we uncovered.

There were few researchers working in pancreatic cancer, and there were only a handful—perhaps six researchers—funded by the National Cancer Institute. That has really changed. I don’t know how many researchers currently work in pancreatic cancer, but judging from the size of the audience at the recent AACR conference, this research community is growing by leaps and bounds.

Treating Patients

What drew you to work in the area of pancreatic cancer, and how does your work with patients inform your research?

I’m always drawn to areas of great need. People with pancreatic cancer are very sick and they need our help. Right now, we use combinations of chemotherapy that can help patients feel better and live longer. And we know we can improve on this much more.

At UCSF, we have a concierge nursing team of extremely skilled caregivers who counsel patients about the resources available to them, particularly with regard to treatment, and help them navigate the medical system. It is always rewarding to me to help, even if we can only treat their pain

Our Pancreas Center is poised to learn from every patient and to rapidly apply our laboratory discoveries in the clinic.  If we understand this disease, we can beat it. ■

Disclosure: Dr. Tempero reported no potential conflicts of interest.



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