3/4/16. Zubin Birnbach. Improving Treatments for Pancreatic Cancer. Kiki Contreras. The Evergreen School Meridian Ave N, Shoreline, WA 98133

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1 3/4/16 Zubin Birnbach Improving Treatments for Pancreatic Cancer Kiki Contreras The Evergreen School Meridian Ave N, Shoreline, WA Essay Biomedical Research Saves Lives Not an English Language Learner

2 About five years before I was born, my grandfather died of pancreatic cancer. Pancreatic cancer is one of the most deadly types of cancer in the world. Only 6% of people survive for five years or more after contracting this disease 1. In the past few years, scientists have figured out why the chemotherapy, the method they have been using for the past 50 years, never actually attacked the tumor. Recently, many studies have been conducted that try to get the chemotherapy into the tumor. I interviewed Dr. Sunil Hingorani, a pancreatic cancer researcher at Fred Hutchinson Cancer Research Center. He told me that treatments for pancreatic cancer had not changed until a few years ago. The only available chemotherapy was a drug called Gemcitabine. Recently, they introduced two new chemotherapy regimens called Folfirinox and Gemcitabine plus Abraxane. These only increased survival by a few months and had bad side effects. Dr. Hingorani found that the pancreatic tumor has the almost the same pressure as the heart and that crushes all of the blood vessels inside of it. It shields itself in hyaluronic acid. It also cloaks itself in immuno suppressors. These deflect all of the drugs and T cells that are trying to destroy the tumor. Dr. Hingorani and other scientists around the country are leading the charge to destroy the barriers around pancreatic cancer and change it to one of the most treatable cancers in the world. The first pancreatic cancer treatment that I researched is the Halo 202 trial, led by Dr. Sunil Hingorani. Dr. Hingorani discovered that hyaluronic acid inside of the tumors extracts the water out of the surrounding tissue and creates high pressures inside the tumor 4. Because of these high pressures, it makes it hard for cancer killing drugs to get to the tumor. By using an enzyme called PEGPH20, Dr. Hingorani dissolved the hyaluronic acid, lowered the pressure and made it possible for cancer killing drugs to get to the tumor 4. This study can change the

3 world of pancreatic cancer treatments because it finally allows the cancer killing drugs to consistently get to the tumor. Another prospective treatment for pancreatic cancer is being investigated by Dr. Sunil Hingorani and Dr. Phil Greenberg. They have figured out that pancreatic tumor cells create a cloak that makes the tumor invisible to T cells that try to attack and kill it. So they engineered T cells to target a protein called mesothelin. This protein is in almost all cancers. In a mouse model of pancreatic cancer, the mice given engineered T cells lived 78% longer than they would have without the treatment 3. This is a very promising study that might also improve human survival by 75%. The last trial I researched is led by scientists at Texas Tech University Health Sciences Center El Paso, shows that Nimbolide, an extract that comes from neem leaves, has promise for treating pancreatic cancer. Nimbolide blocks the tumor s signaling pathways that cause inflammation, help the tumor survive and grow, and develop metastasis 2. The drug also reduced the amount of cancer cells in the body by 80% and their migration capabilities by 70% 2. This is important because, combined with other studies, it may cause the cancer to spread less and that makes it easier to attack. For the past 50 years, pancreatic cancer treatments have been few. They also haven t worked. But around three years ago, scientists began to look at the area around the tumor and not just the tumor itself. Because of this, the survival rates have gone progressively up. The sad thing is, none of these drugs have been approved, so only people in clinical trials can access them. We hope that soon these drugs will be approved and people worldwide can get life changing treatments.

4 Reflective Paragraph Before I did this project, I didn t know that for the past 50 years we have been treating pancreatic cancer with something that didn t even work. I also didn t know that pancreatic cancer is the most deadly cancer in the world. Doing this project made me realize that biomedical research is the basis of our everyday life. All of the small pills that we take went through testing. They were because of biomedical research. Without biomedical research, a lot of us wouldn t be here. We should continue to support biomedical research because it is interesting, cool, and the basis of our everyday life. Bibliography "Prognosis of Pancreatic Cancer Pancreatic Cancer." Prognosis of Pancreatic Cancer Pancreatic Cancer. Hirshberg Foundation For Pancreatic Cancer Research. Web. 26 Feb c_cancer.html Catharine Paddock PhD. Pancreatic cancer may be treatable with tree extract. MedicalNewsToday. MedicalNewsToday, 2/12/16. Web. 2/22/ Woodward, Kristen. "Immunotherapy for Pancreatic Cancer Boosts Survival by More than 75% in Mice." Fred Hutchinson Cancer Research Center. Fred Hutchinson Cancer Research Center, Web. 26 Feb

5 4. Keown, Susan. "New Treatment Doubles Progression free Survival in Some Pancreatic Cancer Patients." Fred Hutchinson Cancer Research Center. Fred Hutchinson Cancer Research Center, Web. 26 Feb Hingorani, Sunil. In person Interview. February 9, 2016