By Jennifer Fernandez
Finding a way to fight pancreatic cancer is personal for Kirsten Bryant.
She was studying cell biology at Cornell University and considering cancer research during the last year of getting her doctorate in 2013 when her father died from pancreatic cancer.
“After going through the process of treatment with him and realizing how few options there were for pancreatic cancer patients … I felt like I was in a position to potentially make a difference with the training that I had,” she said.
The five-year survival rate for pancreatic cancer is stubbornly low at just 13 percent, in part because it tends to be diagnosed only after it’s advanced. It has not been studied as vigorously as other cancers, many of which we have learned much more about — leading to the development of treatments that improve survival rates, Bryant said.
Federal grants helped her launch a pancreatic cancer research lab at UNC Chapel Hill’s Lineberger Comprehensive Cancer Center.
Cuts by President Donald Trump’s administration to the National Institutes of Health, which includes the National Cancer Institute that has funded much of Bryant’s research, have not touched her funding so far. But her lab has not gone unscathed. One of her researchers is waiting on confirmation of a fellowship award that would typically start this summer. Her cohort has been delayed twice already, Bryant said.
Bryant worries what will happen to research like hers when such critical support disappears.
She’s not alone.
UNC Chapel Hill has had 97 grants from federal and state agencies terminated, a spokeswoman told NC Health News in an email on May 12.
“We came to this field to be able to make a difference,” said UNC’s Vice Chancellor for Research Penny Gordon-Larsen, whose research focuses on the molecular and genetic underpinnings of severe obesity.
“We’re committed to getting diseases cured, and we want to do that work desperately,” said Gordon-Larsen, who is waiting on confirmation for expected funding to continue her own work. “So anything that gets in the way is very frustrating.”
Pancreatic cancer
The pancreas is a tadpole-shaped organ about six inches long that sits deep within the abdomen, between the stomach and the spine. It is considered a dual organ because it plays a role in two systems — producing enzymes that help digestion and making hormones that control blood-sugar levels.
More than 67,000 people will be diagnosed with pancreatic cancer this year in the United States, according to the Pancreatic Cancer Action Network.
The American Cancer Society estimates 51,980 people will die of pancreatic cancer this year. Of those, it’s estimated that 1,910 will be North Carolina residents.
Though pancreatic cancer is projected to make up only 3.3 percent of new cancer cases this year, it’s expected to cause 8.4 percent of all cancer deaths, the National Cancer Institute says.
It’s a type of cancer that mostly happens randomly, but smoking, obesity and age put people at a higher risk, according to the Pancreatic Cancer Action Network.
Pancreatic cancer is also difficult to diagnose. The gland’s position deep inside the abdomen makes tumors difficult to see or feel during routine exams. Tumors tend to be found by imaging technology such as MRIs.
In the early stages of the cancer, there aren’t any noticeable signs or symptoms. And once symptoms — which range from back pain to jaundice to weight loss — do appear, they present in a similar way to other illnesses.
The Pancreatic Cancer Action Network says diagnostic tests are “urgently needed” to find this type of cancer in the earliest stages.
Starving growth
Some researchers are working on early detection, while others, like Bryant, are trying to find better ways to treat pancreatic cancer.
Her team has been looking at a family of genes that, when mutated, can cause the disease. The vast majority of pancreatic tumors begin to form after a mutation in one particular gene, which creates a mutant protein that drives pancreatic cancer. This mutant protein is the focus of Bryant’s research.
After decades of investigation, therapies that successfully target and arrest these mutant proteins are relatively new. The first inhibitors were just approved for use three to four years ago, Bryant said.
There are currently very few targeted therapies for pancreatic cancer, and some approved therapies provide an average of only two more weeks of survival, she said. In contrast, this new therapy — which is in phase 2 trials that test effectiveness — showed a 14-month survival advantage.
However, there is still more work to be done, Bryant said, because resistance to the therapy eventually forms. She said her team can observe this in the lab, as well. They saw an increase in a metabolic process where cells seem to actually eat themselves. The team then created a treatment to stop that metabolic process, which is “almost like starving the cancer cells,” she said.
The next step is exploring other ways to prevent the uptick in that cellular self-eating process and to allow targeted therapies to better attack the cancer.
“Our research is really focused right now on understanding mechanisms of therapeutic resistance and coming up with novel combination therapies to treat this disease,” Bryant said.
Funding cuts on the horizon
The specter looming over research like Bryant’s is the current uncertainty in federal funding — especially for health-related research.
Through April, the federal government ended nearly 700 National Institutes of Health grants totaling $1.81 billion, according to a May 8 report in JAMA. In addition, NIH has cut back new grants by at least $2.3 billion since the start of the year, STAT reported.
At UNC Chapel Hill, NIH ended funding for 26 projects, a spokeswoman wrote in an email, and the university was a subrecipient of 16 grants that lost NIH funding. The university also had one project directly terminated by the Centers for Disease Control and Prevention and two where the university was a subrecipient.
It’s not clear how many jobs have been affected by the cuts. The spokeswoman said the university “is still working through programmatic and staffing implications of all the grant terminations.”
Bryant was awarded a special early investigator award through the NIH’s National Cancer Institute that can be extended for two years. Typically, getting the extension would be a given, she said, but she has not yet heard if her award will be extended.
Money has to come from many different pools to fund a cancer research lab, Bryant said. While foundations may play a role, the majority of funding comes from government sources, she said.
One of her early awards came from the Pancreatic Cancer Action Network to help her take her postdoctoral work into her first faculty position. Most researchers who got this type of first award now have their own pancreatic cancer research labs, Bryant said.
That award paid for the first couple of months of her lab, which allowed her to do the initial work to be able to pursue bigger grants from the government, she said.
“That’s how the system usually works,” Bryant said. “You get small foundational grants. They allow you to get the preliminary data that allows you to get the large grants from the federal government. And if we lose that piece, everything will kind of fall apart.”
Momentum
It is crucial to give the kind of support Bryant received to early career researchers, Gordon-Larsen said.
“You don’t get to grow the next generation without that (early investment),” she said. “And there has been a lot of talk in D.C. about … reducing those kinds of early career support programs.”
Amid all of the funding cuts, Bryant is grieving the loss of a fairly recent award focused on pancreatic cancer research.
The Department of Defense has a Cancer Research Program that distributes money to programs for various cancer research projects. Pancreatic cancer was added several years ago, and Bryant said she was one of the first research labs to get that grant funding.
The Trump administration recently cut the program.
“The fact that this is gone is very frustrating,” she said.
Research into pancreatic cancer has recently made some big strides, but it still lags behind the work done on many other cancers, she said.
“I believe that a lot of our lack of progress is just due to a lack of brain power and manpower, and as we bring more and more people into the field, we can make the steps that have already been made in other cancers,” Bryant said.
For instance, extensive research on breast cancer revealed subtypes that require different treatments, she said. That type of work is now being done with pancreatic cancer, and that came out of another UNC lab.
“Now we’re starting to realize that treatments affect one more than the other,” she said. “So it’s earlier days, but we’re already starting to see these steps that other more treatable cancers have gone through.
“I’m encouraged,” she continued, “but we need to keep the momentum going.”
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