In June 2013 I was diagnosed with pancreatic cancer. Pancreatic cancer is a very difficult cancer, with a five-year survival rate of only seven percent. The only potential cure for pancreatic cancer is a harsh operation, called a “Whipple,” in which parts of the pancreas and other organs are removed, and the remaining organs are sewn together.
After chemotherapy and radiation I became eligible for the surgery, which was performed in March 2014. The surgery was successful, and all of the visible cancer was removed. But even when it appears that all the cancer has been removed by surgery, pancreatic cancer frequently recurs. The cancer returned In August 2014, and my doctors determined that it had spread elsewhere in my body. I then went on a year of rigorous chemotherapy which made the tumors disappear on scans. In August 2015 I went on a lighter, maintenance chemotherapy. Still, months later, the cancer is not visible on scans.
I told my story to an event sponsored by the Miami affiliate of the Pancreatic Cancer Action Network. The video of my talk is online (https://youtu.be/cVZ3Ls9H2gc).
Cancer and Genetic Mutations
Journal entry by Robert Glazier — 11/5/2016
Long ago all diseases of a certain type were linked together as “cancer.” Over time, doctors recognized that different cancers are different diseases: for example, prostate cancer is different from pancreatic cancer, with different treatments and different prognoses.
More recently, doctors have began to understand that a person’s genetic profile can sometimes be the basis for treating a person with a disease that starts in a particular location based on the person’s genetic mutations, rather than solely the place of origin. Not all pancreatic cancers, for example, are alike. This is known as personalized medicine.
Personalized medicine is in its early stages, and has not yet found much information useful for the treatment of pancreatic cancer. But there is some. Let me explain.
Over the last few years I have learned that I suffer from two unusual conditions.
First, I have Gilbert’s Syndrome. This condition, which about 3% to 12% of people have, means that my body does not process bilirubin as well as it should. This isn’t much of a problem. It simply means that for me a slightly elevated bilirubin level is not something to be concerned about, as it would be with most people.
Second, I have an unusually toxic reaction to one of the drugs in Folfirinox, the chemotherapy regimen I was on for a year. The drug is called Irinotecan. I learned this from experience—I had miserable diarrhea, which disappeared when they removed the Irinotecan. After they did this I had genetic testing of my tumor, and it disclosed that I have a genetic mutation which would make the drug toxic for me.
This week I learned that these two conditions—my high bilirubin levels and my toxic reaction to Irinotecan—are linked. They are both caused by the same genetic mututation, known as UGT1A1.
Scientists hope that with time they will discover effective treatments for pancreatic cancer based on genetic mutations. I hope that I am around to benefit from those advances.
