Neuroendocrine tumors of the pancreas (PNET), also known as islet cell tumors, are unique cancers that produce hormones, causing debilitating symptoms and stimulating tumor growth.
Eric Nakakura, M.D., Ph.D., an Assistant Professor of Surgery, a member of the multidisciplinary GI Oncology Program and a research scientist in the Surgical Oncology Laboratory, notes that the incidence of neuroendocrine tumors of the pancreas has been increasing over the past few decades and that the disease presents significant challenges to treat:
"Neuroendocrine tumors frequently metastasize to other parts of the body, the most common presentation at diagnosis. At this advanced stage, most candidates are not surgical candidates. Moreover, currently available therapies are generally ineffective in shrinking tumors or providing durable relief of debilitating symptoms, underscoring the urgent need for more effective therapies."
Unlike patients with metastatic pancreatic adenocarcinoma (the most common type of pancreatic cancer), a carefully selected group of patients with advanced neuroendocrine tumors of the pancreas (PNET) may benefit from surgery to palliate their symptoms and extend their lives.
Translational Research
Dr. Nakakura has collaborated in the lab with basic scientist Douglas Hanahan, Ph.D., who developed a strain of lab mice genetically engineered to develop pancreatic neuroendocrine tumors. This research helped pave the way for a clinical trial led by Principal Investigator Emily Bergsland, M.D., Associate Professor in the Division of Hematology Oncology in the Department of Medicine, RAD001 and Erlotinib in Patients With Neuroendocrine Tumors. The study is evaluating, for the first time, the combination of two targeted therapies aimed at altering the biochemical events necessary for the growth of neuroendocrine tumors.
Personalized Medicine
The UCSF Helen Diller Family Comprehensive Cancer Center has a multidisciplinary team dedicated to the treatment of patients with neuroendocrine tumors of the gastrointestinal tract. "Our goal is to give drugs keyed to the specific molecular characteristics of a patent's tumor," said Nakakura. "Identifying biomarkers are crucial for identifying the biology of a patent's tumor that will be predictive of response to treatment."
Surgical oncologists at UCSF perform complex surgery of the pancreas, liver, stomach, and intestines. This is augmented by specific clinical trials for patients with advanced neuroendocrine tumors.
Nakakura is optimistic about the development of future treatments:
"We are attacking human cancer from multiple points, from animal models to the interrogation and profiling of tumor specimens from patients.This approach has led to the identification of critical determinants of neuroendocrine tumor growth and hormone production, and novel diagnostic markers.
I believe that our bench-to-bedside focus will lead to earlier detection of neuroendocrine tumors when they are still operable, and to more effective treatments for inoperable advanced disease."