Diabetes and Pancreatic Cancer Present ... - University of Utah

Diabetes and Pancreatic CancerPresent Interlocking Health ProblemsPancreatic cancer and diabetes havea circular relationship. People withpancreatic cancer are at high riskfor developing diabetes. People withdiabetes are twice as likely as thosewho do not have the disease to developpancreatic cancer.Diabetes and the PancreasThe pancreas makes insulin, whichcontrols the way the body uses sugar.People with diabetes cannot use sugarproperly because they have too littleinsulin in the bloodstream.Pancreatic tumors may block insulinfrom entering the bloodstream, eventhough the pancreas still makes it.If surgery removes the tumor so theinsulin can be released properly, thediabetes will be cured.Some people develop diabetes becauseof their cancer treatment. Whenremoving the tumor also removes thepart of the pancreas that makes insulin,diabetes will occur.Having diabetes means that the bloodcontains too much glucose (also calledblood sugar). Glucose is the mainenergy source for cells in the body.However, too much blood sugar canlead to serious health problems.Eating Well with Diabetes and CancerPeople with both diabetes and cancerhave special diet needs. A healthy dietis especially important for people withdiabetes. Making wise food choicescan help keep blood sugar levels closerto normal and improve overall health.Medicines and exercise also helpimprove healing, control weight, andincrease quality of life.People with cancer and diabetes needto follow the advice of their healthcareteam. The Linda B. and RobertB. Wiggins Wellness Center offersHuntsman Cancer Institute patients freeconsultations with a registered dietitian(RD). The dietitian can help coordinatemeal schedules with diabetes medicines.People with both diabetes and cancer havespecial diet needs. A healthy diet is especiallyimportant for people with diabetes.An RD can also design an eating planthat helps control blood sugar levels andcancer-related weight loss.To make an appointment with theWellness Center dietitian or RD, call801-587-4585.Clinical Trials UpdateClinical trials help doctors discoverthe best treatments possible. Patientsmay or may not directly benefit fromparticipating in a clinical trial. If youhave questions, please talk to yourdoctor for more information. At rightis a list of Pancreas Cancer ResearchProgram clinical trials currently open.A full list of Huntsman Cancer Instituteclinical trials is available atwww.huntsmancancer.org/clinicaltrials.IRB 36843 – Kimberly Jones, MDPhase III – Compares the effectsof weekly doses of ABI-007 plusGemcitabine versus Gemcitabinealone in patients with metastaticadenocarcinoma of the pancreas.ABI-007 is approved for treatmentof other recurring cancers, andGemcitabine is known to be effectivein pancreatic cancer.Current and past issues of the Pancreas Cancer Research ProgramNewsletter can be viewed atwww.huntsmancancer.org/cancerInformation/newsletter— page 5 —

Food Choices Support Healthy Blood Sugar LevelsMany pancreas cancer patients havetrouble maintaining proper blood sugarlevels. (See article on page 5.) Here aresome tips for healthy eating:• Eat food from each of these five foodgroups at each meal every day:−−Fruits and vegetables−−Whole grains, cereals, and breads−−Dairy products−−Meat, fish, eggs, dried beans,and nuts−−Fats and oils• Eat meals and snacks at regular times.• Choose high-protein foods such asdried beans, peas, and lentils; leanmeats; and low-fat dairy products.• Choose high-fiber foods with complexcarbohydrates such as bran cereals,cooked beans and peas, whole-grainbread, fruits, and vegetables.• Choose small amounts of food withhealthy fat, including olives, avocados,nuts, seeds, and fish such as mackerel,lake trout, herring, sardines, albacoretuna, and salmon.• Cook with small amounts of healthyfats such as olive, canola, andpeanut oils.If you have diabetes, be sure to followyour health-care team’s diet advice.Salads provide creative opportunities to addmore vegetables and fruits to a healthy diet.Huntsman Cancer Institute2000 Circle of Hope, Room 3130Salt Lake City, Utah 84112RETURN SERVICE REQUESTEDNONPROFIT ORGANIZATIONU.S. POSTAGEPAIDSALT LAKE CITY, UTAHPERMIT NO. 1529

23456Sunil Sharma, MD, Joins HCICancer Radiation Therapy Entersthe Fourth DimensionResearch SpotlightDiabetes and Pancreatic Cancer PresentInterlocking Health ProblemsClinical Trials UpdateFood Choices Support HealthyBlood Sugar LevelsPancreas Cancer Research Programat Huntsman Cancer InstitutePANCREAS CANCER RESEARCH PROGRAM NEWSLETTER – FALL 2009Firsthand Account“I wake up every morning. That’s the absolute best thing,” says William Bowling,a patient at Huntsman Cancer Institute (HCI). He was diagnosed with pancreaticadenocarcinoma in June 2009. Although the seriousness of his disease is daunting,his voice sounds sure and strong.Until a few weeks ago, William owned a trucking company in Roosevelt, Utah,hauling water used in the drilling process to the oilfields. Since his cancerdiagnosis, William’s focus has shifted to his young family. He and his wifecelebrated their twentieth wedding anniversary on October 12. They have twodaughters and four sons between the ages of 14 and three.“I really strive to do things today,” says WilliamBowling, who was diagnosed with pancreaticcarcinoma in June 2009.William says that ending his habit ofprocrastination is the main change he’smade since his cancer diagnosis. “Nowinstead of saying ‘someday I ought to,’I really strive to do things today.”That includes spending time on thesoccer field. “We’re a soccer family. Wealways have been,” William says, andcancer isn’t changing that. Williamcoaches his 12-year-old son’s team,and his 14-year-old daughter coachesthe 7-year-old’s team.“The day I was diagnosed, we satdown together as a family to decidehow to face this,” William says. “Wecould spend our time moping andworrying, or we could live every daycontinued on page 2Mission StatementThe mission of the Pancreas CancerResearch Program (PCRP) atHuntsman Cancer Institute is toreduce suffering from pancreascancer and improve survival rates forpatients with the disease. Three goalsevolve from this mission: preventingpancreas cancer, detecting it early,and improving treatment options.The PCRP, a component of theGastrointestinal Cancer ResearchProgram, combines the expertise ofspecialized researchers and clinicianswith the resources of the UtahPopulation Database to identifyand study genetic and other factorscontributing to pancreas cancer.HOW TO REACH USHereditary GastrointestinalCancer Registry801-585-19361-877-422-6860 toll freeGI Cancer Program801-587-44221-877-624-4422 toll freeHigh Risk Pancreas Cancer Clinic801-587-9555Pancreas Cancer Research Program801-585-60481-866-809-3799 toll freewww.huntsmancancer.org/gi

Firsthand Account(continued from page 1)Sunil Sharma, MD, Joins HCI asSenior Director of Clinical Researchwe have together to the fullest.All of us chose living to the full.”In hope of assuring many morefull days, William is participatingin an HCI clinical trial headedby Kimberly Jones, MD. Thetrial tests whether overall patientsurvival can be improved bycombining two drugs known tobe effective in pancreatic cancer,giving them at higher doses andon a different treatment schedulethan the FDA currently approves.William has advice for anyonefacing pancreatic cancer: “If thereis a clinical trial available to you,do it.”For up-to-date,accurate cancerinformation,visit theHOPE Guidewww.hopeguide.orgHuntsman Cancer Institute (HCI) isdeveloping a world-class program forthe study of new cancer therapies. TheCenter for Investigational Therapeutics(CIT) has two divisions—a researchbranch where scientists in the lab willstudy and develop new cancer therapiesand a clinical branch where doctorsoversee the use of these new therapies ina Phase I clinical trials program.Phase I clinical trials are the initialhuman studies that test effectivenessand proper dosages for new treatments.Many standard cancer treatments usedtoday emerged from clinical trials.Phase I trials are often the best hopefor patients who are not responding tostandard treatments.Sunil Sharma, MD, co-director of theCIT and senior director of clinical researchat HCI, joined HCI in July 2009. He is aprofessor in the Department of InternalMedicine at the University of Utah.“I am excited to bring a Phase I clinicaltrials program to the people of Utahand the Intermountain West,” saysSharma. “It gives me a great sense ofsatisfaction to know how many peoplecould benefit from this program.”In the clinical setting, Sharma isinterested in the treatment of patientswith gastrointestinal (GI) cancers,mesothelioma (a form of cancer usuallylinked with asbestos exposure), andrare tumors. In the laboratory setting,he is internationally recognized in thearea of early-phase clinical trials andtranslational drug development.Sharma is an oncology consultant tomany leading pharmaceutical andSunil Sharma, MDbiotechnology companies. He receivedhis medical oncology training at theUniversity of Texas Health ScienceCenter, San Antonio, where hetrained with Daniel Von Hoff, MD,a pioneer in the area of new cancerdrug development. At Memorial SloanKettering Cancer Center, he specializedin Phase I clinical trials and cared forpatients with GI cancers. He also took aleadership role at the drug developmentcompany Novartis Pharmaceuticals,responsible for the company’s early andtranslational drug portfolios. Beforejoining HCI, he set up a program inexperimental therapeutics with a largePhase I program at the Nevada CancerInstitute, Las Vegas.“Dr. Sharma is already having anincredible impact on advancing HCI’smission,” says Mary Beckerle, PhD,executive director of HCI. “He bringsto HCI a wealth of knowledge andexperience, and his commitment tocollaborative science embodies the highestlevel of teamwork and scholarship.”New Blog Addresses GI Cancer IssuesKeep up on the latest news on research, wellness, and survivorship at the Gastrointestinal CancerProgram’s new blog. Recent entries include links to videos, healthy eating tips, and introductionsto staff members.To read the blog, go to www.hci.utah.edu/group/gi/program.jsp, scroll to the bottom of thepage and click the GI Blog banner.— page 2 —

Radiation Treatment for Cancer Enters the Fourth DimensionComputed tomography (CT) scan “movies” track tumormovement caused by breathing. A robotic couch preciselypositions the body with less than a millimeter of variation.Cancer radiation treatments may take days rather than weeks.These features describe the new image-guided radiationtherapy (IGRT) suite at Huntsman Cancer Hospital (HCH).The suite, in operation since August 2009, adds the latestcutting-edge technology. The equipment guides radiationtreatment precisely to the tumor and spares the surroundinghealthy tissues.Radiation therapy is often used to treat many cancers,including pancreatic cancer. It helps control the disease andimproves patient survival. Radiation therapy works by causingdeadly damage to cancer cells. In normal cells, damage can bemore easily repaired by the body.At the beginning of the treatment planning process, a highspeedCT scanner takes several series of tumor images. At thesame time, a camera tracks the rise and fall of the patient’sbreathing. All these images are combined to produce a“movie” that shows how the tumor changes position duringeach breath. This adds the fourth dimension of time to theusual three-dimensional CT images. With informationfrom this scan, the radiation oncology team can design anindividual treatment plan for each patient. They can keep theradiation focused on the tumor and avoid damage to healthytissue in the area.The new IGRT suite includes the Artiste®, the latest radiationtreatment equipment from Siemens, a supplier of healthcaretechnology. HCH is one of the few cancer centersworldwide that has this treatment system. In this IGRT suite,a high-speed CT scanner in the same room allows preciseidentification of the target area. Another recent addition tothe IGRT suite includes a robotic couch for our Novalis®treatment system. This couch precisely positions a patientbased on X-ray images taken before treatment. Each of theseIGRT features allows treatment delivery accurate to less thana millimeter.Image-guided radiation therapy (IGRT) allows precise delivery ofradiation to cancer while minimizing damage to surrounding healthytissue. Figure A shows a pancreatic tumor (pink) inside the high dosearea (red outline), and surrounding tissue where cancer is likely to havespread (turquoise) inside a lower dose area (yellow outline). Figure Bshows a stereotactic body radiation therapy (SBRT) plan where thehigh-dose radiation (red) is sharply focused on a liver tumor (orange).The rest of the liver (purple) receives a much lower dose (blue).HCI Radiation Oncology staff members Steve Meisner, ElaineRandolph, Diane Everett, and Troy Taylor operate the new IGRT suite.The suite includes the Siemens Artiste® and a high-speed CT scanner,which together allow state-of-the art image-guided stereotactic bodyradiation therapy (SBRT).Because these systems are so precise, sometimes radiationtherapy can be complete in just a few high-dose treatmentsover a few days. This is called stereotactic body radiationtherapy (SBRT). In pancreatic cancer, healthy-looking tissuenear the cancer could contain microscopic cancer cells. Thesetissues must be included in the treatment area. Then radiationmust be given over five to six weeks to reduce harm to healthytissue. The radiation oncologist consults with other membersof the cancer care team to determine the appropriate radiationtherapy plan for each patient.These world-class technology advances and HCH’sexperienced team of professionals make radiation treatment assafe and effective as possible for cancer patients.— page 3 —The Novalis®, HCI’s high-tech image-guided treatment unit capable ofstereotactic body radiation therapy (SBRT). This instrument also allowsstereotactic radiosurgery, useful in treating tumors in surgically riskylocations. Radiation Oncology staff members Erin Schooler, DebbieWilson, and Brennen Esch operate the equipment.

Research SpotlightNew research oftenchallenges oldideas about disease.Charles Murtaugh,PhD a member ofthe Pancreas CancerResearch Program (PCRP), heads a labthat studies the origins of pancreascancer. Some of the lab’s findingshave overturned old assumptions.Scientists in the Murtaugh lab studythe process by which cells in thepancreas normally take on differentfunctional roles. This process iscalled cell differentiation. They alsoinvestigate what goes wrong whenpancreatic cancer develops.The pancreas contains severaldifferent types of cells:• Islet cells control blood sugar.• Acinar cells produce enzymes thathelp digest food.• Duct cells form a network thatchannels the enzymes intothe intestine.Under the microscope, pancreaticcancer cells look like duct cells.Because of this resemblance, manyscientists believed that the first stepsof tumor formation occur induct cells.Researchers from the Murtaugh labsuggest a different possibility. Theirstudies have shown that pancreaticcancer can start from acinar cells inmice. They have also found that earlyin cancer development, acinar cellschange from their normal state tobecome more like duct cells.Reduce Risk—Quit SmokingDo you care about someone who smokes? Ask for HCI’sfree booklet “How to Help Your Loved One Stop UsingTobacco” available from the Cancer Learning Center.For more information, call the Cancer Learning Centerat 801-581-6365 or 1-888-424-2100 toll free.Currently, Murtaugh lab researchersare trying to understand whatmakes this change in the acinar cellshappen. They study mice to findtreatments that keep the change fromoccurring. The researchers believethere is a strong chance that suchtreatments may prevent or reversepancreatic cancer. If the researchidentifies treatments that workin mice, then Huntsman CancerInstitute clinical trials could testthem in humans.In other studies, Murtaugh labresearchers found that mouse acinarcells become more prone to cancerwhen pancreatitis has injured thepancreas. This may also occurin humans. If so, it may explainthe connection between chronicpancreatitis and higher pancreaticcancer risk.The Murtaugh lab is studying miceto see whether drugs that inhibitpancreatitis also prevent pancreaticcancer. Again, if their research showsthat these drugs work in mice, HCIclinical trials can see if they work thesame way in human patients.They are conducting this study incollaboration with Matthew Firpo,PhD, research assistant professor inthe Department of Surgery at theUniversity of Utah. Firpo is an HCIinvestigator and a member of thePCRP.Murtaugh is an assistant professor in theDepartment of Human Genetics at theUniversity of Utah and a member of HCI’sGastrointestinal Cancers Program.Help AdvancePancreas CancerResearchIndividuals in the community, oftenpatients diagnosed with pancreascancer and their family members,help provide funding for the PancreasCancer Research Program. Theprogram uses these donations to payresearch support staff, to obtain neededresearch equipment, and to fund pilotresearch projects. National researchorganizations usually support studiesonly after preliminary studies showthat a larger study could yield positiveresults. Internal funding for pilotstudies helps investigators perform thismuch-needed groundwork.If you would like to donate to cancerresearch, contact Huntsman CancerFoundation at 801-584-5800 orwww.huntsmancancerfoundation.org.Wellness CenterPromotesBalanced CareThe Linda B. and Robert B. WigginsWellness Center offers programs thataddress physical and emotional needs ofpatients and their families, including:• Fitness Program that providespersonalized exercise routines forcancer patients• Nutrition counseling with aregistered dietitian• Connections to support groups,workshops, and individual counseling• Bone health and osteoporosis program• Acupuncture for pain and nausea relief• Yoga classesFor more information about their services,call 801-587-4585 or visitwww. huntsmancancer.org/wellnesscenter— page 4 —