Pancreatic Cancer Group: Introduce yourself and connect with others

My name is Elisabeth. In 2021, i was incidentally diagnosed as having an ATM gene mutation that placed me at high risk of pancreatic, ovarian and breast cancer. Tbe genetics GI dr i initially saw thought i was at relatively low risk of pancreatic cancer (no family history). In Dec 2023, i had a baseline pancreatic abdominal MRI which showed pancreatic cysts. The pancreatic oncology surgeon i subsequently saw has identified my diagnosis as malignant neoplasms and is monitoring them w regular MRIs. i have just made an appt at Mayo because i want to see a top pancreatic specialist in a world class pancreatic clinic

Hi
My 88 year old dad has been diagnosed with pancreatic cancer. He had jaundice and that’s what led to a series of tests that revealed the cancer. He’s been healthy and active all hi life but doctors recommendation now is to avoid any harsh treatment (because he’s too weak to take it) and just best manage his symptoms. He has extreme fatigue and needs assistance for everything and has swelling in his legs due to the jaundice. Any advice on symptom management techniques or drugs would be much appreciated

in my case, genetic testing showed i was at elevated risk of pancreatic cancer because of an ATM gene mutation. i was advised to follow up regularly with a genetics GI specialist for a high risk protocol aimed at maximizing early detection

I had a Whipple 12 years ago for a diagnosis of high grade, poorly differentiated pancreatic cancer with portal vein involvement. I wouldn’t say it was awful but it was challenging and got through it to where I feel as good as before onset of illness. It was a new experience and I found ways to successfully deal with the challenges.

I am retired from a 40+ year career in clinical cancer, immunology and stem cell research and began my career as a medical technologist. I am very active as a research patient advocate on the GI Cancers Committee of the Eastern Comprehensive Oncology Group (ECOG-ACRIN), American Society of Clinical Oncology (ASCO) and the Hematology/Oncology Pharmacy Association. I am also a 12 year survivor of stage IV metastatic to the liver that was imaged a week after the Whipple.

Back in 2012, the resolution of a CT was less than today. Being diagnosed and quickly having a Whipple, the metastatic disease was below the detection threshold of a CT at that time and how I ended up having the procedure as a stage IV patient. Aggressive chemo and the detection of a gene mutation from genetic testing led to targeted therapy for maintenance monotherapy.

@stageivsurvivor - What was your immediate, post Whipple chemo treatment 12 years ago? What was/is your monotherapy that followed?

Given your professional work history and as a current volunteer for patient advocacy, what are your thoughts on this 2022 journal article by Okuna, et. al., titled "Berberine Overcomes Gemcitabine-Associated Chemoresistance...." ? Any advice?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9611392/

I am a 75 year-old male diagnosed with Pancreatic Adenocarcinoma nearly 1 year ago with a 3.5 cm malignant tumor at the head of my pancreas. Pre-adjuvant treatment at the Mayo Clinic included Folfirinox (discontinued after 4 cycles due to allergic reaction to Oxaliplatin), switch to Gemcitabine/Abraxane for 2 months, followed by 3 weeks of radiation treatment with reduced dose Gemcitabine. Anticipated Whipple surgery in January of this year was postponed due to elevated CA19.9 levels, as well as in February for the same reason. Two months treatment with Folfiri followed in March and April, but CA19.9 levels continued to rise and several small lesions of less than 1cm appeared on the liver in late April imaging. Given liver mets and rising CA19.9 levels, Whipple surgery is no longer an option and prognosis is poor (life expectancy 4-6 months). (Note that tumor size per several CT scans and metabolic activity of tumor per several PET scans has been relatively constant during past 11 months.) I was half heartedly offered renewed treatment with Gemcitabine/Abraxane as the only chemo treatment, but it was ineffective in the past as CA19.9 levels rose while receiving a couple of cycles of it in September-October of last year. I am currently exploring alternative/integrative treatment options and my wife came across the article cited above, thus, my question above regarding the article and the possibility of renewing Gemcitabine chemo treatment with Berberine added.

Thanks in advance for any comments you may have.... and thanks also for your longstanding and ongoing engagement on Mayo Connect. Your informed commentary has been helpful and valued by me and others.

Of course, if anyone else cares to weigh in, please do so. Thank you all.

Warren in Alaska

Hello Warren,

Thanks for details on your case, questions and the publication on the Berberine study for addressing chemo resistance. The graphics and dot plots in Figure 3 of the flow Cytometry data showing cell cycle arrest in S and G2/M phases and the dot plots showing inducement of apoptosis is some of the same technique did in the research lab using a very sophisticated Flow Cytometry instrument to generate that type of data.

After Whipple, it was unbeknownst to me that metastatic disease was detected in a post-surgical CT done 7 days after. All that was communicated to me in 2012 was no intestinal blockage. The tumor board met and based on their awareness, decided on palliative care only with Gemzar. Abraxane was not yet FDA approved until 2013. My liver did not make the enzyme necessary to metabolize Gemzar so it was ineffective right from the first cycle.

When the first treatment CT scan was done showing significant growth of many tumors in the liver, Inagain advocated for Folfirinox as I did before chemo was ever started but my willingness to do it was apparently not communicated to the tumor board. As soon as the CT results were available the very morning I was about to receive another chemo cycle, Folfirinox was administered and continued for 24 months every 15th with no issues to cause a pause, break or change in treatment.

I happen to know Daniel Von Hoff MD who was the pioneering oncologist that conducted the clinical trials on Gemzar , Gemzar plus Abraxane vs Gemzar and then Gemzar/Abraxance vs. Folfirinox. I will phone him today and ask if he has knowledge of studies using Berberine to enhance Gemzar. I will also be seeing him in early August at a meeting.

Of note is the paper on Berberine is a more recent one published in 2022. It was encouraging that the study used organoids of human cells. Although no results from an in-vivo study on humans, this is as close as it gets in pre-clinical studies after animal models for safety before a phase 1 trial. The question is if a group upas proposed or conducting a phase 1 trial? I’ll do a search on clinicaltrials.gov.

If there is no clinical trail for Berberine, did you have Next Generation Sequencing of a tumor done for molecular profiling? If yes and no mutations or actionable biomarkers were detected, there is a category of clinical trials using small molecule drugs that target the cell energy and respiration cycles or drugs that blocks the cell signaling pathway causing apoptosis and cell death. #PanCan.org can do a search for clinical trials of this nature by calling 877.272.6226, M- F, 7:00am-5:00pm PT.

As for incorporating Berberine into treatment, the first person to consult about taking a supplement with chemotherapy is the hematology/oncology pharmacist. If you are at a comprehensive cancer center for treatment, the infusion clinic likely has a satellite pharmacy staffed with hem/onc pharmacists. If you were not introduced to this important care team member, ask the IV infusion nurse to make the introduction or be on the lookout for a person with a white lab coat delivering the IV infusion bags with the chemo to your cubicle. The next person to discuss assuming there is no interactions with all the medications you may be on is your oncologist. And then for the oncologist and hem/onc pharmacist to consult.

Warren,

I sent you a private message related to the inquiry on Berberine. Please check your connect.mayoclinic account in-box and let me know about the proposal by private message.
Steven

Welcome, @suelan55. Here are couple of discussions that might be relevant for you:
- Switching to chemoradiation (Xeloda + radiation): What to expect?
https://connect.mayoclinic.org/discussion/questions-about-chemo-radiation/

- Whipple procedure: What is the recovery like?
https://connect.mayoclinic.org/discussion/pancreatic-cancer-whipple-procedure/

Or maybe you have some tips to offer in this discussion:
- Anyone have light headedness from chemo (folfirinox)? https://connect.mayoclinic.org/discussion/light-headed-from-chemo/

Got it. Thank you. I'll reply to your private note shortly.

@steffi2, I add my welcome. What have you learned about your treatment plan? Any update?