Our Bold Goal for the Pancreatic Cancer Survival Rate - Cassadie Moravek

[MUSIC PLAYING]

HANNAH LIPPITT: Hello

and welcome to the Totally Clinical podcast brought to you by Teckro. Totally Clinical is a deep dive into the freshest trends, big-time challenges and most excellent triumphs of clinical trials. I'm Hannah, your host. Join me as I chat with industry experts, trailblazers, thought leaders and, most importantly, the people benefiting from clinical research. So, tune in, settle back and don't touch that dial. It's time to get Totally Clinical.

[MUSIC PLAYING]

HANNAH LIPPITT: Joining me this week is Cassadie Moravek, who is Associate Director of clinical trial initiatives at pancreatic Cancer Action network, a nonprofit patient advocacy organization in the United States. The network works closely with grassroots advocates to increase funding, covering all areas from early detection to new approaches like cutting-edge genetic and biomarker treatment options.

During the podcast, we will discuss whether you should get genetic testing if you have a family member diagnosed with pancreatic cancer, the future survival rate and the merits of online direct to consumer genetic tests. Cassidie, could you start by telling the listeners more about what inspired you to get involved with the Pancreatic Cancer Action network?

CASSADIE MORAVEK: I joined the organization just over 12 years ago. I had my degree in biology and was really looking into how to impact patients with cancer. Of course, everyone throughout the world at this point has been touched in their family by somebody with cancer, and so I really wanted to figure out how I can get involved and help patients through their diagnosis and through their journey. And that's where I found the Pancreatic Cancer Action Network and I actually started in our patient services call center.

So I was talking to patients and caregivers and health care professionals providing information on pancreatic cancer, including clinical trials and their testing options, which 10 years ago were not as many as there are today, so we've definitely made great strides over the last 10 to 12 years in that area. And then I went on to manage that team, really overseeing our resources and our clinical trial finder or know your tumor service, our patient registry.

And then just recently have transitioned over to our clinical trial operations team, really working on our precision promise platform trials. So, it feel like it's so important for people to work together to provide information and resources and hope for patients with cancer, including patients with pancreatic cancer, because there's absolutely hope

out there and there are advances being made in everyone really is working together.

HANNAH LIPPITT: I imagine when patients are first diagnosed, they aren't sure about where to go or who to talk to about next steps. So many people don't realize the options available to them, even though genetic testing has made huge leaps forward in the last few years. How can patients discover this information?

CASSADIE MORAVEK: First and foremost, I would say patients and caregivers can reach out to PanCAN patients services. So we have trained case managers who can provide great information about genetic testing and biomarker testing of tumor tissue and all of those options available for patients. So I would say that's definitely the first step.

I would say a next step is really seeing a specialist who specializes in pancreatic cancer and sees the large number of pancreatic cancer patients. These doctors usually are more familiar with the options available to patients, including genetic testing and biomarker testing, so that's a great step as well. And if someone needs help finding a specialist, the patient services here at PanCAN also has lists of specialists throughout the United States, and we can help find doctors who will specialize in pancreatic cancer.

And just to note, you had mentioned genetic testing has made huge leaps forward, and I would say it definitely has over the past years and per the updated National Comprehensive Cancer Network guidelines – which are really the guidelines that doctors use to diagnose and treat patients with pancreatic cancer – those guidelines have been updated to recommend that all patients diagnosed with pancreatic cancer undergo genetic testing for inherited mutations. So those are the mutations that are passed down from parents to children, and they can cause an increased risk of pancreatic cancer. So that's one thing that the guidelines now recommend. And in addition to determining a person's increased risk for someone who already has pancreatic cancer, it can also help them determine what treatment options they may have. And the guidelines also do include for advanced pancreatic cancer patients – so those patients who have locally advanced disease that isn't able to be removed by surgery or metastatic disease, so disease that has spread to other organs other than the pancreas – but those patients should actually undergo biomarker testing of their tumor tissue to see if there's any specific alterations

in the tumor tissue that may also lead to additional treatment options that they may not otherwise have.

HANNAH LIPPITT: And how can patients access testing?

CASSADIE MORAVEK: Testing is available through a number of different avenues so patients can get it through their institution, through their doctor or their hospital. A patient's hospital may also partner with a testing laboratory to actually complete the testing or the hospital may do the testing themselves, and then finally, there are services available out there like PanCAN patient services. We have a “Know Your Tumor” program where we can actually provide patients access to testing through a certified laboratory to have their tumor tissue tested, as well as some genetic testing as well. So, all of that really leads me to say that there definitely have been huge leaps forward in the past years, and patients may have treatment options available through their doctor or even through clinical trials that are studying specific

biomarkers or alterations that are identified through genetic testing and biomarker testing.

HANNAH LIPPITT: So, if you've lost a family member to pancreatic cancer or have someone in your family recently diagnosed, how accurate and useful is genetic testing and what would be your advice in terms of the process?

CASSADIE MORAVEK: So one thing to note is a pancreatic cancer patient is still living. It's important for them to get the genetic testing to see what mutations may be present in them that could be passed down. So if the patient is still living, that's definitely a first step. And then if there is an identified mutation, then the family members can get testing. However, with this disease, sometimes the patient is no longer living, and especially for people who have lost a loved one, a few years back before genetic testing was normal in pancreatic cancer, we don't have that ability. So for those individuals, it's definitely important to talk to their health care professional and also even seek out the advice and counsel of a genetic counselor.

Genetic counselors can really look at a person's family history of pancreatic cancer, other cancers in the family, and also really just talk to the individual, talk to the person, to determine what they are wanting to get out of the genetic testing for inherited mutations, and also just to understand to help the person understand what the risks and benefits of testing are. Of course, if you find that you have a mutation that increases your risk for pancreatic cancer or other cancers, that of course, gives you the knowledge to be able to then be followed up by surveillance studies. So there are a number of clinical research studies out there to follow patients who have an increased risk based on a genetic mutation.

And there's also just regular care through your doctor, or maybe being followed more closely and being able to look out for the signs and symptoms of pancreatic cancer. So that's definitely a benefit of having the testing. On the flip side, you may also find that you don't have a mutation that is increasing your risk of cancer, which is also helpful to know as well. So, it really is a very personal decision to get genetic testing for inherited cancer risk or inherited mutations, but definitely a conversation that the people should have

with their doctor – with their health care provider – if there is a family history of pancreatic cancer.

HANNAH LIPPITT: So, many of the listeners will have seen genetic tests they can access easily online. What are your thoughts on this?

CASSADIE MORAVEK: Yes, absolutely. There definitely are a number of tests out there these days that are direct to consumer, so you probably see them advertised regularly. And sometimes those tests do test for some genetic mutations associated with cancer risk, but sometimes it's a limited set. And so, it's really important to talk with your clinician, with your doctor and really get a comprehensive genetic testing panel to test for inherited cancer risk that really is going to be more broad and be picking up more of these mutations that may increase a person's risk because some of the direct to consumer tests out there have a lot of offerings,

but they don't cover all of the mutations that have been known to increase cancer risk across the board.

HANNAH LIPPITT: Clinical trials play a huge role when it comes to access to best possible care, where patients can access cutting edge treatments that are critical when it comes to diseases like pancreatic cancer with such low survival rates. What kind of developments have you seen in the types of trials used to treat patients?

CASSADIE MORAVEK: So more and more clinical trials have really moved from being cancer-specific to really being biomarker-specific, so really focusing on specific changes within a patient's body or when it comes to inherited mutations or specific changes within a patient's tumor and really targeting those specific aspects and that really reaches across all cancers. And so that's really where the genetic testing and the biomarker testing really now very much meet up within and intertwine with clinical trials because so many clinical trials now are looking at subsets of patients

based on specific biomarkers or specific mutations that the patient has or that a tumor has.

HANNAH LIPPITT: I know that the Pancreatic Cancer Action Network has tools where patients can locate trials and get access to this type of high-quality care. Can you explain more about this?

CASSADIE MORAVEK: Through patient services we do have our clinical trial database and clinical trial finder, and so patients and caregivers and health care professionals can reach out to our patient services call center. Or they can go to ClinicalTrials.PanCAN.org and to access our clinical trial finder, and there you just provide a few details about the stage and type of pancreatic cancer, previous treatment history and then where you're looking for clinical trials in the US and then you are provided a list of clinical trials that a patient might be eligible for. So, yeah, you can reach out to patient services and get more information about clinical trials and have any of your questions answered about clinical trials because clinical trials really are the way that we're going to advance research and outcomes for pancreatic cancer patients.

So, it's important for patients to know what their options are, and clinical trials really are an option for treatment at any point in the journey. I think many patients feel like they need to wait until they've exhausted any of the treatment options outside of clinical trials before they consider clinical trials. But that's not the case these days. There's actually a number of clinical trials that are looking for patients who have been recently diagnosed, and they're studying new treatments in these patients. So, it's important to reach out to patient services, to your doctor to really discuss clinical trials from the beginning and at any point that you need to make a treatment decision.

And then another thing that I want to mention is we've talked about genetic testing and biomarker testing and our Know Your Tumor precision medicine service does also provide a list of biomarker clinical trials based on a patient's genetic or biomarker testing results. So that's a way to get a slightly more tailored list of clinical trials based on the person's individual tumor

biology or individual biology. So those are some ways that it can help patients find clinical trials.

HANNAH LIPPITT: How do you see genetic testing developing in the future, and what, in your opinion, will be the role of patient advocacy groups?

CASSADIE MORAVEK: Advancements are being made in biomarker testing and genetic testing every day and is learned about patients with pancreatic cancers and the tumors themselves through biomarker and genetic testing. Really, more focus can be put into developing treatments to target these biomarkers and improve patient outcomes, and so the more we learn through biomarker testing, the better the testing gets and the more treatment options we may have available. And right now, through pynchon's know your tumor program, we've actually looked at some of the data that we've collected from over 1,000 patients that we've been able to do genetic testing and biomarker testing on. And currently about 25% of patients with pancreatic cancer that we've tested have what is called an actionable alteration that can be targeted with an existing therapy for cancer. It may not be specific to pancreatic cancer, but it's specific to the biomarker. And so these patients are able to receive treatments with these therapies, which is really great and they're able to have sometimes better outcomes than traditional chemotherapy and sometimes even fewer side effects. So as more therapies are developed for these additional alterations that are found outside of this 20%, the hope really is that number will grow from 25% and really continue to expand as more therapies are available.

And interestingly, another piece of research that came out of our Know Your Tumor program is that we found that overall survival for patients who had an actual mutation and went on a matched therapy actually had overall survival increase of about one year over patients who didn't go on match therapies or didn't have an actual alteration. So there's definitely room to improve the outcomes here and in pancreatic cancer based on biomarker testing and genetic testing.

And then I think the second part of your question was really what advocacy groups can do? And I think in addition to providing programs like Know Your Tumor and providing awareness about the importance of pancreatic cancer research, I think patient advocacy groups also have a role in continuing to educate patients and health care professionals and the community on the importance of testing both biomarker and genetic testing. And I think another great thing that has brought us together in the pandemic, even more so is the ability to work across different advocacy groups to break down barriers, to access to testing and really making sure that there's consistent testing terminology so that everyone understands what patients are talking about, what doctors are talking about it, that we can all be speaking the same language.

And then ultimately, just ensuring the patients still have access to see a specialist for their disease – so in this case, a doctor who specializes in pancreatic cancer.

HANNAH LIPPITT: In your opinion, will the survival rate of pancreatic cancer considerably improve in the next few years?

CASSADIE MORAVEK: I would absolutely like to hope so. So we've absolutely seen increases over the last few years and advancements in treatment options and genetic testing and biomarker testing continue. And there has been an impact on drug development because of the pandemic, which I think has allowed us to have opportunities we may not have had previously in drug development and be able to learn to think about doing things different and really bringing even more patient centricity to drug development, determining how we can bring clinical trials to patients or closer to patients through telemedicine through decentralized trials. So there's definitely a lot of opportunity that has arisen from the pandemic, even though the pandemic did have maybe a little bit of a slowing effect on drug development in the early days when clinical trials were having to close because of the effects of the pandemic on our health care system.

So I think overall, I see a positive impact from this and hopefully more drug development improvements in the coming years. And I think that with continued advancements, the survival rate for pancreatic cancer will improve, and the Pancreatic Cancer Action Network actually has a goal to drive our five-year survival from 11% to 20% by 2030. So it's definitely an audacious goal but we're really going to tackle this by funding more scientific research by disrupting that traditional pancreatic cancer clinical trials system with our new approach, which is our precision promise platform, clinical trial and also through leading an early detection initiative. So, I

think definitely PanCAN is working to push this forward, and I think the field is as well. So I definitely see hope in improving the survival rate considerably over the next two years.

[MUSIC PLAYING]

HANNAH LIPPITT: Cassadie, thanks so much for coming on the podcast to discuss the critical work you do at the Pancreatic Cancer Action network, and that's your dose of Totally Clinical for all the listeners out there. You can follow tekrar on Twitter. The handle is tekrar official LinkedIn and Facebook and subscribe to our YouTube channel. And, of course, download the Totally Clinical podcast on apple, Spotify and Google. See you on your next visit and remember to bring your friends. Thanks for listening! Goodbye!

[MUSIC PLAYING]