I put them to Dr. Matthew Kulke, director of the carcinoid and neuroendocrine tumor program at the Dana-Farber Cancer Institute. Our conversation is below, but here’s my takeaway:
In fact, there has been very good news in the past year about the rare type of tumor that affected Steve Jobs, a pancreatic neuroendocrine tumor. For the first time in a generation, there are new treatments available, ‘targeted’ therapies that differ from conventional chemotherapy. But like many other forms of cancer, the disease is still not curable once it has spread. So early detection is key, and there’s hope for improved targeted therapies in coming years.
Dr. Matthew Kulke: “I think the main point, and perhaps the good that can come out of all the publicity about Mr. Jobs, is in awareness of these tumors. Not everyone is aware of them, and early diagnosis and awareness could be very helpful in identifying people early, at which time they can still be cured. The other important point is that with recent developments, even for people where they have spread beyond the point where surgery is helpful, there are now effective treatments for the first time in decades.
(Dr. Kulke said he could not discuss Steve Jobs’ treatment specifically.)
There are really two different types of cancer that can arise in the pancreas. The most common is what people know of as pancreatic cancer, and that is quite a challenging disease to treat. What Mr. Jobs had is a more unusual type of cancer, which is a pancreatic neuroendocrine tumor. And these tumors, we think, arise from the islet cells in the pancreas — the cells that make hormones. And they do behave in a different way from the more common type of pancreatic cancer.
They are often somewhat slower-growing. At the same time, at least until very, very recently, there have been very few effective treatments for people where the pancreatic neuroendocrine tumor has spread and metastasized. One of the things that has happened just in the past year is that there were two new targeted therapies approved for pancreatic neuroendocrine tumors. I think they were really the first new treatments for neuroendocrine tumors in the last 30 years. And we’re optimistic that these will at least help people who have metastatic neuroendocrine tumors.
How good are they? Are they like Gleevec (a targeted therapy used in other cancers)?
It’s similar to Gleevec, a similar idea. One is called Sutent, and the other is called Afinitor. They’re still not curative — we have a long way to go — but they can help slow the tumor growth.
And when you say they’re targeted, what do you mean?
They’re not traditional chemotherapy in the way that people think about chemotherapy. They’re pills and they target specific molecules in the cancer cell to slow their growth.
These are drugs that target pathways that are common in many different types of cancer. What’s new is that there has been increasing interest in pancreatic neuroendocrine tumors and they were specifically tested and found to be effective in these tumors. They more than double the time it takes the tumors to grow.
So — was it too late for Steve Jobs? Or even with them, it’s not cure?
I can’t comment directly on his specific case, but it’s really a mixed-news picture: We have some very exciting and effective new drugs to help people who have neuroendocrine tumors. At the same time, there’s still a lot of work to be done to find more effective treatments. As we’ve seen, this is still a fatal disease, even though people can often live for years with it right now.
Can you define what the central challenge is with these particular tumors?
These tumors can often be very difficult to identify at an early stage. But caught at an early stage they can be removed successfully with surgery, people can be cured. But once they have spread beyond the point where surgery can remove all of the tumors, then we focus on treatments that can help slow the tumor growth or shrink the tumors down. We still don’t have systemic treatments that can cure these tumors — and that’s the challenge moving forward.
I think the fact that we have identified targeted treatments that work is very exciting and I hope that it’s only the beginning. I hope that additional targeted therapies are coming and we can get a better understanding of what makes these tumors grow. And we’ll be able to be smarter about how we treat them.