By the end of 2019, nearly 57,000 people will be diagnosed with pancreatic cancer (Sheikh, 2019). Of those diagnosed, only one in ten will live longer than five years (Sheikh, 2019). Three-fourths of those diagnosed will live less than a year (Sheikh, 2019). Because it is not usually found until it is stage four, this disease does not have a good prognosis. Surgery alone is not enough to treat the disease, and there is no effective, targeted chemotherapy (Sheikh, 2019). A study published in October 2019 completed groundbreaking research that has the potential for early detection and treatment of pancreatic cancer, as well as other types of malignancies.
Aykut et al. (2019) published their research study that discovered the presence of a fungi mycobiome (fungal community in or around an organism) next to pancreatic ductal adenocarcinoma (PDA) tumors. The specific fungi, Malassezia, was found to travel from the gut to the pancreas. The researchers were able to study both humans and mice with PDA, and both had 3,000 times the normal amount of Malassezia cells when compared to humans and mice without PDA. The writers of this study took the research further, when they ablated the mycobiome in the mice, and the tumors stopped growing. When the Malassezia fungi was reintroduced, the tumors in the mice began to grow once again. (Aykut et al., 2019)
In order to determine how fungi could make it to the pancreas, Aykut et al. (2019) fed mice a species of brewer’s yeast labeled with a green fluorescent protein. The researchers were able to track this particle from the gut, then through the sphincter of Oddi to the pancreas. Different fungi were introduced to the mice, but only the Malassezia resulted in oncogenesis (normal cells transform into cancer cells). Malassezia sounds like it may be a dangerous kind of organism, when it is, in fact, found on the skin and scalp of both animals and humans. It is mostly known to cause dandruff and skin irritation (Sheikh, 2019). The fungi are also found in the gut in inflammatory bowel diseases.
When Aykut et al. (2019) administered an antifungal drug to the mice which successfully caused the fungi to disappear, the tumors stopped developing. This is not the first time researchers believed antifungal drugs could be used as a cancer treatment. A group of anti-cancer researchers from the Repurposing Drugs in Oncology (Ecancer) look for common medicines that can be used as therapies for cancer (Ecancer). One example of their research is the inexpensive drug itraconazole, used for skin and nail fungus, has shown success in the treatment of non-small cell lung cancer and prostate cancer (Ecancer). There are roadblocks in developing new treatments from already established medications, because only the owners of the drug can apply for a new indication for a medication (Ecancer).
In addition to the potential for intervention and prevention of PDA (the presence of Malassezia near the pancreas can indicate the risk of developing PDA), an additional and important scientific realization came from the study by Aykut et al. (2019). Research can now be focused on the microenvironment of cancers and tumors, to see what types of cells are surrounding the cancer that may or may not be causing the cancers to grow and proliferate. Dr. Brian Wolpin, a gastrointestinal cancer researcher in Boston, stated “We have to move from thinking about tumor cells alone to thinking of the whole neighborhood that the tumor lives in,” (Sheikh, 2019). More studies are needed to see if antifungals can be used as treatment, and there will be some red tape while completing these studies. Antifungals are not without side effects, but they do show promise for this deadly disease, as well as other cancers.
Aykut, B., Pushalkar, S., Chen, R., Li, Q., Abengozar, R., Kim, J. I., … Miller, G. (2019). The fungal mycobiome promotes pancreatic oncogenesis via activation of MBL. Nature. doi: 10.1038/s41586-019-1608-2
Ecancer. (2019). Anti-fungal drug shows promise as potential new cancer treatment. Retrieved from https://Ecancer.org/en/news/7202-anti-fungal-drug-shows-promise-as-potential-new-cancer-treatment.
Sheikh, K. (2019, October 3). In the Pancreas, Common Fungi May Drive Cancer. The New York Times. Retrieved from https://www.nytimes.com/2019/10/03/health/pancreatic-cancer-fungi.html