Johns Hopkins gastrointestinal oncologist Michael Pishvaian and his colleagues are bringing clinical trials and highly specialized care for patients with pancreatic cancer to the greater Washington, D.C., region at Sibley Memorial Hospital.
A leader in biomarker-based treatments for the condition, Pishvaian will continue Johns Hopkins’ ongoing Phase I trial program at Sibley Memorial, where patients with advanced disease who don’t have other treatment options can participate in trials for novel therapies. He leads Sibley’s new Pancreatic Cancer Program, bringing the expertise of the Johns Hopkins Kimmel Cancer Center’s Pancreatic Multidisciplinary Cancer Clinic and the Johns Hopkins Precision Medicine Center of Excellence for Pancreatic Cancer program to the area.
With the expansion of the program to Washington, Sibley recently gained capacity to genetically test pancreatic cancer tumors.
“What we hope is that every pancreatic cancer patient will have their tumors molecularly tested as we build the precision medicine program, and that we’ll be able to tailor therapies based on their results,” he says.
A Breadth of Experience in Caring for Patients with Pancreatic Cancer
Pishvaian splits his time between patient care and research, and his clinical practice is informed by a high volume of patients.
“The average oncologist sees three to five pancreatic cancer patients per year, and I see over 100 annually,” he says. “So there’s definitely a degree of expertise that comes with seeing the same cancer type over and over again and understanding the subtleties of the presentation, the therapeutic options and, ultimately, the outcomes.”
Researching Treatments for Subsets of Patients
Pishvaian’s research focuses on predictive biomarkers in gastrointestinal cancers, with a focus on pancreatic cancer and the DNA damage response (DDR) pathway, which senses, signals and repairs DNA lesions and contains the most common predictive biomarkers in pancreatic cancer. Twenty-five percent of patients with the condition harbor genetic mutations that could lead to a treatment that’s not standard for the disease, Pishvaian says.
His research also focuses on how to enhance the responsiveness and overcome resistance to therapies for patients with DDR mutations. He shares an RO1 with a researcher at another institution with the purpose of investigating resistance to PARP inhibitor-based therapy.
In a study led by Pishvaian and published in Clinical Cancer Research, patients with stage 4 pancreatic cancer were treated with a PARP inhibitor in combination with standard chemotherapy. These patients experienced an increase in survival time — about 14 months, compared with the typical survival time of eight months — and a doubled response rate — nearly 60% compared with the typical 30%.
To further expand biomarker-based therapy, Pishvaian focuses on building biomarker-based clinical trials for small subgroups of patients with pancreatic cancer through a new national clinical research program called Target Panc. The first trial, which will launch soon at Johns Hopkins, looks at patients whose tumors have BRAF V600E mutations, which accounts for about 2% of pancreatic cancer patients.
The program has a number of other trials in the pipeline that Pishvaian hopes to activate this year or early next year.