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Annual Report 2019 : For pancreatic cancer researcher, ending cancer is personal
For pancreatic cancer researcher, ending cancer is personal
After losing her mother to pancreatic cancer at age 55, Florencia McAllister, M.D., is driven to find new ways to treat and diagnose the disease.
Florencia McAllister, M.D., was inspired to become a pancreatic cancer doctor and researcher after her mother and grandfather died from the disease. Photo by Nick de la Torre
Newly graduated from medical school in her native Argentina in 2002, Florencia McAllister, M.D., joined a lab in New Orleans, where she used gene therapy to defend the body against opportunistic fungal and bacterial infections.
After many pioneering findings, McAllister trained to become a gastrointestinal medical oncologist – a highly specialized doctor who treats stomach cancer, liver cancer, bile duct cancer, gallbladder cancer, pancreatic cancer, bowel cancer and esophageal cancer. She thought her days studying bacterial immune response were over.
“I was saying, ‘I’m done with this. I want to go study tumor biology and tumor immunology,’” she recalls.
But McAllister wasn’t done with bacteria.
Microbiome research offers new pancreatic cancer treatment approach
Recently, McAllister, now an assistant professor of Clinical Cancer Prevention, published striking findings in the journal Cell, raising the possibility of transplanting feces from a healthy donor into a pancreatic cancer patient to fight the disease.
McAllister and colleagues reported:
- The rare long-term survivors of pancreatic cancer have a distinctive bacterial signature, or microbiome, on their tumors that is connected to a strong immune response against the cancer.
- Using fecal transplants from these long-term human survivors to alter the tumor microbiome in laboratory mice who had pancreatic cancer greatly prolonged their survival.
“Results of our experiments represent a significant opportunity to improve pancreatic cancer treatment by altering the tumor immune microenvironment,” McAllister says. “There’s promise here, but we have a lot of work ahead.”
A fecal transplant clinical trial is under development and is expected to open in 2020.
Florencia’s a phenomenal physician-scientist who is working on critically important questions.
Mother’s pancreatic cancer treatment inspires her research
McAllister is applying a full-court press to the disease, which took her mother’s life at age 55. In addition to her lab research and mentorship of young scientists, McAllister treats patients and directs MD Anderson’s high-risk pancreatic cancer clinic, devoted to finding ways to catch the disease early when it’s still treatable, or even better, to prevent it outright.
“Florencia’s a phenomenal physician-scientist who is working on critically important questions of pancreatic cancer and how to both treat and prevent it,” says Powel Brown, M.D., Ph.D., chair of Clinical Cancer Prevention.
“Her work fulfills the goal of a physician-scientist – to do discovery research in the lab, have an impactful finding that will eventually lead to treatment and then have the wherewithal to take it to clinical trial.”
Only 20% of pancreatic cancer patients are diagnosed when the disease is still in its early stages and surgery is possible, making survival more likely. Treatment options are few for the 80% whose disease has advanced, with only 5% to 7% surviving to five years.
While surgical patients have better survival – more than 40% of MD Anderson patients who receive chemotherapy before surgery live at least five years – progression can still be swift.
McAllister’s mother had chemotherapy and a surgery known as the Whipple procedure, in which surgeons remove the wide part of the pancreas, the first part of the small intestine, the gall bladder and the bile duct. Those who undergo the operation may have a five-year survival rate of up to 25%.
“I was a postdoc at the University of Pittsburgh when she was diagnosed,” McAllister recalls. “I was in the bed next to her the night before her surgery and during the two weeks of recovery time, writing my papers and grants.”
Despite surgery and chemotherapy, the disease eventually spread to her liver, and McAllister’s mother passed away 16 months after her diagnosis.
“It was very difficult,” McAllister says. “She remains a big motivation for me.”
Early research career
McAllister first became interested in research while studying at the National University of Rosario Medical School in Rosario, Argentina. She landed a research fellowship in the lab of Jay Kolls, M.D., now a professor at Tulane University.
“I had no real research experience, but Jay sort of took a risk,” she says.
She participated in a series of findings about the cytokine interleukin-17, a protein that helps cells “talk” to each other and is especially important in the immune system, and the Th17 CD4 helper T cell, which plays a key role in a healthy immune system’s functioning.
Later, during a research fellowship at Johns Hopkins University, she showed a connection between interleukin-17 and early cellular changes that lead to pancreatic cancer.
Her team noticed Th17 T cells around pancreatic cancer, apparently in response to bacteria, leading McAllister to wonder whether bacteria had a role in cancer and setting her on the path to the microbiome discoveries.
She’s made finding a cure for this terrible disease the central mission of her life.
High-risk pancreatic cancer clinic helps patient with genetic mutations
MD Anderson hired McAllister from Johns Hopkins to continue her research and to develop the high-risk clinic, where first-degree relatives of pancreatic cancer patients can come to be tested for inherited genetic variations that can raise their risk of developing the disease.
All MD Anderson pancreatic cancer patients receive genetic testing. About 10% test positive for risk-raising mutations, which means their close relatives also need testing.
Relatives also are monitored for other risk factors, such as chronic inflammation and cysts in the pancreas. When warranted, imaging is done to screen for cancer.
“Recently, research revealed that new-onset diabetes can be a risk factor in developing pancreatic cancer,” McAllister says. “As a result, lab tests to detect diabetes are now included in high-risk clinic visits.”
The clinic also conducts studies to identify proteins, DNA or other biomarkers that can be tested to confirm the presence or absence of cancer. The goal is to use these biomarkers to identify and treat pre-malignancies, and to develop clinical trials aimed at preventing pancreatic cancer.
Colleagues say McAllister is ideally suited to make progress against the disease.
“Florencia is one of the most creative, compassionate and hard-working physician-scientists I have met,” says Anirban Maitra, M.B.B.S., scientific director of the Sheikh Ahmed Bin Zayed Al Nahyan Center for Pancreatic Cancer Research and co-leader of MD Anderson’s Pancreatic Cancer Moon Shot®. “She’s made finding a cure for this terrible disease the central mission of her life.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
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