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Researchers in Oxford have found that an individual’s immune system – and in particular the presence of T-cells amongst tumour cells – may play an important role in survival after surgery to remove pancreatic cancer.

The study by the University of Oxford’s Department of Oncology and Kennedy Institute, supported by the NIHR Oxford Biomedical Research Centre (BRC), suggests that pancreatic cancer can be categorised in terms of a person’s own immune system. The research also involved colleagues from the universities of Cambridge, Birmingham, Leeds and Maastricht.

The paper, Immuno‐phenotypes of Pancreatic Ductal Adenocarcinoma: Meta‐analysis of transcriptional subtypes, is published in the International Journal of Cancer.

Pancreatic cancer is an aggressive cancer and has limited treatment options. In the early stages of the disease, the tumour often causes few symptoms, which can make it difficult to diagnose. After diagnosis, only 5% of patients survive for five years. Even after an operation in the earliest stages of the disease, only 20% of patients are alive after five years.

The study conducted a meta‐analysis of 353 pancreatic cancer patients from four different studies to derive a classification based on immunological parameters.

It found that if pancreatic cancer patients had higher levels of T-cells – a type of white blood cell that plays a key role in a body’s immune response – in their cancer, they would live longer after an operation.

In contrast, those whose tumour had higher levels of neutrophil cells – a component of the innate immune system – fared worst after surgery.

People who had neither neutrophils nor T cells in their cancer would on average live for a couple of years after an operation before dying from their cancer.

“This is a significant step forward in our understanding of this recalcitrant disease. Prognosis is generally very poor, and we need to find new ways to treat it,” said Dr Shivan Sivakumar, Clinical Lecturer in Oncology at the University of Oxford, who led the study.

“Although our approach will need to be validated in larger studies, it does suggest that we are now able to stratify pancreatic cancer based on how a person’s own immune system reacts to the cancer.

“Existing immune treatments that work well against skin cancer and lung cancer do not work in pancreatic cancer. However, we can now start studying other types of immune therapy, based on the immune cell ‘signatures’ present in a patient’s pancreatic cancer.”

Dr Sivakumar continued: “In Oxford, we are now profiling the immune system in the tumour in great depth, so we can identify every cell present. This would help us decide how and in whom immune-therapy might work best. This will tell us how future clinical trials should be designed.”

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