Jobs' death from "complications of pancreatic cancer" hints at the vast complexity of the disease to which he succumbed at the age of 56.
One of the reasons why pancreatic cancer tends to be such a threatening condition is that it is usually only detected until it begins to metastasize and symptoms such as abdominal pain, weight loss, or jaundice appear.
Pancreatic cancer is one of the most aggressively spreading cancers; only about 4% of patients can expect to survive 5 years after their diagnosis. There are about 44,000 new cases diagnosed in the U.S. each year, the vast majority of which are known as adenocarcinomas that attack cells and enzymatic tissues, and release toxins from the body.
Jobs had a rare form of pancreatic cancer, called an islet cell neuroendocrine tumor, which represents just 1% of the total cases of pancreatic cancer diagnosed each year. If diagnosed timely, cancer can be cured by surgery. In fact for neuroendocrine tumors, survival is measured in years, unlike in case of adenocarcinomas in which it is measured in months.
Islet cells that secrete hormones like insulin represent the endocrine part of the pancreas. The cancerous growth in this region, or insulinoma, is considerably slow. After studying the accumulation of genetic mutations in pancreatic cancer tumors, researchers concluded that the disease takes an average of 7 years to form a substantive tumor and closer to a decade to start moving to other organs.
Because it is so different from adenocarcinoma, its aggressively spreading counterpart, a different variety of chemotherapy drugs were used to treat Jobs’ endocrine cancer. Jobs lost his battle with cancer at a time when researchers are constantly pushing the boundaries of treatments, particularly with antitumor agents that can home in on abnormally growing cells with increasing precision. Two new drugs got approved by the FDA after his death :
- Everolimus (sold as Afinitor) works by blocking the mTOR kinase target to alter cellular signaling
- Sunitinib (sold as Sutent) blocks a vascular endothelial growth factor.
However, neither is a cure. Each provides some modest benefit.
Other than surgery and chemotherapeutic drugs, targeted anticancer drugs like erlotinib that specifically target the growth factors on cancer cells are also employed for the treatment of patients with advanced pancreatic cancer. The drug has been shown in trials to improve overall survival by 23% after a year when added to routine chemotherapy. The tumors in patients being treated with erlotinib and chemo also develop more slowly than those in patients receiving chemotherapy alone.
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