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Welcome to Live Well with UCI Health.

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My name is Gina Grad.

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I'd like to introduce you

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to Doctor Jennifer Valerin

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Board certified medical oncologist

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who specializes

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in gastrointestinal cancers,

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including pancreatic cancer.

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Doctor Valerin,

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thank you so much for being here.

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We really appreciate it. Thank you for having me.

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So many questions.

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And I know I'm not alone when I say

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that I have lost a very dear person

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in my life to pancreatic cancer,

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and it's so

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I, I'm sure it's not to you,

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but it seems so mysterious to

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so many of us.

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And I know there's been

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just a lot of buzz in general

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about pancreatic cancer lately,

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and a lot of these new opportunities

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still that are going to make things

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better and, and slow down,

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you know,

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the sickness

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and help people faster and live longer.

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And unfortunately,

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that wasn't the case

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with a loved one of mine.

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It just seems like he got a diagnosis

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and then it was done.

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So it was just really, really scary.

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So I would love to know why

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pancreatic cancer is so deadly

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and so difficult to treat.

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My understanding is that

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and please correct me if I'm wrong,

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but that

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we don't screen for it

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as often and it's hard to get to.

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Is that just in my in the right place?

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Am I in the right ballpark? Yeah.

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So I think there's a lot of reasons

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why pancreatic cancer has started

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to be turned out to be

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a really difficult disease to treat.

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Okay.

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You know, so first of all,

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a lot of times

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pancreatic cancer

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patients don't have

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very specific symptoms. Okay.

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So they’ll present for example,

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not necessarily even with abdominal pain,

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but it'll actually be back pain.

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The pancreas is located in the back

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part of the stomach,

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and it rests on a group of nerves.

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And that can actually radiate to the back.

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Okay.

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And so,

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you know, and

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how many Americans out there

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and people around the world

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have back pain, right.

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Everybody. Sure.

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So so I think that's one of the reasons

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why it's difficult to catch early.

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Additionally, more recently

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people have been on a lot of medications,

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the GLP-1 medications to

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to to help them lose weight. Right here.

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And so,

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you know,

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they're trying to

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intentionally lose weight

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and so they kind of,

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you know, misjudge

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what their symptoms are coming from. Got it.

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So I think those are

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some of the things that make it

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a little bit confusing.

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You know,

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also with pancreatic cancer,

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we don't screen

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unless you happen to

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have a family history. Okay.

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So, about 20% of patients,

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maybe 10 to 20% of patients

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will have a hereditary reason

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for their disease. Okay.

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And in those patients

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we do regular screening.

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And we actually have high risk

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pancreatic cancer clinics,

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one of which we do at UCI Health.

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But but aside from those 20%

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or so of patients,

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then we may not necessarily catch this early.

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Okay.

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So I guess what you're saying

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too, like

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everything else, sometimes it's genetic,

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sometimes it seems random to us, but

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we pay special attention

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to the people who have it in the family. Exactly.

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Okay. Because cancer caught early.

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You can flip the actual survival curve.

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Of course. And so we can cure

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a lot more patients

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when they're caught earlier,

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but pancreas cancer also,

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unfortunately happens

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to be one of the diseases

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that spreads early as well.

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So, you know,

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we have data to show that in patients,

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even with stage one's disease,

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about 40% or

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so patients will have

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what's called circulating tumor DNA.

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So they'll have small bits of tumor

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that's circulating throughout the body.

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Even at a very early stage.

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Have you happened to notice.

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And this might just be anecdotal,

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but does it affect women or men

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more or is it pretty equal?

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It affects men more than women.

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But it's it's not like a huge percentage

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like we see in some other cancers.

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Okay, so I told you,

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of course, that I have a very,

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you know, a special connection to this.

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And I understand

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that you have

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a personal connection as well,

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and that it led you to even pursue this

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in the first place.

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And I would love to hear about that.

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Yeah.

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So, you know, when I was,

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I was at college

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at UC San Diego,

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and at the time

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I was actually working in a lab.

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We were working

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at a neuroscience laboratory,

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and I was looking

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at the development of the retina.

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And so I was really nerdy

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and always loved working with my hands.

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And so, you know,

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I was thinking I was going to get a PhD.

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And then when I was in the lab in my

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fourth year of college,

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and then after graduation,

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I was living with

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my aunt up in northern San Diego, and she

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started losing weight.

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And of course, you know,

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she had been trying to lose weight

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for like a decade or two.

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So she was thrilled. She was happy.

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Yeah. Exactly. Don't ask questions.

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Exactly. Right.

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But the weight kept coming off

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and this was like

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20 years ago,

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and she was unfortunately

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diagnosed with pancreatic cancer.

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And I lived with her

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from the day that she was diagnosed

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until the day that she passed away.

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Wow.

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And I remember it at the time, you know,

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frantically looking on clinicaltrials.gov

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we tried

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standard chemotherapy, mushrooms,

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you know, electromagnetic fields. Wow.

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All those things and nothing worked for her.

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And she passed away

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and she, you know,

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looking on clinicaltrials.gov,

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she really had no options for her.

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And so I decided that I was going

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to instead change my career,

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go into medicine,

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become an oncologist,

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and specifically treat pancreatic cancer.

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And that never changed.

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Wow.

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And, you know,

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I decided

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with, you know, like,

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now we're seeing all these amazing

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breakthroughs and medications

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and things

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that I wanted to be a part of the change

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and to bring novel therapies

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to pancreatic cancer patients.

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Wow.

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What what an unbelievable story.

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I mean, for most of us,

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we think like,

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you know,

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and I just think about that person

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every day. Anyway, but you changed

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your entire life's purpose

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to help other people.

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So thank you

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on behalf of everyone affected by this.

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It's really amazing.

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You know, like,

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I breathe and I sleep and I,

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you know,

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think all the time

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about pancreatic cancer,

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which is hence the purple hair.

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Oh, okay.

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This is the pancreatic cancer color.

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I am so glad you addressed that

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because I was like, when do I get to ask

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about her amazing hair?

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It is.

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It is quite lovely. Thank you.

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So where have we been

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in the field of pancreatic cancer

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and its treatments?

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And what seems to be our limitations?

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What are our successes?

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Where are we?

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More recently,

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I'm sure that everybody's

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heard in the news.

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We've had some really amazing

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breakthroughs in the field.

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And honestly,

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I think that, you know,

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the changes that we've seen in the past,

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like five years

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or so

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have been bigger leaps

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than we've had in decades.

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And, you know,

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prior to this,

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we were really only treating

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with chemotherapy. Right.

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But more recently,

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there's been some novel medications

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or new medications

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that are coming down the pipeline.

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They target a molecule called KRAS

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K-R-A-S. And KRAS, we believe

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It's one of those molecules

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that is always on in pancreas cancer.

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Okay.

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So about 90% of pancreas

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cancer

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patients are going to

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actually have a mutation in KRAS

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that causes it to continue

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to tell the cells to grow and divide.

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Okay.

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And so, you know,

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with KRAS inhibitors

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it's just totally blown up in the field.

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Wow.

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So now we're able to target

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the one thing that is making this go

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so out of control

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that we can't catch up with it. Absolutely.

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That's incredible.

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And how did we why don't I take credit.

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How did we discover this?

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When did this happen?

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So it's kind of

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been a while in the making.

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So there was initially in the 80s,

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a scientist named Channing Der

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who ended up finding

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that KRAS was a molecule

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that was important in pancreas cancer.

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And then more recently,

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there was a doc at UC San Francisco,

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one of our sister institutions,

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that founded a special binding pocket

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in KRAS that he was able to drug.

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Oh that's incredible.

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And so we used to believe that KRAS

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was essentially undruggable, just based on

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kind of the way

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that the

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the molecule sits, that it's

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a very flat molecule.

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And then more recently

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we've been able to actually

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drug this, this, this target,

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but actually do it with a pill.

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that's so amazing.

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I mean,

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everyone always says,

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I just wish

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there was a magic pill for feeling

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like, well, now there's a magic pill.

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Are we still in the research stage?

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Are we giving these to patients,

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you know,

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and just trying it

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and seeing what happens? Where are we?

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Yeah.

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So, you know, actually at UCI Health.

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we were some of

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the original investigators

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with these medications. Okay.

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We ran the phase one

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and phase two clinical trials.

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We're using it in

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different settings at this point.

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So right now, for example,

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I have a trial where

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we're treating patients

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with the molecule by itself as a pill,

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as a first treatment

00:08:45:17 - 00:08:47:23
for pancreas cancer rather than trying

00:08:47:23 - 00:08:49:08
chemotherapy first.

00:08:49:08 - 00:08:50:08
So right now

00:08:50:08 - 00:08:52:22
we have almost 20 patients

00:08:52:22 - 00:08:54:16
that are on the medication.

00:08:54:16 - 00:08:56:10
This in the second line

00:08:56:10 - 00:08:58:07
has actually moved on from work

00:08:58:07 - 00:08:59:03
that we did here

00:08:59:03 - 00:09:00:20
in the first and second line

00:09:00:20 - 00:09:01:09
or sorry,

00:09:01:09 - 00:09:03:07
first and second phase trials

00:09:03:07 - 00:09:05:01
to a phase three trial

00:09:05:01 - 00:09:06:09
that's going to

00:09:06:09 - 00:09:08:18
be coming out with all the formal data

00:09:08:18 - 00:09:10:09
coming up at our national conference.

00:09:10:09 - 00:09:12:03
That's awesome. Yes.

00:09:12:03 - 00:09:13:13
I'm really curious to

00:09:13:13 - 00:09:15:05
and I imagine something that has been

00:09:15:05 - 00:09:16:18
so historically aggressive,

00:09:16:18 - 00:09:18:04
like pancreatic cancer,

00:09:18:04 - 00:09:19:14
you know, people I would imagine

00:09:19:14 - 00:09:20:22
don't have to think that hard

00:09:20:22 - 00:09:22:05
to want to give it a try.

00:09:22:05 - 00:09:23:20
But when you're

00:09:23:20 - 00:09:25:16
recruiting, for lack of a better word,

00:09:25:16 - 00:09:26:14
I don't know how this works,

00:09:26:14 - 00:09:28:06
but when you're asking a patient

00:09:28:06 - 00:09:31:08
to do a trial, in your experience,

00:09:31:08 - 00:09:32:09
are they pretty skittish

00:09:32:09 - 00:09:32:22
or are they just like,

00:09:32:22 - 00:09:33:14
yes, whatever

00:09:33:14 - 00:09:35:03
the newest thing is, I want it?

00:09:35:03 - 00:09:35:11
You know,

00:09:35:11 - 00:09:37:16
it kind of depends on the setting, right?

00:09:37:16 - 00:09:39:20
So in pancreas cancer,

00:09:39:20 - 00:09:42:09
I feel like I have it a little bit easier

00:09:42:09 - 00:09:44:04
when I'm trying to talk to patients

00:09:44:04 - 00:09:45:10
about clinical trials,

00:09:45:10 - 00:09:46:16
because everybody knows

00:09:46:16 - 00:09:48:12
what a deadly disease this is. Right.

00:09:48:12 - 00:09:49:14
So as of now,

00:09:49:14 - 00:09:52:21
we only have a 13% five year survival.

00:09:52:21 - 00:09:54:21
And I think that that's really going to

00:09:54:21 - 00:09:57:11
change over the next 5 to 10 years.

00:09:57:11 - 00:09:58:22
This drug is likely going to be

00:09:58:22 - 00:09:59:20
FDA approved.

00:09:59:20 - 00:10:01:22
I think it's the tip of the iceberg.

00:10:01:22 - 00:10:03:02
We're doing all sorts

00:10:03:02 - 00:10:04:07
of really interesting

00:10:04:07 - 00:10:05:18
studies here at UCI

00:10:05:18 - 00:10:07:09
and kind of adding on

00:10:07:09 - 00:10:07:16
to what

00:10:07:16 - 00:10:09:18
we've already accomplished

00:10:09:18 - 00:10:10:16
and what we've already seen

00:10:10:16 - 00:10:12:02
with these medications.

00:10:12:02 - 00:10:13:11
And so,

00:10:13:11 - 00:10:15:01
you know, patients sometimes,

00:10:15:01 - 00:10:16:10
of course, are apprehensive

00:10:16:10 - 00:10:17:14
when they say, you know,

00:10:17:14 - 00:10:18:05
this is something

00:10:18:05 - 00:10:19:07
that's never been tried.

00:10:19:07 - 00:10:20:15
And... Of course...

00:10:20:15 - 00:10:22:04
but for the most part,

00:10:22:04 - 00:10:23:20
and because I do believe

00:10:23:20 - 00:10:25:06
in clinical research

00:10:25:06 - 00:10:27:09
and I do believe in pushing,

00:10:27:09 - 00:10:29:16
you know, the envelope and giving,

00:10:29:16 - 00:10:30:15
you know, patients

00:10:30:15 - 00:10:32:03
all of the best options

00:10:32:03 - 00:10:33:13
that they have out there.

00:10:33:13 - 00:10:34:08
Then it's, you know,

00:10:34:08 - 00:10:35:21
it's an honest conversation

00:10:35:21 - 00:10:37:08
about how I feel

00:10:37:08 - 00:10:39:11
and what I recommend for people.

00:10:39:11 - 00:10:40:07
Well, of course,

00:10:40:07 - 00:10:41:19
we all know what the side effect

00:10:41:19 - 00:10:44:05
of not treating it is, but I'm curious

00:10:44:05 - 00:10:45:07
what the side effects are

00:10:45:07 - 00:10:46:10
from this medication

00:10:46:10 - 00:10:47:12
and what people can expect

00:10:47:12 - 00:10:48:14
when they take it.

00:10:48:14 - 00:10:49:02
Yeah.

00:10:49:02 - 00:10:49:07
You know,

00:10:49:07 - 00:10:50:19
I think that a lot of people

00:10:50:19 - 00:10:52:03
have already seen on TV

00:10:52:03 - 00:10:53:02
the former senator

00:10:53:02 - 00:10:54:13
who was treated with this medicine

00:10:54:13 - 00:10:55:04
and he had,

00:10:55:04 - 00:10:57:01
you know, the bloody rash down his face

00:10:57:01 - 00:10:59:00
and whatnot. That happens.

00:10:59:00 - 00:11:01:04
You know, a rash is very common, happens

00:11:01:04 - 00:11:03:12
in about maybe 90% of people or so. Okay.

00:11:03:12 - 00:11:05:22
So it’s just to be expected. It’s to be expected.

00:11:05:22 - 00:11:07:20
But the very severe rash happens

00:11:07:20 - 00:11:09:23
in maybe about 10% of people. Okay.

00:11:09:23 - 00:11:12:17
And so I think that one of the things

00:11:12:17 - 00:11:14:13
that we're also working with

00:11:14:13 - 00:11:15:22
here is we work very closely

00:11:15:22 - 00:11:17:11
with our dermatology colleagues.

00:11:17:11 - 00:11:19:03
Oh, that makes sense. And we’ve come up with some ideas

00:11:19:03 - 00:11:22:09
with some ideas about how to best manage these,

00:11:22:09 - 00:11:22:16
you know,

00:11:22:16 - 00:11:23:15
these side effects

00:11:23:15 - 00:11:25:10
so that we can keep patients

00:11:25:10 - 00:11:26:16
on the medications

00:11:26:16 - 00:11:27:19
for as long as they can

00:11:27:19 - 00:11:28:17
and to have benefit

00:11:28:17 - 00:11:30:00
for as long as they want.

00:11:30:00 - 00:11:32:22
That's so wonderful because I think and

00:11:32:22 - 00:11:33:11
I mean,

00:11:33:11 - 00:11:34:16
I think I'm pretty jaded,

00:11:34:16 - 00:11:35:23
but I think a lot of people are.

00:11:35:23 - 00:11:37:17
So I think I speak for a lot of people

00:11:37:17 - 00:11:40:19
when I say it's it's so refreshing

00:11:40:20 - 00:11:41:18
to hear you say like,

00:11:41:18 - 00:11:42:06
oh, we're working

00:11:42:06 - 00:11:43:13
hand in hand with dermatology.

00:11:43:13 - 00:11:45:07
Because what I would imagine

00:11:45:07 - 00:11:47:23
most people would say is, you know what?

00:11:47:23 - 00:11:48:21
You're alive.

00:11:48:21 - 00:11:49:23
You should be grateful.

00:11:49:23 - 00:11:50:17
There's the door.

00:11:50:17 - 00:11:51:11
And again,

00:11:51:11 - 00:11:52:22
I'm being a little facetious,

00:11:52:22 - 00:11:54:18
but to say we understand

00:11:54:18 - 00:11:56:12
that rashes are quite unpleasant

00:11:56:12 - 00:11:58:01
and we will help address that too.

00:11:58:01 - 00:11:59:05
It's just really it's

00:11:59:05 - 00:12:00:13
just it's refreshing.

00:12:00:13 - 00:12:01:10
Yeah. And, you know,

00:12:01:10 - 00:12:03:23
I mean, the thing is, in the end,

00:12:03:23 - 00:12:04:21
and this is what I always

00:12:04:21 - 00:12:06:00
tell my patients,

00:12:06:00 - 00:12:08:16
It’s your body. It’s not mine. Right. Right.

00:12:08:16 - 00:12:11:22
And so I can't be the only one who's okay

00:12:11:22 - 00:12:13:18
with the side effects that they have. Right.

00:12:13:18 - 00:12:14:03
I mean,

00:12:14:03 - 00:12:14:20
it's not just

00:12:14:20 - 00:12:16:20
rashes. It’s diarrhea or nausea

00:12:16:20 - 00:12:18:03
or vomiting or fatigue,

00:12:18:03 - 00:12:20:04
but it's not the same that we see

00:12:20:04 - 00:12:21:09
with chemotherapy.

00:12:21:09 - 00:12:24:02
That was my question to comparatively

00:12:24:02 - 00:12:26:06
is one harsher than the other.

00:12:26:06 - 00:12:26:16
Yeah.

00:12:26:16 - 00:12:28:04
You know they're just they're different.

00:12:28:04 - 00:12:30:07
I do have so one of my patients,

00:12:30:07 - 00:12:31:01
for example,

00:12:31:01 - 00:12:33:09
she's been on this medication

00:12:33:09 - 00:12:35:04
for about two and a half years.

00:12:35:04 - 00:12:36:17
Wow. She has her ups and downs.

00:12:36:17 - 00:12:38:08
But you know, for the most part

00:12:38:08 - 00:12:39:20
she's living her best life.

00:12:39:20 - 00:12:42:23
And I think that, you know, once

00:12:42:23 - 00:12:45:12
you kind of get this hit the sweet spot

00:12:45:12 - 00:12:47:02
of adjusting the dosage

00:12:47:02 - 00:12:49:18
and making it more tolerable for patients

00:12:49:18 - 00:12:50:22
and addressing

00:12:50:22 - 00:12:53:03
the things that are priorities to them,

00:12:53:03 - 00:12:54:10
then I think that that's

00:12:54:10 - 00:12:55:20
where you know, the,

00:12:55:20 - 00:12:57:01
you know, the beauty of giving

00:12:57:01 - 00:12:58:13
these agents are because,

00:12:58:13 - 00:12:59:07
you know, the other thing

00:12:59:07 - 00:13:00:08
about chemotherapy,

00:13:00:08 - 00:13:01:14
for example, is,

00:13:01:14 - 00:13:01:19
you know,

00:13:01:19 - 00:13:03:04
you're hooked to an infusion

00:13:03:04 - 00:13:04:03
chair, right?

00:13:04:03 - 00:13:05:06
You're hooked to a pump.

00:13:05:06 - 00:13:07:15
For how many hours? Yeah.

00:13:07:15 - 00:13:09:15
Go home with a pump for 48 hours.

00:13:09:15 - 00:13:10:09
And, you know,

00:13:10:09 - 00:13:12:01
they'll feel good for a couple of days,

00:13:12:01 - 00:13:13:14
but then they crash and burn

00:13:13:14 - 00:13:14:12
and they're in bed

00:13:14:12 - 00:13:16:02
for almost 3 or 4 days.

00:13:16:02 - 00:13:16:20
And then,

00:13:16:20 - 00:13:18:07
you know, in a two week cycle,

00:13:18:07 - 00:13:19:13
they come back and repeat.

00:13:19:13 - 00:13:20:00
Right.

00:13:20:00 - 00:13:20:11
With this,

00:13:20:11 - 00:13:21:19
when you have a pill,

00:13:21:19 - 00:13:22:03
you know,

00:13:22:03 - 00:13:23:17
aside from the trial visits

00:13:23:17 - 00:13:25:08
that we have with patients,

00:13:25:08 - 00:13:27:01
you can go on a trip,

00:13:27:01 - 00:13:28:10
you can go to an event,

00:13:28:10 - 00:13:29:00
you can do

00:13:29:00 - 00:13:30:05
the things that you want to do.

00:13:30:05 - 00:13:32:03
It's a game changer. It's a game changer.

00:13:32:03 - 00:13:33:14
And like I said, you know,

00:13:33:14 - 00:13:35:18
it is just the tip of the iceberg

00:13:35:18 - 00:13:37:13
because I think the things that where

00:13:37:13 - 00:13:37:21
we're going

00:13:37:21 - 00:13:39:12
to really make some strides

00:13:39:12 - 00:13:42:02
with these medications are either combining,

00:13:42:02 - 00:13:42:08
you know,

00:13:42:08 - 00:13:44:07
combining them with other,

00:13:44:07 - 00:13:45:16
other novel therapies

00:13:45:16 - 00:13:47:02
to see if we can get

00:13:47:02 - 00:13:48:17
even more lasting effect

00:13:48:17 - 00:13:50:22
or potentially using it

00:13:50:22 - 00:13:52:22
with other modalities of treating.

00:13:52:22 - 00:13:54:08
So like, for example,

00:13:54:08 - 00:13:55:13
we have some studies

00:13:55:13 - 00:13:58:09
where we are doing local therapy

00:13:58:09 - 00:14:00:01
at the level of the blood vessel

00:14:00:01 - 00:14:01:18
to try and free up the,

00:14:01:18 - 00:14:03:11
you know, the blood vessels from cancer

00:14:03:11 - 00:14:04:22
so that we can cut it out.

00:14:04:22 - 00:14:05:19
Oh my goodness.

00:14:05:19 - 00:14:06:18
So I think again.

00:14:06:18 - 00:14:07:18
Like when we're talking.

00:14:07:18 - 00:14:09:08
Because surgery is really the way

00:14:09:08 - 00:14:10:18
that you cure this disease.

00:14:10:18 - 00:14:12:15
So when we're adding these things on

00:14:12:15 - 00:14:14:08
and talking about these other ways

00:14:14:08 - 00:14:15:14
of treating patients,

00:14:15:14 - 00:14:16:19
I think that's where

00:14:16:19 - 00:14:18:12
we're going to really make strides.

00:14:18:12 - 00:14:20:18
You speak so eloquently about this,

00:14:20:18 - 00:14:22:06
and I am going to go

00:14:22:06 - 00:14:24:05
completely the other direction.

00:14:24:05 - 00:14:25:19
I suppose I could Google it,

00:14:25:19 - 00:14:26:17
but when I have an expert

00:14:26:17 - 00:14:27:10
here, I'd rather

00:14:27:10 - 00:14:29:20
just be the dumb one and ask you.

00:14:29:20 - 00:14:31:03
I know you people say like, oh,

00:14:31:03 - 00:14:32:21
you can live with one kidney or oh,

00:14:32:21 - 00:14:34:05
you know, blah blah blah blah.

00:14:34:05 - 00:14:36:08
Why is the pancreas so important?

00:14:36:08 - 00:14:36:13
Like,

00:14:36:13 - 00:14:37:16
why can't we just get rid of it

00:14:37:16 - 00:14:39:02
and be like, oh you're fine.

00:14:39:02 - 00:14:41:03
Yeah, I love that question.

00:14:41:03 - 00:14:43:15
So because I always start my visits with,

00:14:43:15 - 00:14:45:03
you know, what is the pancreas?

00:14:45:03 - 00:14:46:17
Yeah. Where is it in the body.

00:14:46:17 - 00:14:49:04
Why is the pancreas. Absolutely.

00:14:49:04 - 00:14:49:23
And you know, so

00:14:49:23 - 00:14:52:13
it's essentially this fleshy organ

00:14:52:13 - 00:14:54:01
that sits between the stomach

00:14:54:01 - 00:14:55:17
and the small intestine. Okay.

00:14:55:17 - 00:14:57:20
The the underneath the right rib

00:14:57:20 - 00:14:59:14
cage is where your liver sits. Right.

00:14:59:14 - 00:15:01:02
So it’s kind of in that pocket.

00:15:01:02 - 00:15:02:03
That's right there. Okay.

00:15:02:03 - 00:15:04:14
And the function of the pancreas

00:15:04:14 - 00:15:05:14
is a couple of things.

00:15:05:14 - 00:15:06:21
So one is it helps you

00:15:06:21 - 00:15:08:12
with your blood sugar regulation.

00:15:08:12 - 00:15:11:01
So it regulates insulin? Insulin and glucagon...

00:15:11:01 - 00:15:11:10
Okay.

00:15:11:10 - 00:15:13:13
Which makes the blood sugars go up and down.

00:15:13:13 - 00:15:15:04
But it's also very important

00:15:15:04 - 00:15:16:22
for digesting your food.

00:15:16:22 - 00:15:18:14
So anytime that you eat

00:15:18:14 - 00:15:20:13
you release pancreatic enzymes.

00:15:20:13 - 00:15:21:19
That basically helps

00:15:21:19 - 00:15:22:08
the food

00:15:22:08 - 00:15:23:09
be broken down

00:15:23:09 - 00:15:25:04
so that the little micronutrients

00:15:25:04 - 00:15:26:20
can be absorbed into the body,

00:15:26:20 - 00:15:28:17
and so that you don't become deficient

00:15:28:17 - 00:15:30:00
in various different things.

00:15:30:00 - 00:15:31:00
Okay, I might be going

00:15:31:00 - 00:15:33:15
the wrong direction here, but let's say,

00:15:33:15 - 00:15:36:00
would something like a G tube

00:15:36:00 - 00:15:37:04
help in any way?

00:15:37:04 - 00:15:39:09
Or is it not about you eating it,

00:15:39:09 - 00:15:40:05
going through your mouth, down

00:15:40:05 - 00:15:41:08
your esophagus, in your stomach?

00:15:41:08 - 00:15:43:04
It doesn't matter. Yeah.

00:15:43:04 - 00:15:43:19
I mean, so,

00:15:43:19 - 00:15:44:02
you know,

00:15:44:02 - 00:15:46:02
the esophagus goes into the stomach

00:15:46:02 - 00:15:47:19
and then once it hits the c-loop

00:15:47:19 - 00:15:48:14
of the

00:15:48:14 - 00:15:49:23
of the small bowel,

00:15:49:23 - 00:15:51:14
that's where the enzymes

00:15:51:14 - 00:15:53:02
are actually released into the food.

00:15:53:02 - 00:15:55:13
So it's actually almost like past your stomach

00:15:55:13 - 00:15:56:11
at that point. Okay. So that wouldn't make a

00:15:56:11 - 00:15:58:20
a difference... to absorb the nuttrients. I see.

00:15:58:20 - 00:16:01:00
Well so it sounds like there

00:16:01:00 - 00:16:02:16
really are some amazing things

00:16:02:16 - 00:16:03:18
not even just happening right now,

00:16:03:18 - 00:16:05:08
but still on the horizon.

00:16:05:08 - 00:16:08:05
What we know about those so far,

00:16:08:05 - 00:16:09:15
you know, to be determined,

00:16:09:15 - 00:16:11:04
but that you can see

00:16:11:04 - 00:16:13:02
now that we've had this big breakthrough,

00:16:13:02 - 00:16:13:22
it's just building

00:16:13:22 - 00:16:15:11
blocks from here on out.

00:16:15:11 - 00:16:18:10
And we you know, you mentioned

00:16:18:10 - 00:16:19:22
surgery is really the best way

00:16:19:22 - 00:16:21:08
to really cut it out.

00:16:21:08 - 00:16:24:02
But why is the pancreas

00:16:24:02 - 00:16:25:23
so hard to work on.

00:16:25:23 - 00:16:27:09
Yeah, that's a good question.

00:16:27:09 - 00:16:29:01
There's there's several things.

00:16:29:01 - 00:16:30:17
So you know, one thing is,

00:16:30:17 - 00:16:33:05
is that when we see the development

00:16:33:05 - 00:16:34:19
of a pancreas cancer,

00:16:34:19 - 00:16:38:06
it forms what's called like a fibrous rind. Okay.

00:16:38:06 - 00:16:41:09
So it basically almost feels like a rock.

00:16:41:09 - 00:16:43:08
Oh, okay. So even just to stick

00:16:43:08 - 00:16:46:00
a needle in it for a biopsy is difficult.

00:16:46:00 - 00:16:48:05
It's... Okay. It's also connected.

00:16:48:05 - 00:16:48:12
You know,

00:16:48:12 - 00:16:49:18
when you do a surgery,

00:16:49:18 - 00:16:50:12
you want to have

00:16:50:12 - 00:16:52:04
what's called negative margins.

00:16:52:04 - 00:16:54:09
So basically you don't want to cut

00:16:54:09 - 00:16:55:19
halfway into the tumor

00:16:55:19 - 00:16:57:19
because then you're not better off

00:16:57:19 - 00:16:59:13
by taking it out, right? Okay.

00:16:59:13 - 00:17:01:07
And so but because of that,

00:17:01:07 - 00:17:02:11
all of the areas,

00:17:02:11 - 00:17:03:10
as you can imagine,

00:17:03:10 - 00:17:04:07
while it's there in

00:17:04:07 - 00:17:06:03
the stomach, are kind of connected

00:17:06:03 - 00:17:07:18
and touching other places.

00:17:07:18 - 00:17:09:18
So, you know, the main surgery

00:17:09:18 - 00:17:10:07
that we do,

00:17:10:07 - 00:17:10:17
at least

00:17:10:17 - 00:17:12:22
for cancers of the head of the pancreas,

00:17:12:22 - 00:17:14:23
is we do something called the Whipple,

00:17:14:23 - 00:17:16:21
which is where you cut out

00:17:16:21 - 00:17:19:04
part of the stomach, part of the small bowel.

00:17:19:04 - 00:17:20:17
Oh, wow. The pancreas head.

00:17:20:17 - 00:17:21:16
The bile duct,

00:17:21:16 - 00:17:23:18
part of the liver, the gall bladder. And you

00:17:23:18 - 00:17:25:17
basically reroute that all together.

00:17:25:17 - 00:17:28:07
So it is a very morbid procedure,

00:17:28:07 - 00:17:29:05
but it's the way that

00:17:29:05 - 00:17:30:16
we can cure patients.

00:17:30:16 - 00:17:32:12
And so I think if we,

00:17:32:12 - 00:17:34:05
you know, maybe, you know,

00:17:34:05 - 00:17:36:03
ten years, 20 years down the line,

00:17:36:03 - 00:17:38:07
we'll find a better operation for that.

00:17:38:07 - 00:17:39:05
But right now,

00:17:39:05 - 00:17:40:07
what we're trying to do

00:17:40:07 - 00:17:42:22
is make that operation easier,

00:17:42:22 - 00:17:44:19
because when the...

00:17:44:19 - 00:17:46:02
when the cancer is wrapped

00:17:46:02 - 00:17:47:13
around blood supply,

00:17:47:13 - 00:17:49:16
you can't just cut through the major,

00:17:49:16 - 00:17:50:00
you know,

00:17:50:00 - 00:17:52:02
arteries and vessels that are there.

00:17:52:02 - 00:17:53:14
So I think that's one of the things

00:17:53:14 - 00:17:55:02
that makes it so difficult.

00:17:55:02 - 00:17:56:05
And at this point,

00:17:56:05 - 00:17:57:13
we're trying these various

00:17:57:13 - 00:17:59:08
different kind of tricks.

00:17:59:08 - 00:17:59:22
As I said,

00:17:59:22 - 00:18:00:03
you know,

00:18:00:03 - 00:18:01:18
things on clinical trial,

00:18:01:18 - 00:18:03:22
we have this really amazing medication

00:18:03:22 - 00:18:04:19
that we're actually going to

00:18:04:19 - 00:18:05:07
be presenting

00:18:05:07 - 00:18:09:09
where we use a special light therapy.

00:18:09:10 - 00:18:10:20
It's then activated.

00:18:10:20 - 00:18:12:11
And then at the level of the blood

00:18:12:11 - 00:18:13:12
vessel, it

00:18:13:12 - 00:18:15:18
basically causes the cells to die.

00:18:15:18 - 00:18:18:15
And then that frees up the key vessels

00:18:18:15 - 00:18:20:02
in order to cut them out.

00:18:20:02 - 00:18:21:22
So that's called VTP therapy.

00:18:21:22 - 00:18:23:07
It's a photo therapy.

00:18:23:07 - 00:18:24:12
That definitely sounds like

00:18:24:12 - 00:18:25:08
we're living in the future.

00:18:25:08 - 00:18:26:09
That's incredible. I know,

00:18:26:09 - 00:18:27:09
it sounds like Star Wars or something

00:18:27:09 - 00:18:28:21
That's Star Wars, that's lasers.

00:18:28:21 - 00:18:30:07
That's incredible.

00:18:30:07 - 00:18:32:02
And with any luck,

00:18:32:02 - 00:18:33:13
it sounds like we're going

00:18:33:13 - 00:18:34:06
the right direction.

00:18:34:06 - 00:18:35:13
And conceivably

00:18:35:13 - 00:18:37:18
maybe this could be considered

00:18:37:18 - 00:18:38:19
a chronic disease

00:18:38:19 - 00:18:39:13
you can live with

00:18:39:13 - 00:18:41:06
at some point as opposed to a

00:18:41:06 - 00:18:42:15
a death sentence.

00:18:42:15 - 00:18:42:22
Yeah.

00:18:42:22 - 00:18:43:07
You know,

00:18:43:07 - 00:18:45:00
when I speak with my patients,

00:18:45:00 - 00:18:46:10
I try to be,

00:18:46:10 - 00:18:48:09
first of all, realistic, right?

00:18:48:09 - 00:18:50:21
Because again, it's their life, right?

00:18:50:21 - 00:18:53:04
And so we think about, you know,

00:18:53:04 - 00:18:54:07
what are the short

00:18:54:07 - 00:18:55:00
term goals

00:18:55:00 - 00:18:56:21
that patients want to accomplish.

00:18:56:21 - 00:18:58:10
So going to weddings, going

00:18:58:10 - 00:19:00:08
to parties, going on trips

00:19:00:08 - 00:19:02:05
and those things are so important.

00:19:02:05 - 00:19:03:21
But we're also trying to think

00:19:03:21 - 00:19:05:20
about the long term goals for people.

00:19:05:20 - 00:19:07:15
And you know, as of today,

00:19:07:15 - 00:19:09:21
I may not be able to get somebody out to

00:19:09:21 - 00:19:10:16
ten years,

00:19:10:16 - 00:19:13:06
but we're trying to push those numbers.

00:19:13:06 - 00:19:13:15
Yes.

00:19:13:15 - 00:19:15:06
And like I said, this patient of mine

00:19:15:06 - 00:19:16:19
who's already lived for two

00:19:16:19 - 00:19:17:17
and a half years

00:19:17:17 - 00:19:19:01
on this medication,

00:19:19:01 - 00:19:20:09
but three and a half years

00:19:20:09 - 00:19:21:13
with the disease,

00:19:21:13 - 00:19:23:17
I mean, that's incredible. Truly.

00:19:23:17 - 00:19:25:13
I think that, you know, again,

00:19:25:13 - 00:19:26:11
these are the things

00:19:26:11 - 00:19:27:22
that we're trying to push for

00:19:27:22 - 00:19:30:01
because months is not enough. Yeah.

00:19:30:01 - 00:19:31:05
And we're really making

00:19:31:05 - 00:19:32:19
a difference. Doctor Valerin.

00:19:32:19 - 00:19:34:11
This is so inspiring.

00:19:34:11 - 00:19:35:03
And just

00:19:35:03 - 00:19:36:21
I know it’s going to give so many people

00:19:36:21 - 00:19:39:05
so much hope. Thank you for what you do.

00:19:39:05 - 00:19:41:04
Thank you for spending time with us.

00:19:41:04 - 00:19:43:08
Thank you for not making me feel

00:19:43:08 - 00:19:45:03
like the dumbest person on Earth,

00:19:45:03 - 00:19:46:13
because I didn't know

00:19:46:13 - 00:19:48:06
exactly what the pancreas did.

00:19:48:06 - 00:19:49:15
Just thank you for your time.

00:19:49:15 - 00:19:51:11
This is really, really exciting.

00:19:51:11 - 00:19:52:21
Thank you so much for having me,

00:19:52:21 - 00:19:54:06
and I'm just so excited

00:19:54:06 - 00:19:55:13
to see what's coming out next.

00:19:55:13 - 00:19:57:00
Us too. Thank you.