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My little brother, Jim Fetty of Buckhannon, WV, was diagnosed with pancreatic cancer on March 21, 2006, after months of misdiagnosis.  He was just 36 years old.  He passed away just 18 months later on October 4, 2007 at the age of 38.  I made him a promise on that last day that I was going to do do something about this disease because no one else should have to suffer as he did.  I miss him every single day.

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My dad was the healthiest he was in years. We caught his tumor too late, it spread to his liver. As we were living in Maryland, we had one of the best oncology centers located at Johns Hopkins. I remember the doctors clearly saying  they couldn’t do anything for him. Surgery was out of question and because his bilirubin count was so high, if he got chemotherapy, it would kill him. It was extremely aggresive and took his life in just a month from diagnosis. As his oldest son, I had to slowly watch him die while in hospice. I hope no one has to ever witness what I had to. PC can happen to anyone, at anytime. RIP E.J.M 9/3/17

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was diagnosed with this disease on 10.26.2020. At first her PCP thought to believe she had an upper respiratory infection. After continued pain for 2 months she went to the ER and that is when it was discovered.  Within a few days of testing, she was at 

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My mother left this world on March 15, 2021. She was diagnosed with this disease on 10.26.2020. At first her PCP thought to believe she had an upper respiratory infection. After continued pain for 2 months she went to the ER and that is when it was discovered.  Within a few days of testing, she was at a stage 4 Mestastic pancreatic to to the liver. My mother WAS NOT A drinker, smoker, no processed food, and a very active 68 yr old. I was there for every doctor appt, scans, etc. We went to the top cancer clinic in the state of FL and made major changes to lifestyle, diet, etc. I watched this cancer kill my mother slowly everyday. The amt of pain she was in is unbearable to describe. I watched her take her last breath while in hospice care. This cancer has no mercy and will take ones life quickly. My mother kept her faith, believed in God and believed she would go into remission. Cancer does not descrimnate. I really wish early detection was an option so that many lives can be saved.

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I ADVOCATE FOR MY SISTER CINDY

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My dad left this world at the young age of 61 on October 19, 2020. My mom, brother and I do our best to honor him everyday through kindness, music, and advocacy. I am so in awe of the courage and positivity he faced this evil disease with. He spent much of the month before he passed in the hospital unable to eat and in intense pain. The day after he passed, one of the nurses from the oncology floor texted me that they had put up his obituary in the break room. The social worker tried to take off work to come to his funeral. Even in his darkest days, he managed to be a light in the lives of everyone he came into contact with. I miss him so much. I truly believe this cancer only targets the best of people.

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I first did not believe this ugly cancer would destroy my brother! He was always so positive about recovery and his hashtag post on Facebook was #RonNeverGivesUp. He was able to have a successful Whipple surgery and was declared cancer free! Less than 6 months later he was again in a fight for his life. The chemo took him down almost to his death, but he never gave up and refused to let it win!  Less than a year later Mayo told him to prepare himself for the end and call hospice. He still refused to give up! He reluctantly went on hospice care and told us all “there are people who go off hospice and do not die.”  We moved him and his wife to Washington State from Arizona. He immediately went on hospice on his 61st birthday, November 4th. I was next to him when he passed away in November 16, 2020. He never gave up! Even minutes before death he talked to us. He did not want to leave us. Pancreatic cancer is the most brutal cancer I have ever witnessed! No one should have to suffer the pain and horrible death of this nasty cancer! I will not give up advocating for a cure. And I can still say #RonNeverGaveUp.

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My daddy was diagnosed with Pancreatic Cancer in July if 2012. Only one week after he retired @ age 65. He and my mother were looking forward to starting the relaxed season of their lives and enjoy travel the lake and a lot of fishing! In one instant our lives were changed forever! We found ourselves on a desperate struggle for survival. It was a constant battle but we enjoyed every good day we were blessed with for almost 6 years!! When he got his diagnosis the local doctors told us he would not live 3 months, they discouraged us form seeking specialist, they said there was no hope! That was not acceptable for us! However if his family doctor had stayed current on the symptoms of PC and followed the research and recommendations for testing my dads diagnosis might have come 2 years prior, maybe if it had been discovered 2 years prior when he was diagnosed with type 2 diabetes at age 63 with no family history he would have been able to have surgery. Maybe it would not have changed anything. Had we as a family know the symptoms maybe we would have pushed for more testing when he got the diabetes diagnosis! I just can’t stress to people enough how important it is for people to be educated about pancreatic cancer!! Know the signs and symptoms! Get a second and third opinion!!
I was a daddy’s girl, I loved him so much, my heart aches every day to see his sweet face and her his voice! I miss him more today than all the days before since he left us, but not as much as I will miss him all the days that are yet to be!!

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I raise awareness for my mother Sandra. Love you mommy. Rest In Peace. We will continue the fight until there is a cure. 💜

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My mom passed

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I was diagnosed in August of this year at the age of 69.  The tumor was on the head of my pancreas. I had the whipple surgery. It had not spread anywhere in my body and no nodules were involved. My doctor wanted me to have chemo as a precaution but I chose not to have it. I also advocate for my dad. He passed away from stage IV at the age of 72. We miss him to this day!

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My mom was my biggest hero, she passed away in 2018 from this disease. My family and I have been hurting ever since and we will always continue to fight this battle and advocate for her every day. She was a fighter, she loved this organization as it helped with so much so the right thing to do is help others. Give them hope and strength.

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My dad was diagnosed in May of this year. He is still fighting the good fight. I advocate for him. Our family is united together because noone fights alone. 2020 has been a rough year. I pray for everyone who is and has been touched by this cancer.

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My beautiful Mom who lost the battle and gained her wings in 2017.

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My beautiful Mom Anita Gilland who lost her fight June 15, 2019

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My beautiful Mom Anita Gilland who lost her fight June 15, 2019

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I advocate for myself and all the others who have had to fight the big fight against pancreatic cancer. Being diagnosed at age 40, my life has completely changed. 6 months of fulfirinox, the whipple on July 2020, followed by 6 weeks of chemo radiation. This is the first time in 10 months I haven’t had a doctors appt every week. Now to focus on survivorship.

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For my mom that just started chemo today 💜

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I will continue this battle until the end!! 

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I will continue this battle until the end!! 

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I will continue to help in anyway that I can in honor and memory of my amazingly strong and loving Mother -
Diane Valliere March 1961- April 2020.
I am an only child and was raise by my mom and god mom 💟 I am lost without my mom 💔 She was my rock and never let me down, always there when I needed her and never giving up on me.....So now its my turn to continue her battle in honor & love to hopefully one day sooner than later help beat this terribly tragic Pancreatic Cancer Disease and find a cure!!! In your name mom 💟

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This is my friend Joy. We met for the first time as we both attended our first Pancreatic Cancer Action Network meeting. At that time, she was then an 8-year survivor. Joy is now our 15-year Survivor. She and I have become great friends, and I am blessed to be able to witness all that she does. We have traveled in life together as chairpersons, advocates, and always-volunteers. Of the many photos that I have of Joy (I am her self-designated paparazzi), this one shows the influence that she has on our world. As a former cross-country coach, physical education teacher, girl scout leader, jump-rope team captain, and PanCAN chairperson, she rocks us with hope. In all the moments and photos of watching her giving encouragement to others; mischief making; leading us in this battle; and in her own fight; we support and will never stop in our mission to end this cancer. So, in this entry, I honor Joy, my extra reason to #DemandBetter. We need better to bring an early diagnosis tool, a cure, longer lives, and complete survival. There is so much more to do, and "We Believe.”

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Losing my mom has been the hardest thing I’ve ever had to go through. The fact that it could have been preventable with better early detection tools for pancreatic cancer is infuriating. She was going to the doctor with pain for 5 months - AS A CANCER SURVIVOR - before she herself demanded a blood test that would later show cancer antigens and finally prompt her clinical team to scan her. What my mother went through over the next 11 months during her fight with pancreatic cancer was traumatic and something no human should have to suffer through. I promise to never stop fighting to end this horrific disease and demanding adequate research for early detection. I hope I can play a part in saving someone else’s mother 💜

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I think of him every day and miss the laughs we used to share.  In his honor, I promise to WAGE HOPE.  I will continue to fight for early detection, better treatment options,  awareness, and patient/family support.

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I fight to end pancreatic cancer I will always fight in memory of my lovely wife Lisa A Smith. She was diagnosed November 8, 2019 she passed away five months later April 15, 2020. We were together 18 years she fought this cancer to her last breath. She was a strong person and never gave up. We must end pancreatic cancer and all cancers.

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My mom was strong & resilient. I was only 20 years old when I lost her to this disease. She was 43. She died in 38 days. We NEED change 💜

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I advocate for my grandfather, who passed away from pancreatic cancer after battling the disease for 9 months, and for all others, including so many who have faced such a difficult diagnosis.

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Pancreatic cancer took him 83 days after diagnosis in 2002. The only thing that hurts my heart more is knowing his prognosis wouldn't be much better off if he were diagnosed today, 18 years later. Demand better.

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My mom was diagnosed in December 2018 and sadly passed away 4 months later. I never expected that she would not survive- we were so optimistic that she would beat this horrible disease. It is heartbreaking to watch someone you love fight so hard, and lose the battle. We miss her everyday.

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My mother was diagnosed in 2017, 10 days before her retirement gala. It was devastating and we didn’t have time to process the diagnosis. We had to move full speed ahead with research and finding the right cancer treatment center. That was the most difficult time in my life. My mother was so very strong and served her community for years and now she was going to have to fight her biggest battle after fighting for the rights of others for so long. As an only child and her primary caregiver, my heart was broken as I watched my mother gracefully try to push through the illness and treatments while trying to maintain a sense of normalcy by continuing to do the things she enjoyed as much as possible. My mother was on her cancer journey for 1 year and 3 months. My way of trying to turn pain into positivity was to write about about our love story, her cancer journey, and being a caregiver. I wrote, “Caregiving For A Warrior” 💫💜 www.kearniwarren.com but I still miss her terribly. #RevBerniceWarren

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For my husband, Anh Nguyen, and everyone who lost the battle against this disease, for all who are  currently fighting it, and for all those at risk of getting it. Every moment matters. Demand better. 

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For my husband, Anh Nguyen, and everyone who lost the battle against this disease, for all who are  currently fighting it, and for all those at risk of getting it. Every moment matters. Demand better. 

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Advocating for my DAD - Hoeun Chung, FRIEND - Kirk Akahoshi, and the countless others who have been diagnosed and will battle this disease

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Advocating for my DAD - Hoeun Chung, FRIEND - Kirk Akahoshi, and the countless others who have been diagnosed and will battle this disease

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I advocate in the hope that others will never have to experience this loss. WAGE HOPE & DEMAND BETTER 💜

Alice Chung
PanCAN NYC Affiliate Chair

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Advocating for Sang W. and Joe M. and so many diagnosed with pancreatic cancer. Praying and striving for early detection, new and best treatment options for patients and increased survivorship.
Advocating for Sang W. and Joe M. and so many diagnosed with pancreatic cancer. Praying and striving for early detection, new and best treatment options for patients and increased survivorship.
My sister in law, Bev, died in 11 short months, fighting til the end in 2018.  Team B will be in the CO virtual PurpleStride Walk once again next weekend, doing what we can to support PanCAN and patients and families.

ADVOCACY + PanCAN=   
            HOPE

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Help Make A Difference
Help Make A Difference 
My friend’s father pasted away from cancer and we miss him very much! We need to make a difference for future generations!
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For my dear friend Vicki
For my dear friend Vicki
Vicki was diagnosed in June 2019, entered a clinical trial and fought with such heart and bravery.  She died on Jan 1st, 2020 at 63 years young.  I miss her so much.  My friends and I are running a marathon in her honor and to raise funds for PanCan - reading these stories broke my heart but lifted my spirits.  One day we will find a cure. 

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For my dad 💜
For my dad 💜
Advocating on behalf of my dad who died in 2011, just 9 months from diagnosis. I look forward to the day when no other daughter must watch her dad suffer as I did mine. 

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For Dad, our rock, and 2 great-aunts, great-grandmother, and all my family who battled
For Dad, our rock, and 2 great-aunts, great-grandmother, and all my family who battled
Pancreatic cancer runs in my family on my mom's side--two of my grandmother's sisters, her mom, and several other members all passed from pancreatic cancer. Thankfully, my 92yo grandmother and my mom were spared. But we were shocked in June 2012 when my FATHER was diagnosed with Stage IV. There was no possibility for surgery, and after just 4 months, he passed away surrounded by his family. I hope he knows that we are continuing the fight through advocacy--and through my own biomedical 

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Advocating for Sang W. and Joe M. and so many diagnosed with pancreatic cancer. Praying and striving for early detection, new and best treatment options for patients and increased survivorship.

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Advocating for Sang W. and Joe M. and so many diagnosed with pancreatic cancer. Praying and striving for early detection, new and best treatment options for patients and increased survivorship.

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My sister in law, Bev, died in 11 short months, fighting til the end in 2018.  Team B will be in the CO virtual PurpleStride Walk once again next weekend, doing what we can to support PanCAN and patients and families.

ADVOCACY + PanCAN=
HOPE

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My friend’s father pasted away from cancer and we miss him very much! We need to make a difference for future generations!

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Vicki was diagnosed in June 2019, entered a clinical trial and fought with such heart and bravery. She died on Jan 1st, 2020 at 63 years young. I miss her so much. My friends and I are running a marathon in her honor and to raise funds for PanCan - reading these stories broke my heart but lifted my spirits. One day we will find a cure.

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Advocating on behalf of my dad who died in 2011, just 9 months from diagnosis. I look forward to the day when no other daughter must watch her dad suffer as I did mine.

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For Dad, our rock, and 2 great-aunts, great-grandmother, and all my family who battled

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For Dad, our rock, and 2 great-aunts, great-grandmother, and all my family who battled

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Pancreatic cancer runs in my family on my mom's side--two of my grandmother's sisters, her mom, and several other members all passed from pancreatic cancer. Thankfully, my 92yo grandmother and my mom were spared. But we were shocked in June 2012 when my FATHER was diagnosed with Stage IV. There was no possibility for surgery, and after just 4 months, he passed away surrounded by his family. I hope he knows that we are continuing the fight through advocacy--and through my own biomedical research!

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My dad died of pancreatic cancer in 2008. He was fortunate to survive 4.5 years after diagnosis after a whipple surgery, chemo, and radiation. I’m fighting for my dad and all the other souls who are taken too soon from this deadly disease. We need more research to advance knowledge, screening, and treatment so more people can actually say they’re a survivor rather than family/friends of the deceased. 

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My dad died of pancreatic cancer in 2008. He was fortunate to survive 4.5 years after diagnosis after a whipple surgery, chemo, and radiation. I’m fighting for my dad and all the other souls who are taken too soon from this deadly disease. We need more research to advance knowledge, screening, and treatment so more people can actually say they’re a survivor rather than family/friends of the deceased. 

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My Grandpa passed away in January 2018 after being diagnosed with pancreatic cancer in early October 2017. He started chemo in November and was on his last days after the holidays. After he passed, I learned that diabetes is a symptom of this disease and he had been diagnosed with that in May 2017. By the time he was diagnosed, he was already Stage IV. The cancer had taken over his pancreas, liver and some of his kidney. He was already gone then but we had no idea the outcome this cancer causes. Chemo really exhausted him and eventually he said wanted to die. He was tired of fighting within those 2 months. Eventually my Pop got so weak and has already been loaded into an ambulance twice before we decided that it was his time. Somehow, he fought and stayed longer than expected but passed away the 6th day in hospice. I like to think he was comfortable and in peace when he passed. Around the 3rd day, he stopped be coherent but I still held his hand. I didn’t want him to leave. He was only 70.
This is what the disease does. It will take the healthiest of them all away from us due to the lack of early screenings and patient care. These patients deserved better!

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Pancreatic cancer took our amazing mom way too soon! I feel like from the moment she was diagnosed she was fighting for time.  That is completely unacceptable and she deserved better as do so many others! I am the baby of my family, and it hurts my heart everyday that my children have had to grow in a world without their amazing Momo.  They will never experience how big her heart was, or feel the love she would give.  This horrible disease has taken too many loved ones with almost zero time to fight back.  So I continue to fight for her, for those who have fought and those still fighting! #TeamWalkingWithHope #DemandBetter #WageHope

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Polly and I shared a common interest in running. While we ran we shared stories of raising our kids, our families, where to get the best lattes, best burritos, or best merlot. After running, probably 25 - 30 half marathons together, Polly contracted pancreatic cancer. She used to tell me she could run forever but on June 2, 2009 that changed! Now, when I run, I still think about those conversations & miss her so much!

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For my mom & dad.  It took Drs more than 6 months to diagnose my dad, we were told to go home and put his house in order. No one survives. When my mom was diagnosed we were again told to go home and put her house in order. I #WageHope & #DemandBetter so no one else has to hear no one survives, there is no hope, go home and put your house in order.

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My Father Stan and all those lost to Pancreatic Cancer

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My Father Stan and all those lost to Pancreatic Cancer

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Pancreatic cancer took our wonderful Dad Stan away from us far too soon. He didn’t have a fighting chance against this horrible disease, and is missed every day. We will never give up the battle - continuing to honor his memory and fight for those who have also lost loved ones or are facing this merciless disease now. 💜

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Dawniestrong and all Pancreatic Cancer Survivors!

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Dawniestrong and all Pancreatic Cancer Survivors!

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I advocate for myself and anyone facing this horrible disease. I was diagnosed at 53 years old in Dec 2019. I had a Pancreaectomy and Splenectomy in January 2020, 12 rounds of chemo and 28 radiation treatments within the same year. I am now a 1 1/2 year survivor and want so badly to find a cure and early detection so no one ever has to go through this! Its a mean cancer and I'm so afraid of it coming back. We need the funding for research to give us the lives we deserve to have!

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Myself and all pancreatic cancer survivors 

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Myself and all pancreatic cancer survivors 

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I advocate for myself and others facing this devastating disease. I am 67 years old, diagnosed with Pancreatic Cancer in 2015. My treatments included chemotherapy,  next A clinical trial consisting of chemotherapy, radiation therapy and ascorbate  In November of 2015 I had Whipple surgery. Latest scan was NED!  There is great need for funding for testing, therapies and research. Praying for all 🙏🏻

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My sweet father died in 2018 after fighting the battle for 14 months . He was diagnosed at stage 4 and underwent varied chemo and clinical trials that seemed hopeful . His mother died of it and his nephew was diagnosed as well at age 37. We need research and a cure!

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I “Advocate” for my Best Friend and Father, Craig J. Wintle whose strength and courage inspired me to “Take Action for others.” His legacy is carried on through the advocacy efforts done on his behalf for all Pancreatic Cancer patients and families here in our beautiful home state of Utah!

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I attend Advocacy Day every Summer to share the stories of my Dad, my Uncle, and many others who have had an impact on my life that have been affected by this terrible disease.  We advocate so the future doesn't have to face the same devestation we have. -- Alison Lewis, Mission Chair | Phoenix Affiliate

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Our dad was diagnosed in January of 2019, two weeks after retiring as a gastroenterologist. His world came full circle in the worst way and he passed 9 months later. Still feels surreal some days. We created a team and raised money to complete the PanCan walk in DC but are advocating this week instead to contine to raise awareness for more funding in his honor and for all the patients and caregivers and families impacted by pancreatic cancer.

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I advocate for all those daughters & sons who have been dealt with hearing their parents & heroes have been diagnosed with Pancreatic Cancer. We must demand better so other sons & daughters can have more time with their family members. Funding research is necessary & my family & I will continue to honor my moms legacy of having fun & helping others!!

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My dad passed away June 2018, two years ago this Thursday. He fought a brave battle throughout the Whipple surgery and aggressive chemotherapy. He never lost his bright smile, amazing hugs, or iconic dad humor. He past when I was only 14, just over two years after his diagnosis. He was taken way too soon. Since then, advocacy and fundraising have become very important to me. The 5 year survival rate of 10 percent needs to be raised. I am proud to be a teen advocate. We must demand better!

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For my husband.  He was diagnosed in mid 2017, did whipple, chemo, oral chemo, radiation, horrible side effects to deal with, but fought it best he could until he passed away a November of 2019.  It’s a mean cancer, seems the more you fight it the harder it comes back at you.

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My Dad was diagnosed with Stage 3 pancreatic cancer in Dec. 2017, and lived for 10 months before passing away in Oct. 2018. My Dad was an active, positive and all-around great person before this awful cancer took him from us. More funding is greatly needed to fight this cancer! In today's world, with so many advances in science and medicine, it is unacceptable that there is no early detection test, few effective treatments and the survival rate is in the single digits! This is why I advocate! Demand better!!

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My brother in-law Kory

My brother in-law was dx with stage 4 pan can on January of 2019. Since his DX he has always had a sense of humor. ( Hence the picture)But we need more funding to help find a cure for this beast.I will advocate for anybody that is diagnosed with pancreatic cancer.We WILL find a cure! 💜

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For my Dad, John Phillips Jr., who was dignosed with Stage IV pancreatic cancer in 2018. The tumor was too large and positioned to where surgery was not an option. After just 3 short weeks of radiation, and a traumatic trip to the ER, he lost his battle with cancer only TEO months after being diagnosed. THIS is why I advocate for pancreatic cancer research funding, to give patients and families more treatment options and LIFE with their loved ones. 

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For my Dad, John Phillips Jr., who was dignosed with Stage IV pancreatic cancer in 2018. The tumor was too large and positioned to where surgery was not an option. After just 3 short weeks of radiation, and a traumatic trip to the ER, he lost his battle with cancer only TEO months after being diagnosed. THIS is why I advocate for pancreatic cancer research funding, to give patients and families more treatment options and LIFE with their loved ones. 

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I advocate for myself, Lillian Johansen, I'm 60 years old. I was diagnosed March 2017 with stage 4, had Pancreaectomy and Splenectomy in July 2018. Started chemo again Oct 2019 for re-occurrence in the surgical bed.  I want to beat this monster and live my life. 

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I advocate for myself, Lillian Johansen, I'm 60 years old. I was diagnosed March 2017 with stage 4, had Pancreaectomy and Splenectomy in July 2018. Started chemo again Oct 2019 for re-occurrence in the surgical bed.  I want to beat this monster and live my life. 

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For My Husband Jeff who was diagnosed  in Jan   2020.  I will be his advocate and stand for others who are facing pancreatic cancer for  much needed funding for research to find a cure.  Early diagnostic testing and effective treatments to detect and end this disease.

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For My Husband Jeff who was diagnosed  in Jan   2020.  I will be his advocate and stand for others who are facing pancreatic cancer for  much needed funding for research to find a cure.  Early diagnostic testing and effective treatments to detect and end this disease.

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For my husband Magic Mike and the other fighters out there.  

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For my husband Magic Mike and the other fighters out there.  

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Mike was diagnosed in December of 2016. After undergoing the Whipple in January 2017, he received chemo, chemo with radiation, followed by more chemo. At his last scan he was NED. We know how this beast is and that's why we fight for early detection and better treatments for pancreatic cancer.

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My husband and mother died exactly 7 months apart in 2018 . Mom was an 11 1/2 year survivor due to successful Whipple surgery; my healthy fit 66 year old husband was dead exactly 7 weeks after diagnosis. Blood work two months before was clear...he got very tired and then feverish with profuse Perspiration. We had Hospice one week...Beth P., Erie, PA

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Mike & Lupe fellow daredevils, forever engraved in my heart💜

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Memory of my sweet husband! Diagnosed 4/19, died 1/19... battled hard but didn’t have many options ! Died at 61! Family is 😞 

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Memory of my sweet husband! Diagnosed 4/19, died 1/19... battled hard but didn’t have many options ! Died at 61! Family is 😞 

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My brother Mark died Friday, June12, 2020; I will continue to advocate for funding to save others.

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My brother Mark died Friday, June12, 2020; I will continue to advocate for funding to save others.

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My Dad passed away in 2017 and I will continue to call and ask Congress every year for funding until there’s a cure!

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The linked article is my clinical story. I was diagnosed April 27, 2018. So far, I’m NED!

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Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, United States

Department of Pharmacy, Mayo Clinic, Jacksonville, FL, United States

Pharmacogenomic testing may have clinical value in the treatment of patients with gastrointestinal malignancies such as colorectal and pancreatic cancer. These types of cancer are often treated with combination chemotherapy regimens. These regimens can lead to severe adverse effects in patients with diminished drug tolerability potentially due to certain genetic variants in the enzymes involved in the metabolism of the chemotherapies. Genetic variants resulting in decreased enzymatic activity of uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) and dihydropyrimidine dehydrogenase (DPD) are known to increase irinotecan and 5-fluorouracil-related toxicity, respectively. We report a case of a patient with pancreatic adenocarcinoma who was found to be not only homozygous for the allele, but also heterozygous for a DPYD variant through pharmacogenomic testing. Potentially severe adverse effects were prevented in this patient's case by implementing preemptive dose reductions. On the basis of the significant implications of chemotherapy-related toxicity in this and other similar cases, we report on the clinical value of integrating pharmacogenomic testing into clinical practice to allow for preemptive and/or point-of-care dose reductions in patients potentially at risk for increased toxicity. This is even more important in an era where combinatorial triplet chemotherapies are increasingly being used.

Introduction

Pharmacogenomic testing can have significant implications for patients with gastrointestinal cancers by reducing toxicity in combination chemotherapy regimens. Combination regimens with 5-fluorouracil (5-FU), leucovorin, irinotecan, and oxaliplatin, such as FOLFIRINOX for pancreatic cancer or FOLFOXIRI for colorectal cancer, are standard of care being used by many clinicians for patients with advanced or metastatic pancreatic or colorectal cancer with good performance status ( Balaban et al., 2016; Leal et al., 2017). Treatment with irinotecan and 5-FU as single agents or in combination may result in severe adverse effects including severe diarrhea, mucositis, and neutropenia. In the TRIBE trial, the FOLFOXIRI arm was significantly associated with higher incidence of grade 3 or 4 neutropenia (50% vs. 20.5%), diarrhea (18.8% vs. 10.6%), and stomatitis (8.8% vs. 4.3%) when compared with the FOLFIRI plus bevacizumab group ( Loupakis et al., 2014). Similarly, when compared with gemcitabine alone, FOLFORINOX treatment was associated with significantly higher incidences of grade 3 or 4 neutropenia (45.7% vs. 21%), febrile neutropenia (5.4% vs. 1.2%), diarrhea (12.7% vs. 1.8%), and thrombocytopenia (9.1% vs. 3.6%) ( Conroy et al., 2011).

The metabolism of irinotecan involves the inactivation of the active metabolite SN-38 to the pharmacologically inactive SN-38 glucuronide by the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) enzyme in the liver ( Iyer et al., 1998). is a known polymorphism in which there is a (TA) ₇TAA sequence in the promoter region of UGT1A1 instead of (TA) ₆TAA. It has been shown that homozygous and heterozygous patients for exhibit more severe grades of diarrhea and neutropenia as a result of irinotecan-induced toxicity ( Iyer et al., 2002; Liu et al., 2014). Irinotecan is often used in combination with 5-FU, a fluoropyrimidine that is also associated with similar adverse effects. Following administration, more than 80% of 5-FU is inactivated by the enzyme dihydropyrimidine dehydrogenase (DPD) in the liver ( Diasio and Harris, 1989). The activity of DPD has been shown to be reduced in four single nucleotide polymorphisms in DPYD - c.1905 + 1G > A (rs3918290, DPYD ∗2A), c. 1679T > G (rs55886062, DPYD ∗13), c. 2846A > T (rs67376798), and c.1129-5923C > A (rs75017182, c.1236G > A/HapB3) - which have proved to be relevant clinical predictors of fluoropyrimidine-associated toxicity ( Meulendijks et al., 2015).

Although the toxicity-associated effects of decreased enzymatic function caused by the UGT1A1 and DPYD variants have been widely studied, few guidelines have been developed to assist physicians in pharmacogenomic-based dosing of irinotecan, 5-FU, and its oral pro-drug capecitabine in patients at risk ( Hoskins et al., 2007; Ruzzo et al., 2017). Furthermore, there is no consensus on recommendation of upfront UGT1A1 and DPYD genotyping as part of cancer treatment protocols. Despite accumulating evidence that upfront DPYD and UGT1A1 genotyping is feasible and may improve safety of irinotecan and fluoropyrimidine therapy for patients, guidelines for universal pretreatment genotyping in clinical practice have not been established in the United States and so it is not supported by the National Comprehensive Cancer Network Panel at present ( Deenen et al., 2016; Cremolini et al., 2017).

Pharmacogenomic tests are commercially available and may be performed prior to starting chemotherapy. These can be ordered as single gene and/or part of pharmacogenomics panel tests. The test results may help physicians make dosing adjustments in the treatment regimens to increase tolerability. Variability in the few published pharmacogenomics-based dosing guidelines and lack of knowledge about its feasibility and benefits might be reasons why preemptive pharmacogenomic testing has not become common practice.

Herein, we report a case of a patient with pancreatic adenocarcinoma who was found to be a carrier of deleterious polymorphisms in both UGT1A1 and DPYD during our recently implemented preemptive and/or point-of-care pharmacogenomics-based genetic testing platform, placing him at increased risk for chemotherapy-related toxicity.

With respect to preemptive pharmacogenomics testing, at our institution, the two genes can be individually tested through blood tests run at the Mayo Clinic laboratories and/or through our Center of Individualized Medicine (CIM) platform employing the commercially available OneOme RightMed pharmacogenomic comprehensive test, which reports on 23 genes of interest. The feasibility of this, alongside our pilot studies, was reported at the American Society of Clinical Oncology (ASCO) meeting in June 2018 (details noted in section "Discussion").

Case Presentation

A 47-year-old man presented to his local primary care physician with symptoms of diarrhea and clay-colored stools in April 2018. Laboratory studies revealed direct hyperbilirubinemia which prompted further workup. A right upper quadrant ultrasound showed gallbladder sludge and dilation of the common bile duct to 12 mm indicating obstructive jaundice. No intrahepatic ductal dilatation was appreciated. Computed tomography scan of the abdomen showed a mass in the head of the pancreas which was found to measure approximately 2.6 cm × 1.4 cm in subsequent magnetic resonance imaging (MRI) examination. No evidence of metastasis was found. The patient then underwent an endoscopic retrograde cholangiopancreatography and placement of a plastic biliary stent across a focal stricture of the distal common bile duct secondary to the pancreatic head mass. A diagnosis of pancreatic adenocarcinoma was made.

Upon transfer to our institution in May 2018, laboratory workup revealed hyperbilirubinemia and elevated liver enzymes. In response to the hepatic workup abnormalities, we started the patient on a neoadjuvant regimen of FOLFIRINOX with reduced doses of 5-FU and irinotecan plus standard doses of oxaliplatin and leucovorin. In cycle 1, the standard dose of irinotecan (180 mg/m ²) was reduced by 50% and 5-FU was only administered as a bolus due to lack of port in the patient in the first cycle and the hyperbilirubinemia. The patient received full dose of oxaliplatin (85 mg/m ² = 190 mg) and leucovorin (400 mg/m ² = 900 mg) along with the reduced dose of irinotecan (90 mg/m ² = 200 mg) and the 5-FU bolus (400 mg/m ² = 900 mg) on day 1 (Table 1). The dosing adjustments were implemented to prevent potentially serious toxicity-related adverse effects from 5-FU and irinotecan while we awaited the results from the UGT1A1 and DPYD genotyping tests, which we have recently integrated into our clinical practice as a quality improvement initiative. We planned to escalate the chemotherapy regimen to full dose for cycle 2 depending on the results from the genetic tests. Despite the marked dose reductions in cycle 1, blood tests prior to initiation of cycle 2 revealed grade 2 neutropenia with an absolute neutrophil count of 1.17 × 10 ⁹/L.

TABLE 1. Dosing adjustments implemented in the FOLFIRINOX regimen.

Prior to administration of cycle 2 of the dose-adjusted FOLFIRINOX, we received the pharmacogenomic test results, which indicated that the patient is homozygous for the allele and an heterozygous carrier of a DPYD variant identified as c.536dupC, a no-activity allele. The pharmacogenomics findings in our patient guided us to maintain some of the dose reductions alongside further modifications based on pharmacogenomics e-consult. Additionally, given the neutropenia, growth factor support was also added to maintain the curative-intent intensity of neoadjuvant therapy. Adjustments in cycle 2 consisted of the same 50% reduction in the dose of irinotecan and a 75% reduction in the 5-FU dose (600 mg/m ² = 1350 mg administered over 2 days from day 1 to day 2) plus omission of the 5-FU bolus. The patient continued receiving standard doses of oxaliplatin and leucovorin in both cycle 2 and 3. Dosing adjustments from cycle 2 were maintained in cycle 3, except for 5-FU which was given as the bolus dose reduced by only 50% (200 mg/m ² = 450 mg on day 1) and the continuous infusion was escalated to 50% (1200 mg/m ² = 2700 mg administered over 2 days) along with pegfilgrastim support starting in cycle 2. No other dosing modifications or escalations were done in cycles 3-5. There was one admission to the ER for diarrhea during cycle 3 requiring IV fluids. This did not occur in cycles 4 and 5.

Because of the young age of onset of pancreatic adenocarcinoma in the patient and a maternal history of breast cancer with a confirmed RAD51C variant (c.790G > A), we performed comprehensive testing to evaluate the following genes: APC, ATM, BMPR1A, BRCA1, BRCA2, BRIP1, CDH1, CDK4, CDKN2A (p14ARF), CDKN2A (p16INK4a), CHEK2, EPCAM, FANCC, MEN1, MLH1, MSH2, MSH6, NBN, NF1, PALB2, PALLD, PMS2, PTEN, RAD51C, RAD51D, SMAD4, STK11, TP53, TSC1, TSC2, and VHL. Results were negative for all genes that were evaluated.

To date, the patient initially received 5 cycles of neodjuvant FOLFIRINOX. The treatment had been well-tolerated with no evidence of severe adverse effects. At the most recent follow-up, MRI examination showed reduction in the size of the tumor to approximately 1.9 cm × 1.6 cm. Furthermore, serum levels of CA 19-9 have steadily declined (Figure 1). Patient subsequent had the disease resected (R0 resection) and is completing the remainder of the cycles adjuvantly with a plan for a total of 6 months of chemotherapy (12 cycles). Clinical course so far indicates both response to the treatment and tolerability despite the deleterious polymorphisms in UGT1A1 and DPYD and the implemented dose adjustments.

FIGURE 1. Serum levels of CA 19-9.

Discussion

Deficiencies in enzymatic function of UGT1A1 and DPD caused by genetic polymorphisms may result in decreased metabolism of irinotecan and 5-FU, respectively, leading to increased risk for chemotherapy-induced toxicity. A dose-finding and pharmacokinetic study supports a role for genotype-directed dosing of irinotecan without compromising antitumor efficacy in patients receiving lower doses due to their homozygous genotype ( Innocenti et al., 2014). Similarly, evidence from a meta-analysis of several prospective and retrospective cohort studies supports a role for upfront screening for the clinically validated DPYD variants (, c.2846A > T, c.1679T > G, and c.1236G > A/HapB3) followed by dose adjustment to increase safety in variant carriers treated with fluoropyrimidines ( Meulendijks et al., 2015). This need for dose modifications of irinotecan and 5-FU in patients with reduced UGT1A1 and/or DPD activity is recognized by the U.S. Food and Drug Administration, but no specific dose adjustments are recommended in the drug labels on the basis of insufficient data.

Currently, published guidelines to assist clinicians in linking pharmacogenomic testing results to appropriate adjustments in chemotherapy dosing are limited, hence the differences among dosing modifications that have been reported in the literature (Tables 2, 3). Available published recommendations based on systematic literature reviews include guidelines developed by the Clinical Pharmacogenetics Implementation Consortium (CPIC) for DPYD genotyping and fluoropyrimidine dosing and by the Pharmacogenetics Working Group of the Royal Dutch Association for the Advancement of Pharmacy for both UGT1A1 and DPYD genotyping and drug dosing ( Swen et al., 2011; Amstutz et al., 2018). Another set of professional guidelines for irinotecan therapy in patients carrying the deficient allele was developed by the French Group of Clinical Onco-Pharmacology and the National Pharmacogenetics Network ( Etienne-Grimaldi et al., 2015). This group also developed guidelines to recommend UGT1A1 genotyping in patients who are going to receive irinotecan doses of ≥180 mg/m ². Although these guidelines provide information that allows clinicians and pharmacists to interpret the implications of pharmacogenomic testing results, there is considerable heterogeneity among their recommendations.

TABLE 2. Pharmacogenomics-based recommendations for irinotecan dosing adjustments.

TABLE 3. Pharmacogenomics-based recommendations for fluoropyrimidine (i.e., 5-fluorouracil, capecitabine) dosing adjustments.

The importance of research evaluating the feasibility and clinical value of preemptive pharmacogenomic testing is being increasingly recognized. A multicenter clinical trial is currently assessing the impact of pretreatment pharmacogenomic testing and dosing modifications on the incidence of adverse events in patients set to receive one or more of the 42 drugs for which a Dutch Pharmacogenetics Working Group guideline is available ( ClinicalTrials.gov, 2017b; identifier NCT03093818). Another study in an oncology clinic is also assessing the feasibility of implementing preemptive pharmacogenomics testing for colorectal cancer patients ( ClinicalTrials.gov, 2017a; identifier NCT03187184). Interestingly, genotype-guided dosing of irinotecan is also being studied in the context of potential benefit from dose escalations in patients with and genotypes as the approach has already been successfully accomplished in early-phase trials ( Toffoli et al., 2010, 2017). Some of these dose-escalation studies are being conducted in patients receiving modified FOLFIRINOX for advanced gastrointestinal malignancies ( ClinicalTrials.gov, 2018b; identifier NCT01643499) and FOLFIRI plus bevacizumab for metastatic colorectal cancer ( ClinicalTrials.gov, 2018a; identifier: NCT02138617).

Preliminary studies in our practice suggest that pharmacogenomic testing to enable genotype-driven dosing of irinotecan and 5-FU is a feasible strategy to help prevent potentially severe adverse effects from chemotherapy. As exemplified by the case reported here, we have found a higher prevalence of UGT1A1 and DPYD variants in our patient cohort than what is reported in the literature ( Baldeo et al., 2018a). This finding along with our clinical experience with a life-threatening case of 5-FU toxicity prompted us to implement a pharmacogenomics-based genetic testing platform in our practice ( Baldeo et al., 2018b). This pharmacogenomics platform has enabled us to better manage treatment regimens in patients at increased risk through patient-specific medication management consults with pharmacists in our institution ( Hughes et al., 2018). Increased tolerability has been observed in our patients while maintaining treatment efficacy. Detailed analyses on these cohorts of patients as part of a quality improvement project with our center of individualized medicine are ongoing.

Concluding Remarks

UGT1A1 and DPYD genotyping are important tools available today to identify patients at increased risk of chemotherapy-related toxicity prior to starting irinotecan and fluorouracil-based regimens. Our case describes a patient who has been successfully treated with FOLFIRINOX despite having decreased enzymatic activity of both UGT1A1 and DPD and thus being at increased risk for chemotherapy-induced toxicity. With quicker turnaround and reduced costs of these pharmacogenomic tests, our group has shown that integrating preemptive and/or point-of-care usage of this is feasible.

Informed Consent

Written informed consent was obtained from the patients for their anonymized information to be included in this report.

Author Contributions

LV-V wrote the manuscript. CH contributed to editing and approval of the final manuscript. PK contributed the patient data, guided the initial draft, edited, and approved the final manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors are deeply indebted to the Center of Individualized Medicine (CIM) at Mayo Clinic for their constant support and encouragement.

References

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Hughes, C., Baldeo, C., Rodgers, J., Ritter, A., Koep, T., Schnettler, E., et al. (2018). Integrating comprehensive point of care and preemptive pharmacogenomic testing for patients with gastrointestinal malignancies. J. Clin. Oncol. 36(Suppl. 15), e18935. doi: 10.1200/JCO.2018.36.15_suppl.e18935

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PubMed Abstract | Google Scholar

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Clinical Value of Pharmacogenomic Testing in a Patient Receiving FOLFIRINOX for Pancreatic Adenocarcinoma

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Pharmacogenomic testing may have clinical value in the treatment of patients with gastrointestinal malignancies such as colorectal and pancreatic cancer. These types of cancer are often treated with combination chemotherapy regimens. These regimens can lead to severe adverse effects in patients with diminished drug tolerability potentially due to certain genetic variants in the enzymes involved in the metabolism of the chemotherapies.

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12 years ago my wonderful mom, Gigi, was diagnosed with pancreatic cancer at 51 years ago and I was only 24. The doctors did not give her hope, but my mom battled for 11 months. "Be Positive" was our mantra that we had (and a sign we carried) to every doctor's visit, every chemo and radiation treatment, and every procedure and hospital surgery. The night before my mom passed away, the last words she spoke were "I want to bring a victory flag to pancreatic cancer." Even though my mom cannot be with us today, I am dedicated to honoring her memory and dedication to helping others by being a pancreatic cancer advocate in hopes to bring a victory flag to pancreatic cancer. I have attended 11 years of Advocacy Days and will not stop until we find a cure for this deadly disease! I want to bring a victory flag to this disease in honor of my mom and in dedication to all the other wonderful people I have met through the PanCan purple family! Advocacy works and we need to make our voices heard!

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April 3, 2017 I was told that I had Pancreatic Cancer. It was an early detection and I was able to go through chemo for three months, the Whipple Surgery, and another six months of chemo therapy. On Aug. 21, 2020 I will be celebrating my third year of being cancer free. We need to continue to support Pancreatic Research so in the future more patients will have a survival story they can tell their children and grand children. Support Pancreatic Cancer Action Network.

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I am surviving, I was diagnosed 9/15/19.  Fortunately my stage 2 tumor was in the head/neck of my pancreas and I underwent Whipple Surgery 10/3/19.  After 7 Folfirinox chemo treatments, my liver was suffering so we stopped chemo.  So far, I've had 2 clear scans.  I pray to be in the very small group of those whose cancer never returns.  And I pray that the 10% five year survival rate grows to 100%. Thank you PanCAN!

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who succumbed to this dreaded disease just 3 weeks after diagnosis. Her only symptom was a stomach ache. Heartbreaking for so many since she touch so many lives during her short 66 years.

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For My Husband,
I advocate for my husband Jon who bravely fought this beast with such courage and determination. He lost his battle in January after a 28 month journey.  We need to find a cure, no one should ever have to endure such pain and discomfort. I  will continue to fight for him and be his voice in finding a cure. 💜
Tracy Spencer from Wisconsin

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Still fighting, diagnosed in July 2019 with Inoperable Stage IV, spread throughout his lungs, and on chemo every other week since. Given 3-6 months but after 10 months he is still enjoying life with his wife, children and 3 grandchildren although the disease is progressing as it almost always does. A dreadful disease without symptoms - we really need more research. Thank you PanCan for the work you do!

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for Pam, who could not say no in a request to "walk with me." 

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for Pam, who could not say no in a request to "walk with me." 

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I advocate for Pam, who founded this organization, and inspired an army to fight pancreatic cancer. Here she is, walking with Alyson at the Nashville 2013 PurpleStride. "How do you say no to Alyson?" For all of us who advocate. Thank you. We will not stop until there is an early diagnosis tool, and a cure. #StillFightingForAllOfUs

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Choon Kyung Kim, a beautiful, loving, gracious, diligent, wife, mother, grandmother, sister, aunt, friend passed away January 9, 2011 from Stage 4 Pancreatic Cancer.  My loving mother passed away 6 months after she was diagnosed with pancreatic cancer.  She work lovingly, tirelessly, diligently, faithfully for her entire life for her family and friends.  Also, my mom was a quiet and humble woman, but with a resolute and strong internal and spiritual faith!!  Her family and friends misses her dearly and forever!!  I love you Mom!!!!!  Please find a cure for this devastating cancer!! God Bless You!! 

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Choon Kyung Kim, a beautiful, loving, gracious, diligent, wife, mother, grandmother, sister, aunt, friend passed away January 9, 2011 from Stage 4 Pancreatic Cancer.  My loving mother passed away 6 months after she was diagnosed with pancreatic cancer.  She work lovingly, tirelessly, diligently, faithfully for her entire life for her family and friends.  Also, my mom was a quiet and humble woman, but with a resolute and strong internal and spiritual faith!!  Her family and friends misses her dearly and forever!!  I love you Mom!!!!!  Please find a cure for this devastating cancer!! God Bless You!! 

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Love, Ann S. (daughter)

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My honorary "little sis" at her first PurpleStride in 2013, shortly after her Whipple. She fought for 31 months and was one of the loves of my life. I won't stop spreading awareness and fighting for an end to this disease. From her earliest days of gleefully riding on my back, holding my pigtails, as we played "horse," until end end of my life -- I will remember her. She loved deeply, laughed heartily, fought passionately, and raised a beautiful son. Her wish was to end this disease for others, and I carry that wish with me. Still her big sis. Still advocating. Always. I advocate for my "Alleycat."

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Franck Peralta, uncle, son, father, husband

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Franck Peralta, uncle, son, father, husband

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In Mat of 2019 my uncle was diagnosed with PANCA, he lived for 6 months after that. He was a loving father, the best uncle and the best brother anyone could ask. I know what this disease is capable of doing to a human and a family and we need to stop it.

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My husband, Steve Krauss, was diagnosed with stage 4 pancreatic cancer on May 20, 2015. He was given 6-8 months to live. No surgery, just chemo and radiation. Countless trips to the hospital, infinite issues, and always, "we'll figure it out" and "Believe". He fought bravely, always with a smile and a "thumbs up", for 37 months. Miraculously, he had 14 months of NSD, no sign of disease, the tumor disappeared, pulled away from the other organs, and he was free from chemo. And during that time , he LIVED. He and I did many things together, and he figured how precious life and family was. He inspired and touched many people. Unfortunately, the cancer came back to wreak havoc in his peritoneal lining. Those last 7 months were horrific, putting him in the hospital so many times. But he never gave up. In the end, he chose when it was time. My sweet husband passed on June 26, 2018, 25 days after our 32nd anniversary, and 1 day before our daughter's 24th birthday. Steve left me physically at 54 years young. I miss him every day. I wage hope for him. In memory of him, and others we lost to this monster of a disease, to those still in the throws of the battle, and to those yet to be diagnosed. He said to me, "The world HAS to find a cure for this disease." We have to.

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My beautiful sister Mary has been fighting pancreatic cancer since February 2016. She continues to do well with a medication she was given as part of a drug trial. I will be forever grateful to the Pancreatic Cancer Action Network and the work it does that makes it possible for me to still have my sister here for good times and tough times. She has a lot more left to do with her life. She cannot attend PANCAN this year because her husband was recently diagnosed with prostate cancer, but I am sure you will see her next year on the steps of the capital wearing her purple.

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Julio Abadia, Father, Grandfather, Friend...

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Julio Abadia, Father, Grandfather, Friend...

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In January 2018 we lost my incredible Dad. He was diagnosed 58 days beforehand. This was a shock that will never go away. He is who I advocate for. We need a cure or at least earlier detection.

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We lost our 68 year old  father 10 weeks after a stage IV diagnosis in March 2019. Please help give more families hope with earlier detection and more treatment options. This cancer is one of the worst due to late diagnosis and aggressiveness. Pancreatic cancer stole away this amazing man. We miss his smile and humor every day.

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Chrissy died last July. She was 53 years old. Someone needs to find a way to stop this terrible disease ! My heart is broken and I will continue the fight .

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My dad was diagnosed at 44 in 2009, and passed in 2010 four months after diagnosis, when I was eleven. Last year, three of my former teachers were diagnosed. I wage hope for my family and community!

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Diagnosed at 25 y/o. Married a week later. Chemo, Surgery , complications, but lived a full life with the disease for 5 1/2 years. He came to 2 Advocacy Days and we have continued for 10 more so far. We miss you Tyler!

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Thanks to the many dedicated advocates before me, Federal funding leading to Precision Medicine and Targeted Therapy became a reality and resulted in my surviving a diagnosis of Stage IV Pancreatic Acinar Cell Carcinoma. I am now celebrating 8 years of survival and have participated in Advocacy Day since 2017 with the goal of helping patients have better outcomes.

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I have Stage IV pancreatic cancer and I am a survivor for 3 years and 3 months  My tumor biopsy revealed a rare mutation called MSI-H which occurs in only 1-3% of the PC population.  Immunotherapy has given my quality of life back to me despite still having active disease.  I have been on Keytruda for over 2 years with minimal side effects. Survivor and Ambassador for PanCan - Karen Kiernan
#PanCan2020@PanCan

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PanCan-Thank you for your vital work!  I am happy to share my voice in memory of my mom and grandmother...

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PanCan-Thank you for your vital work!  I am happy to share my voice in memory of my mom and grandmother...

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My Dad, Sister, Cousin, an old high school friend, and coworker...

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My Dad, Sister, Cousin, an old high school friend, and coworker...

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My Dad, Jack , was around 58 when he died (1984). I remember going to lunch with him and noticed that his eyes were jaundiced. Unfortunately it turned out to be stage IV cancer of the pancreas. He lived about 18 months after diagnosis without treatment.

16 years after he died my Sister Kathi died (2000) of the same disease. I still have the voice recording when she called wanting to talk to me. She broke the sad news when I called her back.  She died at the age of 45 and left 5 children ranging from the age of 1-21.

10 years after my sister died, I lost my first Cousin Janet to pancreatic cancer (2010).  The last time I saw her was at my sister's funeral. I didn't know Janet well as she was quite a few years older than me.  Her daughter and I are the same age and we keep in touch.

Just this year I learned of the death of an old high school friend , Wes, due to pancreatic cancer. I didn't know he was fighting it until about a week before his passing when his wife posted it on his facebook account. He did not live long after diagnosis so I imagine he didn't want to share it with everyone due to such a grime outcome of getting this disease.  I miss his sense of humor in his facebook posts.

Last year Jeff, an old coworker and friend asked me about pancreatic cancer as he noticed that I am active with PurpleStride. He wanted to know more information as he was just recently diagnosed with the disease.  He has gone through chemo and surgery and is currently recovering. He joined me last year in Dallas for PurpleStride.  I hope he will join me this year as well.

Due to the prevalence of cancer in my family, my brother and I have had genetic testing done and we both are carriers of a defective gene (p16). We have been participating in a long term study with Dr. Brand in Pittsburgh. My brother and I make a yearly trek to have an EUS of the pancreas.

This disease is devastating and needs far more funding that it currently receives.  Please consider donating and advocating for more funding to continue the fight!

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My husband who I lost 11 years ago and  I still miss every.single.day 💜

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My husband who I lost 11 years ago and  I still miss every.single.day 💜

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Since then, also lost his mother and first cousin.  Praying for a cure...

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For my husband and all the people who have lost to this disease, for all who are currently fighting this disease, and for all who are at risk   

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For my husband and all the people who have lost to this disease, for all who are currently fighting this disease, and for all who are at risk   

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We need better to find

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Our dear friend, Roz, died in 2011, two and a half  years after surgery for  pancreatic cancer.
My wife, Beth, has lived with metastatic pancreatic cancer for over four years,. We believe her survival is due to  research on the role of BRCA mutations and treatment that was not available to Roz, and 83 chemotherapy treatments and counting. All who meet and know her are amazed at her positive attitude and care for others.

Ian

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My mom, Linda Platt, was 62 years old when she was diagnosed. She fought for 4 years and 10 months before succumbing to this disease. I have been her voice the past 10 years and will not give up till we find a cure!

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My sister was as vibrant as her multi-colored hair. She was kind and hilarious, smart and caring. She LOVED birthdays. Heather would've turned 40 on Sunday, June 21st, but passed 4.5 years ago. I'm again mourning the missed chance at one of her epic parties and laughing 'til our faces hurt.

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This disease must be stopped. No one else should have to lose their family.

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We lost my dad on July 8th 2015, only 7 months from diagnosis.  No one else should have to lose their rock.  If the last few weeks have taught us anything, it is that advocacy works and this is how change
happens. So proud and honored to stand side by side with you all!

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I was diagnosed with Stage 3 adenocarcinoma of the pancreas in November 2013. After chemo, radiation and surgery, I had a recurrence and was Stage 4 Thanks to a clinical trial, I am lucky to be alive today , without signs of the disease for over 5 years. For the many thousands of patients who are not so lucky, we despera Tended to supp

# data[].attributes.subject
I was diagnosed with Stage 3 adenocarcinoma of the pancreas in November 2013. After chemo, radiation and surgery, I had a recurrence and was Stage 4 Thanks to a clinical trial, I am lucky to be alive today , without signs of the disease for over 5 years. For the many thousands of patients who are not so lucky, we despera Tended to supp