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Shaping the Future of Pancreatic Cancer: Interview with Julie Fleshman
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Released: January 02, 2025

John Marshall
John Marshall, MD
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Shaping the Future of Pancreatic Cancer: Interview with Julie Fleshman

John Marshall, MD: Welcome everybody back to Oncology Unscripted. No script at all on this one. And the person who's joining me right now, really, doesn't need a script because she wrote it. She was the one who really defined, in my opinion, what advocacy is all about. Taking maybe one of the most difficult, if not the most difficult, cancer, inspired by a personal story to change the outcome for people with pancreatic cancer. And I'm proud to say she's my friend, but she's also one of my mentors, as she has shown the way for so many as to how to really move the bar in advocacy.

And this is Julie Fleshman, who is coming to us live and we're so grateful, Julie, for your joining us. So, first, welcome to Oncology Unscripted.

Julie Fleshman: Thank you so much for having me. It's always a pleasure to talk to you and be with you.

John Marshall, MD: You are so awesome. And you know, I think that, but let me start from the beginning, because a lot of people were coming up on a change in our world. And we know that advocacy is a critical component to our success in making advances in healthcare. It's not just handed to us. We have to push the forces around us to make it happen. Maybe give us your quick version of, you know, what inspired you and the value of advocacy in the world of pancreatic cancer.

Julie Fleshman: I have a personal story. 25 years ago, now, my dad was diagnosed with pancreatic cancer. 52 years old. Died four months after diagnosis. And I was devastated, and I didn't understand why there was nothing offered for him. Why were there no options? And about that. At the same time PanCAN was founded and I was lucky and privileged to be hired as the first employee almost 25 years ago.

And I've really just watched, you know, the field, the pancreatic cancer field back then, there was nothing. There was no federal funding. There was no philanthropy. There was nobody studying the disease. There were no resources for patients and families. And you know, I really believe PanCAN has been a catalyst for changing that. And today there is a robust pancreatic cancer research community. And I think a lot of exciting things on the horizon for patients. And so, you know, I believe advocacy being the voice of the patient, not backing down when everyone tells you this isn't the way that we get things done, but it makes the most logical sense for overcoming a hard disease and you keep at it, and you keep chipping at it. and I believe advocacy is what gets us to where we're going and accelerates the rate of progress. And in this case, I think has really helped to build a field that just didn't exist before.

John Marshall, MD: You did all that stuff. Let's talk about the important stuff. Why did you pick purple for the ribbon?

Julie Fleshman: So actually, our founder who lost her mom to pancreatic cancer, her mom's favorite color was purple. That is the story.

John Marshall, MD: I love that.

Julie Fleshman: So yes, so you know, and it was one of the colors not taken, right? You need to have something different than the other cancers, but it is a great color.

John Marshall, MD: But all kidding aside, yeah, I actually have several purple ties now because of the of the purple ribbon. But, but all kidding aside, I mean, you and your team have built an incredible infrastructure, not just a Hill presence and advocacy there. Not only a clinical research infrastructure that we'll talk about in a minute, but also operators standing by patients can call in and get advice about what they should do with your team members. And in fact, I think that feeds back to the practicing clinician, because there's a lot that we don't know that's going on out there, particularly the general oncologist in the world of pancreatic cancer. I'm assuming each one of those was a decision and you needed to have the bandwidth to do it. Like how, how much struggle was that to get all of those resources together?

Julie Fleshman: Yeah, I mean, you looked at and said, Okay, where are the gaps, and 25 years ago, there were a lot of gaps. One of the first and most obvious areas was, you know, when someone is diagnosed with this disease, there's no place to go for information or resources. So, building that patient services program in the early days, you know, was so critically, I believe, important for helping patients be informed so that they can make the right decisions about their care and go in and be an advocate with their, you know, doctor. Just as you said, many physicians don't see hardly any pancreatic cancer patients. And so, to have someone come in and ask you questions about clinical trials, about testing, about these different things, hopefully it will also help educate the health care professionals.

John Marshall, MD: Yeah. And you've given these folks a home, a club, if you will, where they can share thoughts. And I think with our, you know, the bad cancers, there isn't that sort of survivorship that you see in some other cancers. So, you've, you've provided that place where people can interact and teach each other, which to me is just critical.

Julie Fleshman: Everybody needs a cheerleader, right? Whether you're a researcher, a doctor focusing on this tough disease, patients and family, someone who's lost someone. And I think that's what PanCAN does. We rally the troops. We make people feel good about the work that they're doing and that there is hope and that we're going to get there. We just all have to work together to do it.

John Marshall, MD: Yeah, I couldn't agree more. Now, the year ahead, we're all pretty sure that the NIH budget is not going to get bigger. We're panicked that it's going to be significantly smaller. And so, I think about a group like yours that has successfully advocated in DOD budget, negotiations to get pancreas cancer research funded there, there's certainly a high priority around pancreatic cancer in the NIH budget.

What are some of your worries as you look to the year ahead and new administration changes?

Julie Fleshman: Yeah, I was actually just on Capitol Hill last week with Madison Marsh, Miss America 2024, who lost her mom to pancreatic cancer. And so, she's been using her platform to talk about the disease. So, she and I were up on the Hill together and talking about increasing the DOD line item for pancreatic cancer research, and just trying to understand the current environment. And definitely what we heard is most likely it will be flat funding. There probably will not be any increases. And I think there is just a lot of concern about what's going to happen to these agencies and what could this look like. So, PanCAN along with the other cancer advocacy organizations are going to have to stay on top of it. I think the good news is that usually health related problems do better during change like this. And so, let's hope that's the case, but this will be a time where the voice of the patient, the voice of advocates is going to be extremely important.

John Marshall, MD: Let me kind of drill down on something you and your team were clearly setting those standards when you develop the concept around Precision Promise. This was an understanding that molecular abnormalities occur. There are different ones in different patients. We have targeted therapies. Could we drive progress in pancreatic cancer through that? And you, a lot of work, a lot of investment, a lot of science went into this, but it didn't turn out the way you want to maybe reflect a little bit about that and that experience for others, because, you know, for me personally, I think it's exactly the right way to go. And lessons we could share for others trying to do this and other diseases.

Julie Fleshman: Yeah. So, Precision Promise was an adaptive clinical trial platform. And so, you know, basically the goal behind it was that you could develop a drug with fewer patients, less cost, less time, a way to accelerate new treatments for patients. All of that's true. And I think we learned a lot about that sort of process, and does this platform concept work? And I think the answer is yes. However, financially, in order to make it financially work, you have to have constantly have new drugs coming into the pipeline on the platform. And that was the part that turned out to be the challenge. Part of that was, you know you were convincing a pharmaceutical company or a biotech company to develop their drug, that PanCAN was going to develop their drug, they were going to lose control. So that proved to be an obstacle. The pharma and biotech companies, you know, changed their priorities and their strategies. And so maybe at one point they were developing this drug in pancreatic cancer and six months later they were deprioritizing the asset. And so all of those things became challenging.

We also had, you know, the last couple of years it's better today, but the last couple of years, I mean the funding for biotech, you know, really dried up. I still think many of them are challenged and so there wasn't even funding to do something even like this that would be less expensive. So, with all of those things, it became a financial risk for PanCAN was the bottom line.

The trial will go on. another organization that is going to launch a new,   you know, basically Precision Promise version 2.0 and learn from all the things that PanCAN learned over the last, you know four years. And, you know, some people have said it was before its time, you know, now with there's so much excitement around drug development and targeting KRAS and all of these things that maybe, you know, if we were launching it today, it would be a different story. We launched it in 2020 in the middle of COVID. It was, you know, couldn't have been a worse time to be launching a big, you know, basically phase three clinical trial for an organization like us that had never operated one before. So, you know, we didn't have everything working with us, we did this, but we certainly learned a lot.

And I think, you know, the investigators that were a part of the network and the sites that were running Precision Promise, really, that part ended up being pretty amazing. That network, and the camaraderie and the sharing and the learnings. And you know, I think that those things will continue far beyond.

John Marshall, MD: Yeah, no, I totally agree with you. You know, we just held here at Georgetown at the Reusch Center, a think tank around pancreatic cancer. And we invited a bunch of very smart people, some of the smartest people in our country around this disease who've made a lot of progress. And the whole point of the think tank was to say, why haven't we cracked this nut? Why have we had a few new medicines? They've helped. Yeah. But we really haven't cracked the nut the way we want to. And it was interesting. One of the participants got up and said, “But wait, we have done it, or we have about to do it and all we really need to do is give it time and ongoing investment. But we're about to reap these rewards in pancreatic cancer, whether it's targeting or new understanding of immune therapies, understanding, how to control cancers and the like. I went into that meeting discouraged thinking there wasn't going to be much in our summary document, or what we were going to be able to share. But I left that meeting maybe as excited as I've ever been, and I'm an old GI oncologist, about the future of where we're going in pancreatic cancer. Reflect a bit where you all are on that and that stance. And the one concern I had, again, is how do we make sure that that investments there, to your previous point? How do we make sure that patients have access to these trials and new medicines around the country? So that all can move this faster.

Julie Fleshman: I've heard multiple physicians and researchers say that they feel we're at a tipping point, and I've never heard, you know, that kind of talk before. I mean for 25 years, I've been told KRAS, RAS super important, but it's undruggable. And suddenly, it's druggable. And so that's pretty amazing and exciting. You know, there are multiple, multiple companies with targets for KRAS for pancreatic cancer. The first phase three trial just launched last month, and then lots of phase two, phase one trials that are in development. So, I mean, this is exciting. This is really important.

John Marshall, MD: Yeah, I was going to say that I saw a bunch of waterfall plots. Everybody knows what those are. Where I'm used to seeing one patient and being excited about that. This was half the patients were below the line. We were seeing lots of responders in those patients.

Julie Fleshman: Absolutely. Most likely it won't be the silver bullet. I think we've learned that in this disease. So, the next step is what do we need to combine it with? What is that going to look like so there's durability and, and we get, you know, even we extend patients’ lives even longer. I think that'll be the sort of immediate next step that we need to begin working on. But I was really heartened at the AACR pancreatic cancer meeting in September. That already it feels like the field is thinking about that, and they're working together across institutions. They're getting together in groups and trying to solve the problem based on different expertise. And so, I do feel like we have a very special community that knows this is hard. That this isn't just going to be the answer, and we're going to have to continue to work together. And PanCAN wants to play that role.

John Marshall, MD: I would go one step further, Julie. I don't think we would be where we are today with that progress without your work and PanCAN's work that's driven this and made sure that in the top of everybody's mind is how We're all tired of taking care of pancreas cancer patients with not much to do. And we are all looking forward to the future in large part, thanks to you. So, I very much thank you for taking the time for talking with us today and wish you well as now we watch that survival curve improve.

Julie Fleshman: Thank you so much. I always appreciate your passion and enthusiasm, and all you do for patients. So, thank you.

John Marshall, MD: I really can't thank Julie enough for joining us in our series Oncology Unscripted. As you can see from our discussion, she’s just all there is out there. She has been such an advocate and positive for so many of us in the space of GI cancers and pancreas cancer in specific. So, a great shout out to her and thank everyone out there for joining us today as we've sort of started to dig in deeper in the world of pancreatic cancer, our hope for the future, as we've developed new agents and new support for our patients that are out there. Join us next time on Oncology Unscripted.

Thanks everybody. John Marshall.

This transcript has been edited for clarity.