Despite decades of research and clinical advances, the diagnosis and treatment of pancreatic cancer remain formidable challenges. Recently, enormous efforts have been made to develop new methods for the early diagnosis and treatment of pancreatic cancer, such as those led by Diane M. Simeone, MD, a surgical oncologist at NYU Langone Health’s Perlmutter Cancer Center, New York, and Chair of the Pancreatic Cancer Action Network’s National Scientific and Medical Advisory Board.
Dr. Simeone was born in Providence, Rhode Island, and, as a child, she was always fascinated by the inner workings of nature. “As a kid growing up, I was an avid backpacker and multisport athlete. During high school, I developed a keen interest in biology, down to the molecular and organismal level. After graduating from high school, I went to Brown University, where, along with my studies, I played on the school’s basketball team. During that period, my interest in science and biology accelerated, which led me to a career in medicine, particularly surgery, a discipline that satisfied my love for the sciences but also gave me the opportunity to fix things.”
Diane M. Simeone, MD
Working With Patients With Cancer
After graduating from Brown University, Dr. Simeone attended Duke University Medical School, where her decision to pursue surgery as a career took root. “After Duke, I went to the University of Michigan for a surgical residency. I had been fascinated by abdominal surgery, to see how the organs and tissues in that complex anatomic area were connected and worked. I enjoyed the satisfaction of being able to remove tumors and see the dramatic change in a patient’s quality of life,” she recalled.
“During the end of my residency, I had the opportunity to care for patients with pancreatic cancer. I was struck by how little we knew about the disease and how the surgical techniques at the time were underdeveloped. So, it seemed like a difficult clinical area that was not getting the attention it deserved. That’s when I decided to embark on a career that would lead to more knowledge and better outcomes for patients with pancreatic cancer,” she said.
A Famous Mentor
Asked about mentors, Dr. Simeone replied: “From a surgical perspective, my most memorable mentor was Dr. Lazar Greenfield, the inventor of the Greenfield inferior vena cava filter. He was the consummate clinician-scientist who demonstrated how one could be an expert in clinical care but also a leader who could make contributions outside the operating room—in the scientific arena—that would advance the field.
On the basic science side, my other noted mentors were Drs. Craig Logsdon and John Williams, who were important contributors to the pancreatic biology field. Their mentorship during my formative years really helped me develop my appreciation of the scientific method and how to generate a working project from a hypothesis.”
Moving up the Ranks
Dr. Simeone progressed through the ranks at the University of Michigan, beginning as Assistant Professor and eventually becoming the Lazar Greenfield Endowed Professor of Surgery. “As head of gastrointestinal [GI] oncology, I helped coordinate all of the disciplines in the care models for our patients with GI cancers, including development of the multidisciplinary clinics, first in pancreatic tumors and then modeling that out to liver and colorectal tumors. I stressed the importance of multidisciplinary care, which, in 2002, led to one of the first multidisciplinary clinics for pancreatic cancer,” said Dr. Simeone.
She continued: “In later years, at the University of Michigan, I was asked to run the translational oncology program, a new initiative for which we built an interdisciplinary program that began with 6 or 7 faculty and grew to a robust program of about 30 faculty. The program then had the ability to attract leading people in various fields such as engineering, mathematics, and drug development. I’m a firm believer in building a continuum that takes what happens in the laboratory and brings it to the clinic, to better outcomes for our patients with cancer. That’s been a driving force in my career.”
Bringing Talent Together
In her current position at Perlmutter Cancer Center, Dr. Simeone leads the Pancreatic Cancer Center, which has been designated as a National Pancreas Foundation Center of Excellence. Asked to summarize her weekly duties, Dr. Simeone replied: “I generally operate 1 to 2 days a week, sometimes more, depending on the case load. I also spend time in the clinic seeing patients with pancreatic cancer. And I run a laboratory with about a dozen researchers, so I spend a portion of each day communicating with them. Mentoring is another important aspect of what I do, making sure we give support and advice to those coming up in the ranks. I would describe that work as a kind of hub where we bring people together from different sectors of the oncology world and try to push the envelope in research and clinical care for patients with pancreatic tumors.”
New Clinical Trial Methodology
Dr. Simeone noted that the past few decades have seen several advances in cancer biology and genomics, and she believes we have a tremendous opportunity and obligation to channel this progress to impact patient care. “Over the arc of my career, and especially during the past 3 years at NYU, leading the Pancreatic Cancer Center, I came to realize there are a couple of things that really need attention if we are to truly make advances in the outcomes of people with pancreatic cancer. To begin, as a field of study, we have not done a good enough job in how we organize and develop clinical trials. So, we have embarked on a large-scale effort with the Pancreatic Cancer Action Network to develop a new clinical trial paradigm, which is called Precision Promise. It is designed to serve as a catalyst to accelerate pancreatic cancer drug development, de-risk industry participation, increase clinical trial enrollment, and transform the way clinical research is done for patients with pancreatic cancer,” said
She continued: “We launched an adaptive platform trial, the largest of its kind for pancreatic cancer. The trial is now open across the country in about 15 centers, which has been done in partnership with the U.S. Food and Drug Administration and a pharmaceutical consortium. Our goal is to bring about significant changes, not only in the access to therapeutics for patients with pancreatic cancer, but also in the development of clinical trials, where we learn things such as why certain treatments work in some patients and not in others.”
Early Detection Models
Dr. Simeone explained that, along with developing new and better clinical trial methodologies, she has also been focusing on trying to develop early-detection strategies for pancreatic cancer, something that has thus far remained elusive. “Although many institutions and cancer organizations have wrestled with early-detection strategies in pancreatic cancer, there really has not been a centralized effort to identify a large cohort of people at risk for the disease. With the help of a founding donation from the Connecticut-based organization Project Purple, we have developed the Pancreatic Cancer Early Detection Consortium (PRECEDE), which is an international group of 35 centers working in close collaboration to transform risk assessment, early detection, and prevention in pancreatic cancer.”
“Although many institutions and cancer organizations have wrestled with early-detection strategies in pancreatic cancer, there really has not been a centralized effort to identify a large cohort of people at risk for the disease.”— Diane M. Simeone, MD
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The PRECEDE consortium will be longitudinally following about 3,000 to 4,000 people at high risk for pancreatic cancer over the next 10 years. “We believe this large-scale platform will be a critical tool to help us develop and validate early detection blood tests for pancreatic cancer and identify new pancreatic cancer susceptibility genes. We’re hoping to assemble a data set demonstrating that screening for pancreatic cancer saves lives. The overall goal here is to shift from identifying people with advanced disease to doing a much better job in defining at-risk populations, so we can treat them more precisely and extend and save lives.”
Guidelines and Running to Decompress
Dr. Simeone has been working with ASCO and the National Comprehensive Cancer Network® (NCCN®) to develop guidelines for germline genetic testing in patients with pancreatic cancer. “We’ve worked with ASCO and wrote a guideline paper that recommends germline testing, and NCCN took that one step farther and incorporated testing into its guidelines. So, I think we’re making important headway in early-detection strategies that will ultimately improve outcomes,” said Dr. Simeone.
What does a busy clinician-scientist do to ward off potential burnout? “First off, spending time with my family and enjoying the outdoors are the best ways to decompress. I’ve recently taken up running in the morning before work, and, I must say, it gives me more energy and a great sense of release.”
DISCLOSURE: Dr. Simeone has served as a consultant or advisor to Celgene; has received research funding from AbbVie; holds intellectual property on “pancreatic cancer stem cells” and “Greenfields Textbook of Surgery”; and has been reimbursed for travel, accommodations, or other expenses by Celgene.