Fellowship fuels research on pancreatic cancer

Working as a pancreatic cancer surgeon, Dr Howe Mao realised research offers the best hope for tackling the deadly disease.

Now, the Health Research Council has granted Dr Howe Mao a $260,000 Clinical Research Training Fellowship to improve molecular understanding of pancreatic cancer in Aotearoa.

After gaining a Bachelor of Medicine and Bachelor of Surgery at Waipapa Taumata Rau, University of Auckland in 2013, Mao completed general surgery training and has specialised in hepatopancreatic biliary surgery at Te Whatu Ora Waitematā for the past 18 months.

He was motivated to research pancreatic cancer with a team of scientists at the University, because patient survival rates have not dramatically improved over recent decades. While some cancers are now highly treatable, pancreatic cancer remains particularly deadly.

“It’s an aggressive cancer – it spreads early and you mostly find it late, because many people don’t have any symptoms,” says Mao.

Even with small pancreatic cancers that have been detected early and surgically removed, the patient survival rate after five years is only 30 percent.

“I wanted to focus on PhD research before I do more pancreatic and liver-related surgeries – the strongest driver was that the outcomes are so poor.

“I love operating, it’s technically very demanding, but unfortunately the outcomes are not always determined by how skilled the surgeons are.

“It comes down to researching and developing treatment options,” Mao says.

He decided it would be most beneficial to start researching with University experts, including senior lecturer in surgery Dr Sanket Srinivasa, professor of molecular medicine and pathology Cristin Print, professor of surgery Jonathan Koea, head of oncology Dr Ben Lawrence, and molecular medicine and pathology research fellow Dr Anassuya Ramachandran.

The researchers will begin by using cutting-edge techniques to carry out a comprehensive genomic analysis of an extremely rare pancreatic cancer type. This will contribute to knowledge of this rare type of tumour, while helping to refine the best use of genomic testing techniques for future samples.

Only about 30 to 40 pancreatic cancer samples are currently held in Te Ira Kawāi Auckland Regional Biobank, a collaboration between the University of Auckland and hospitals in Auckland, that contains more than 70,000 tissue specimens from more than 4,000 patients. The pancreatic cancer samples will be analysed, using a wide range of genomic testing techniques.

The research will focus particularly on gathering genetic data from pancreatic cancer samples from Māori and Pacific patients, to try to fill a knowledge gap. Māori suffer disproportionately high pancreatic cancer rates and higher mortality rates from the disease, compared with non-Māori.

“There are well-known genetic mutations in pancreatic cancer among European patients and there are a lot of efforts to try to find treatments for them.

“When it comes to ethnic minorities, the analysis is less certain about what mutations or variants we’re seeing.

“For pancreatic cancer in Māori and Pacific people, there’s almost no reference – it’s like trying to solve a jigsaw puzzle without being given the edges,” Mao says.

During the three-year fellowship, Mao’s team will work with Auckland Regional Biobank to collect more samples of pancreatic cancer. These samples, with their gene sequence and clinical information, will create a valuable resource for future research.

The team will work with Māori leaders and communities, to understand the cultural needs that must be met before Māori would be willing to donate pancreatic cancer tissue.

“We hope to build up a baseline understanding of what pancreatic cancer looks like in Māori and Pacific patients, so our research can help address the health inequities.

“This information could be used to find a targeted treatment that would particularly help Māori and Pacific people with pancreatic cancer.”

Born in Hong Kong, Mao moved to Aotearoa in 2005, beginning his studies at the Waipapa Taumata Rau, University of Auckland three years later.

He acknowledges that being a pancreatic surgeon is stressful, involves long hours of work, and typically has poor patient outcomes – but he has no regrets about choosing the field.

“The flip side is you get to spend long hours doing what you enjoy – it’s very interesting surgery.

“And you get to spend long hours with your patients.

“Some of my most valuable experiences have been with people near the end of their life: it’s just such meaningful work,” he says.

Other organisations that have helped fund the pancreatic cancer research include Te Aka Mātauranga Matepukupuku, the Maurice Wilkins Centre, NZ Gut Cancer Foundation, Cancer Research Trust of NZ, and Te Whatu Ora Waitematā.