Sonal Noticewala, MD, MAS

Examining the Microbiome to Improve Pancreatic Cancer Treatment

Sonal Noticewala, MD, MAS, of the University of Texas MD Anderson Cancer Center is working to improve outcomes for patients with pancreatic cancer by investigating the role of the microbiome — the bacteria that live in the digestive tract — on how the tumor responds to neoadjuvant chemoradiation. Pancreatic cancer is the third most deadly cancer in the United States, and less than 10% of patients survive more than five years following diagnosis. Recent studies have shown that a more diverse microbiome is associated with a better response to treatments among patients with pancreatic cancer. Dr. Noticewala is leading a study to understand the microbiome profile and which bacteria are associated with a positive response to treatment so that the effectiveness of current therapies can be improved. Dr. Noticewala’s investigation, which began when she was a resident, is supported by a James D. Cox Research Award from the ROI and was launched under the mentorship of Cullen Taniguchi, MD, PhD, before he passed away in 2023.

Dr. Noticewala’s team is taking a unique approach to defining the microbiome in pancreatic cancer. “We are using paired tissue samples of the pancreatic tumors and peri-tumoral regions including areas of the pancreas without tumor and the duodenum, the part of the small intestine that is connected to the pancreas, from patients who had surgery to remove the tumor following chemotherapy and radiation,” says Dr. Noticewala. Studies that use stool samples to analyze the microbiome include the bacteria and other microbes found in both the upper and lower gastrointestinal (GI) tract. However, “Our approach will allow us to focus on identifying the bacteria present in the upper GI tract which is in direct contact with the pancreatic tumor,” says Dr. Noticewala.

With the grant, Dr. Noticewala’s team is:

• Sequencing extracted genomic DNA from the tissue samples to determine which bacteria are present in the tumor, the pancreas without tumor, and the duodenum.
• Identifying the similarities and differences in the microbiome found in the tumor versus the surrounding tissues of the upper GI tract.
• Studying whether a specific microbiome profile is associated with those who respond to treatment compared with those who do not.

This research has led to a prospective trial a novel oral live biotherapeutic that may have anti-cancer activity in cancers that interact with or are in close proximity to the gut and thus, can potentially improve treatment response.

Presentations
 

• A Phase I Study of Oral Live Biotherapeutic MRx0518 with Hypofractionated Preoperative Radiation for Resectable Pancreatic Cancer was presented at ASCO Breakthrough 2023.