
In the Pancreas, Common Fungi May Drive Cancer - pseudolus
https://www.nytimes.com/2019/10/03/health/pancreatic-cancer-fungi.html
======
yread
Actual paper:

[https://www.nature.com/articles/s41586-019-1608-2](https://www.nature.com/articles/s41586-019-1608-2)

Looks pretty strong: getting rid of the fungi stopped tumor growth and
repopulating it with that type of fungi (and not with other types) restarted
it again (in mice). And they've even found a drug target!

Pancreatic cancer is not the most common but one of the most deadly (<10%
survival) with very short times between diagnosis (it's mostly asymptomatic)
and death.

~~~
e40
> _Pancreatic cancer is not the most common but one of the most deadly ( <10%
> survival) with very short times between diagnosis (it's mostly asymptomatic)
> and death._

All but one of the people I've known in my life that died from cancer died of
this form. It's like 7 people.

A useful treatment can't come soon enough.

~~~
selectodude
A useful early warning bio-marker needs to come first.

~~~
mikelyons
or whenever it does, because once we have the bio-marker, we can then throw
what would be the already-invented treatment at it ...

------
isaacyes
What a feeling it must be for the researchers involved in this, if it turns
into a method of improving pancreatic cancer survival. I am glad their are so
many medical researchers driven in this way.

My mother passed away from pancreatic cancer last year; she had no symptoms
until two months before she passed, when she got a diagnosis from a scan.
There are a lot of trials ongoing looking at how the area around the pancreas
impacts how well different therapies work in treating it.

This is really interesting as it suggests a new avenue to improve treatment,
as well as a potential tool for easier diagnosis.

~~~
deftnerd
This reminds me a lot of the cancers attributed to HPV, a common virus. The
researchers who discovered that link have likely saved millions of lives.

Almost every instance of cervical cancer is attributed to HPV. 70% of throat
cancers, 90% of anal cancers, 60% of penile cancers, 75% vaginal, and 70%
vulvar cancers. [1]

It always stunned me that one little virus that used to be seen just as an
embarrassment was re-categorized as being a huge risk factor for deadly
cancers.

If the person who identified a common bacteria being responsible for almost
all ulcers got a Nobel price, the HPV <\--> cancer researchers should also
have been considered, IMHO.

[1] [https://www.cancer.gov/about-cancer/causes-
prevention/risk/i...](https://www.cancer.gov/about-cancer/causes-
prevention/risk/infectious-agents/hpv-and-cancer)

~~~
eth0up
"...person who identified a common bacteria..." (Barry Marshall)

Helicobacter pylori is also a suspect carcinogen, specifically in some stomach
cancers. I am now wondering if it assists this evil fungus in any indirect
way. Over half the world population carries h pylori, apparently mostly
asymptomatically.

~~~
tigershark
Is there a non invasive way of getting tested for it?

~~~
eth0up
There's the poo test and a breath test.. beyond that I'm unsure. The breath
test seems less available, maybe. Consider the following before alarming
yourself though. H pylori, if asymptomatic, may be at a level of what some in
the medical field deem best left alone. The goal in some treatments seems to
beat it down rather than eradicate it. Rationale seems to weigh cost\benefit
of slaughtering all the good stuff to get the bad when the bad might not do
much beneath a threshold. I'm no authority. The subject, I do think is worth
reading about and it doesn't appear there's a clearly advised plan for the
infected asymptomatic majority.

------
ascotan
I'm not surprised that fungi as a causative agent for cancers (and that by
extension anti-fungals might be cancer protective).

It was once believed stomach ulcers were due to acid imbalance and we now know
many types of stomach ulcers are due to infection and treatment with
antibiotics is the proper course of treatment.

I think that more research in this line will be very productive. I believe
that he balance/imbalance of the body's fauna will eventually be shown to be
the root trigger of many other issues. Knowledge like this is invaluable
because it can quickly turn major health concerns into preventable diseases.

It's not just about our genetics, it's about our interplay between our
genetics and our environment.

~~~
tempguy9999
> I'm not surprised that fungi as a causative agent for cancers

It bloody amazes me. What reason or prior experience do you have that makes it
seem reasonable?

~~~
n4r9
This may be a little harsh but I think you could rephrase OP's point as "The
body seems really complicated so I'm not surprised that there are complex
interactions going on".

~~~
tempguy9999
I see what you're saying and it's a good point, but those complex interactions
seem to throw up impossibly amazing stuff, for example the utterly mindblowing
idea of mitochondria being captured organisms. To say "it's complex so
surprises should be surprising" to me just doesn't make work. I still get
staggered by this stuff. If I ever lose the ability to be mindblown, it'll be
a sorry day.

Fungi in the pancreas isn't in the same league but it's still pretty good!

------
jabbadabbadooba
I have (idiopathic) Chronic Pancreatitis and I wonder if the same holds for
me. I'm already on enzymes but not diabetic (yet, knock on wood). There is a
link in the article pointing to Crohns so I have hope that there is some
correlation. If anyone has any more info, I'd gladly hear you out as it could
be life changing for me. For instance, if I'd want to try this myself, what
could be a good off the counter medication (in EU)? And what would be a good
interval of taking these? I notice that doctors are slow on the uptake with
these kind of discoveries so I've become more prone to trying remedies (diet
changes mostly) myself. (Note: I don't shun away from bad news, would like to
hear that too)

~~~
DoreenMichele
I have a condition that can lead to pancreatitis, diabetes and usually
involves digestive enzymes. I've successfully gotten off the digestive
enzymes.

If you aren't already: I will suggest you keep a food and symptom journal,
stay away from table salt (sea salt or kosher salt are both better) and figure
out if you have trouble with specific oils. Symptoms can sometimes lag behind
triggering events substantially. A journal can help you find patterns and make
inferences.

I personally avoid peanut oil. It's very inflammatory and inflammation is has
been linked to diabetes.

~~~
jabbadabbadooba
I've long put off having a food and symptom journal, because I'm pretty
disorganized, but I will take your advice serious. Can I ask how you exactly
correlate the symptoms with your food intake? From what I've read the
digestive system takes max 48 hours from in to out.

~~~
DoreenMichele
I do a lot of reading. I discuss stuff a lot with my adult sons who still live
with me. I look for patterns.

A lot of stuff happens about 48 hours after the triggering event. My son did
some research and this seems to be a significant blood and lymph timing thing.

Other significant time frames seem to be one week, two weeks, one month and
six weeks. These aren't peculiar to "things I ate." These are health events
triggering physiological changes that don't show up until later.

It's harder to connect those longer time frames to the triggering event, but I
am sometimes reasonably confident of the connection because of the specifics
involved and I just read a lot and discuss this stuff a lot and write about it
a lot. Patterns eventually become clear if you pay enough attention.

As your diet changes, your body changes and your needs change. It's a moving
target.

------
tyingq
Somewhat interesting that folksy/homeopathic "cancer cures" often suggest
things like garlic, which is a fairly good antifungal.

~~~
galangalalgol
Is there any downside to periodically taking strong antifungals? We don't have
beneficial fungi do we? I have been considering a dose of ivermectin twice a
year. Studies hav correlates it with a strong anti cancer effect.

~~~
whb07
Here is another point to consider: If you were growing say Shiitake mushrooms
on a container, a "bad" or potential unknown fungus might move in first to it
and out-compete with your crop and thereby ruin your attempt.

But if your Shiitake mushrooms took hold and established a strong and healthy
foothold the other mushrooms/spores/fungi will not be able to "move" in on
after the fact.

So if you took this to a human perhaps the "good" fungus needs to be healthy
and well colonized to prevent other random things from trying to grow in areas
they shouldn't be in.

~~~
ASalazarMX
But I don't want shiitake mushrooms in my pancreas!

~~~
gnulinux
Why not?

------
etiam
First inside brain cells in areas affected with Alzheimer's disease
([https://news.ycombinator.com/item?id=10401344](https://news.ycombinator.com/item?id=10401344))
and now this.

I'm increasingly thinking we have severely underestimated and misattributed
the damage caused by covert fungal infections.

~~~
aantix
Shouldn't this be an easy hypothesis to test?

Or a cohort that has taken some sort of anti-fungal med and we could look at
their outcomes?

~~~
etiam
I'm pretty sure 'easy' is not the word I'd choose to describe it.

To pick one common fungal infection among many: Let's have a look at fungal
nails
([https://www.medicinenet.com/fungal_nails/article.htm](https://www.medicinenet.com/fungal_nails/article.htm)).

As they note, "Onychomycosis is a fungal infection usually caused by a special
type of fungus known as a dermatophyte. Since most of these infections are
relatively superficial, it would seem that topical treatments ought to work
well. This is not the case because the nail unit is relatively impenetrable."

Where I live, typical treatments for an established fungal infection of this
kind would apparently include medical nail varnish with Amorolfin (at least
weekly) or Ciclopirox (daily), _for 6-12 months_ in cases with small, highly
localized infection, or, for larger infections, oral Terbinafine (daily, for 3
months) or Itraconazole.

In my understanding (Life scientist here, but not really medical professional)
Terbinafine is the nicer one of those last two as far as the patient's own
body is concerned - a modern, effective, prescription-free antimycotic - and
it still has a respectable list of side effects
([https://en.wikipedia.org/wiki/Terbinafine#Side_effects](https://en.wikipedia.org/wiki/Terbinafine#Side_effects)).

This is not like procaryotes (Bacteria, Archaea, ...) where many aspects of
their biology is almost alien compared to our own cells and possible to target
with minimal host damage. Save for the fungal cell wall, and some exotic
aspects to DNA reproduction and cell membrane biosynthesis, fungi are _much_
closer to animal, and the game with them tends to be "let's see if we can find
something that hurts you (much) more than it hurts me".

If they are hiding inside human cells or tissues reaching them with
antimycotics to a significant extent at all is tricky. Not sure about the
pharmacological accessibility of the pancreas, to be honest, but many drugs
don't even enter the brain without being specially designed for it, let alone
get inside the nerve cells. And even if we can get in there treatments are
fairly long, disagreeable and/or risky, and far from guaranteed to be
successful.

Is the drug effective against the particular fungus? Does it remain effective
under the course of microbial evolution? Is the body capable of eliminating
the fungus entirely with aid from the drug? (Arguably maybe not, if the fungus
is very good at hiding.)

So, I agree that looking at the existing outcomes after treatment with
antimycotics could be a good first step, but as far as I can see, if you
detect an effect you can be fairly sure there is one, but if you don't detect
an effect that doesn't really tell us much because it could mean either
there's no problem or, just as well, that the treatment has just been too
ineffective in eliminating the deep covert infections for one reason or the
other. And there's every reason to believe we may be in that latter scenario.

But, with Alzheimer's and pancreatic cancer on the list of allegations so far,
is it _worth_ testing? On a society level, yes, unequivocally.

------
eternalny1
This seems like an extremely promising development and the study looks to have
done everything right regarding controls.

I'm hoping this isn't just another "works in mice!" story, but it doesn't seem
like that is the case, as this is dealing with something very different
(specific fungal infection) than most other studies.

------
deftnerd
I have one of the variants of Ehlers-Danlos Syndrome, a genetic condition that
changes how collagen proteins are folded. The results of the condition vary
wildly depending on how specifically the proteins fold, but in my case it's
pretty minor. I'm "hyper flexible" and I'm more prone to fungal infections.

My skin is a buffet for fungal infections and I've been fighting a persistent
Malassezia infection for years. It's caused me to have intense dandruff and
lost a lot of my hair as the infection clogs my hair follicles.

The only thing that helped was taking oral anti-fungals, but once I stopped,
the infection came back within a few weeks.

Reading that the specific fungus I'm fighting is also plausibly responsible
for pancreatic cancer is a bit frightening.

I wonder if I can get routinely screened for pancreatic cancer without
appearing like a crazy person to an uninformed doctor.

~~~
bitL
Pancreatic cancer is one of the worst to detect, often detected in the very
last phase when nothing could be done; if I were you I would insist on regular
checks given you likely suffer from seborrheic dermatitis given your symptoms.

From Internet: "(Eczematic) dermatitis can be one of the earliest indications
of pancreatic cancer."

------
karterk
Back when I was in college, someone gifted me Randy Pausch's "The Last
Lecture". It was my first introduction to this terrible disease. Little did I
know then, that a decade later, I would lose my beloved father in-law to the
same disease.

When he was diagnosed, I digged into Randy's old blog, and realized how little
things have changed since then. There is now a new cocktail of Chemotherapy
drugs, but apart from that we have hardly progressed on this front. I don't
think we could have really saved him even with an early diagnosis.

Surgery seems to be the only permanent, generic cure as far as most cancers
are concerned. But with Pancreas, from what I read, even that gave a very grim
future (as in Randy's case). If at all you survive the Whipples, you will be
entirely on expensive enzyme supplements for the rest of your life AND carry a
significant risk of metastasis.

~~~
sailfast
It seems like the Chemotherapy / radiation is a lot more targeted and has less
side effects. Furthermore, genetically targeted treatments and the early
detection mechanisms of cancerous cells to avoid large scale re-growth seem to
have improved markedly.

That said, detection in the case I'm thinking about was super early which
always helps with outcomes.

~~~
modzu
not for pancreatic. only about 5% of cases have a genetic target, and there is
no known test for early detection. you can look at a healthy pancreas and a
few months later same person is stage iv.

------
dennis_jeeves
Of interest to people who are willing to examine claims of treatment
modalities outside of the mainstream medicine, without labeling them as
quackery:

An Italian oncologist by name Tullio Simoncini believes that cancer is
primarily caused by a fungus and he uses baking soda (sodium bicarbonate) as
the primary treatment. He claims that he's been successfully treating patients
for decades. I'm willing to give him the benefit of doubt, and I'd would
welcome any information from someone who has investigated his treatment, or
has direct experience either as a patient or personally know a patient.

His website:
[http://www.simoncinicancertherapy.com/en/index.html](http://www.simoncinicancertherapy.com/en/index.html)

To the causal skeptic who will feel the urge to respond to my post : It's ok
to be skeptical(Infact it's the wise thing to do, initially), but flippant
skepticism is another matter altogether. Flippant skepticism a dead end, even
if it's very gratifying. I'm also aware that there are unverified rumors that
Simoncini's license was suspended. Personally to me, it does not matter if his
license was indeed suspended.

------
hellofunk
> “This is intriguing and exciting research,” said Dr. Ami Bhatt, who studies
> microbes at Stanford University. “But it’s probably too soon to add broad
> spectrum antifungals, many of which have lots of side effects, to cancer
> treatment regimens, even in experimental settings.”

I wonder if there are natural dietary changes you can make to help reduce the
likelihood of these fungi.

------
XorNot
Could've saved Iain M Banks :(

~~~
melling
Steve Jobs tried to cure his pancreatic cancer with diet for 6 months. This
might have given him more direction.

Pancreatic cancer has taken quite a few famous people:

    
    
        Randy Pausch - Last Lecture
        Steve Jobs
        Patrick Swayze
        Sally Ride - astronaut
        Piers Sellers - astronaut 
        Hans Rosling
        Richard Hatch
        Bill Hicks - Comedian
        Jef Raskin - Macintosh 
        Iain M Banks - Author
    

In the 12 years since Randy’s Last Lecture, we’ve made little progress:

[https://www.cmu.edu/randyslecture/](https://www.cmu.edu/randyslecture/)

~~~
bitL
Steve Jobs had one of the mildest, non-aggressive forms of pancreatic cancer;
had he taken chemo, he would be 99% here today. Instead he let it grow until
there was no hope anymore. Fruitarian diet seems like the worst possible one
for pancreas...

~~~
BurningFrog
I guess that's the downside of a contrarian "Think different" mindset.

Sometimes if you "zig" while the whole world "zags", you build the biggest
company in the world. And sometimes you die from very treatable cancer.

------
jedberg
Is it possible to avoid this fungus? What are the sources of this fungus?

~~~
UncleOxidant
fungi in general are pretty ubiquitous. Not sure about this particular one.

------
Avernar
_PDA tumours in humans and mouse models of this cancer displayed an increase
in fungi of about 3,000-fold compared to normal pancreatic tissue. The
composition of the mycobiome of PDA tumours was distinct from that of the gut
or normal pancreas on the basis of alpha- and beta-diversity indices.
Specifically, the fungal community that infiltrated PDA tumours was markedly
enriched for Malassezia spp. in both mice and humans._

------
agumonkey
Are there any treatments to remove fungi ? I thought they were impossible to
get rid off passed a certain threshold.

------
bitL
Hm, given it's Malassezia, is there a connection to seborrheic dermatitis (the
same underlying organism)? Is there a correlation between patients with
pancreatic cancer and seborrheic dermatitis? I lost auntie a month ago due to
pancreatic cancer, it took less than a year from diagnosis to death.

------
untilHellbanned
I still put my money on K-Ras being much more important than any fungi.

------
dekhn
we've cured cancer in mice more times than people can count. It doesn't really
represent forward progress in human cancer research.

~~~
Retric
We have made truly incredible process in cancer treatment. From 1990 to 2010
the number of cases breast cancer stayed about the same, but the number of
deaths dropped by about 1/3\.
[https://www.sciencedirect.com/science/article/pii/S221353831...](https://www.sciencedirect.com/science/article/pii/S2213538315000065)

It’s hard to say what current rates are as treatment lasts so long. However,
approximately 99% of people with localized breast cancer, which is ~62% of
diagnoses, survive 5 years. 85% with regional cancer, spread to nearby lymph
nodes or other tissue, survive 5 years. Even metastatic breast cancer has
which is 6% of diagnoses has a 27% chance of surviving 5 years.

Now various other types have had more or less success, but amazing work has
been done.

~~~
jessriedel
Your comment is almost completely orthogonal to dekhn's. The point is that,
regardless of progress/stagnation in cancer research, success in mouse models
is not a strong indicator of eventual success in humans.

~~~
Retric
Mouse models are almost the only indicator for future success. So while many
fail, most progress comes through research just like this.

Just remember, successful means lower the rates of deaths they don’t generally
eliminate it. So, yay study 1357 got the survival rate from 5% to 10% that’s
real progress. (Reported as curing cancer). Study 2217 got the survival rate
from 10% or 15% wow progress. (Reported as curing cancer). Study 3... I mean
grated they did help some specific individual within that study so it’s not
meaningless, but come on.

~~~
jessriedel
> Mouse models are almost the only indicator for future success.

What do you mean by this? The vast, vast majority of things that work in mice
do not work in humans. Even if effectiveness in mice is (approximately)
_necessary_ for eventual effectiveness in humans (say, because of our research
methods), this does not make it a good indicator. "Drug doesn't immediately
melt your brain" is also a necessary property, but it doesn't do a good job of
predicting effectiveness.

~~~
Retric
If you only look at everything that has already passed the test then sure the
test does not seem important.

The set of all possible cancer treatments however are not just the set of
treatments that pass animal models. Drugs etc need to go though several hoops
before they are even tested in mice, and even more fail in mice. Everything
that’s made it to this stage is extremely promising relative to the baseline.

~~~
jessriedel
If the baseline is success probability 10^-8, raising it to 10^-5 is extremely
promising at a relative level, but not at an absolute level.

~~~
Retric
That’s fair though 10^-5 is wildly off base.

About 1/3 of drugs that show promise on mouse models are ever tested in
humans. After that Oncology has a 8.3 percent success rate for 2015. So, when
looking at ‘cured cancer in mice’ something like 2.5% is about the right
ballpark, which I would consider promising as a general baseline.

For some comparisons the success rate in clinical trials averages around 14%
though it ranges from around 33.4 percent in vaccines for infectious diseases
to 3.4 depending on the type of treatment being tested.
[https://www.centerwatch.com/cwweekly/2018/02/05/new-mit-
stud...](https://www.centerwatch.com/cwweekly/2018/02/05/new-mit-study-puts-
clinical-research-success-rate-14-percent/)

Baseline is harder to calculate, but 10^-8 is probably reasonable depending on
what’s considered.

~~~
jessriedel
> About 1/3 of drugs that show promise on mouse models are ever tested in
> humans.

Do you have a citation? This seems totally off to me. In so far as the number
refers to something real, I suspect "shows promise" must mean something much
stricter than the threshold that this particular treatment has passed. That
is, I would bet against a 2.5% chance that this particular study leads to an
actual drug approved to treat pancreatic cancer.

------
sawaruna
Does this imply anything regarding the consumption of yeast? Specifically
nutritional yeast which many vegans tend to eat.

------
Camillo
In the coming decades, we'll find that many more diseases than previously
thought are caused by yet-unknown pathogens.

~~~
pfdietz
There's good theoretical reason to think that. Evolution should eliminate
diseases caused by self-defects, but arms races with pathogens can keep
diseases around (either directly, caused by the pathogen, or indirectly, as a
tradeoff due to things being selected for to resist the pathogens.)

~~~
Pwhy1
If diseases caused by self defects arise mainly after reproducing (say in your
50s/60s/70s), would there be much evolutionary pressure to eliminate it?

------
tyingq
Archived: [https://outline.com/3zd62c](https://outline.com/3zd62c)

------
MrBuddyCasino
> Researchers were surprised by the presence of fungi in the typical pancreas
> and immense increase in their numbers in disease. “The pancreas was
> considered a sterile organ until a couple years ago”

I'm surprised that after decades of treating pancreatic cancer, nobody noticed
this earlier. You'd think they take biopsies and take a look at them.

------
29athrowaway
Is this why people are trying to cure their cancer with dog deworming
products?

------
rpmisms
It seems like every week research finds a new carcinogen or anti-carcinogen.

~~~
pseudolus
It seems like every week that the mainstream press, in search of clickbait
content and with no understanding of statistics, misstates the results of some
study or another.

------
ginko
It's either 'a Common Fungus' or 'Common Fungi'.

~~~
tyingq
The NYT either had it right, or corrected it. The linked article says "common
fungi" without the "a".

