On learning she had stage 4 pancreatic cancer that had spread to her liver, Roxane Isal’s first thoughts were for her children, then aged only nine and six.
‘I presumed I had just months to live, so my immediate reaction was “That’s just not enough time”, says Roxane, 43. ‘I couldn’t bear to think of the birthdays and milestones I would miss, or that I would not be there to support them as they grew up.’
Her anxieties were well-founded: pancreatic cancer is one of the most feared cancers, as it claims the lives of half of those affected within three months of diagnosis. About 10,500 people in the UK are diagnosed with the disease each year, with seven in ten cases so advanced at that point that the patient only receives palliative care, according to the charity Pancreatic Cancer UK.
And cases are rising, up by a fifth since the 1990s – mostly in women under 55, like Roxane. Globally, scientists are desperately trying to find out why, but known risk factors include age, smoking, being overweight and having a family history of pancreatic cancer.
Yet, two years after being diagnosed, Roxane is alive – and is cancer-free.
‘I’m still here – which is a miracle,’ says Roxane, who lives in west London with her husband Steve, 52, who works in e-commerce, and their children Maya, 11, and Ellis, eight. ‘My daughter has just entered secondary school – which is a milestone I thought I would never see.’
This has been possible thanks to intense new research efforts into pancreatic cancer – and the fact that Roxane is a carrier of the BRCA gene mutation linked to breast and ovarian cancer, but also an increased risk of pancreatic cancer.
Paradoxically, the same mutation has been found to make tumours more receptive to certain types of chemotherapy and can also enhance the effect of a cancer drug called a PARP inhibitor – these drugs stop the disease progressing, by exploiting the same defective DNA repair process that increases the risk of cancer in the first place, leading to the cancer cell dying.
Roxane Isal lives in west London with her husband Steve and their children Ellis, eight, and Maya, 11
An MRI found a 3.5cm cancer on Roxane’s pancreas. The disease had also spread to her liver. ‘After phoning my husband, I was immediately consumed with how best to tell the children,’ she says
A combination of both treatments destroyed Roxane’s cancer and helped prevent it recurring.
‘Carriers of the BRCA gene respond more effectively to treatment with platinum chemotherapy [one of the more widely used types],’ explains Professor Naureen Starling, a reader at the Institute of Cancer Research and the NHS consultant medical oncologist who treated Roxane.
Research in the New England Journal of Medicine in 2019 found certain patients with stage 4 pancreatic cancer linked to the BRCA gene also responded to the PARP inhibitor, olaparib.
The researchers found that taking olaparib after chemotherapy roughly doubled the amount of time before their cancer returned, from 3.8 months to 7.4 months.
Crucially, a third of stage 4 patients were still alive three years later.
While not a listed NHS treatment, doctors can obtain the dual therapy for NHS patients using special ‘compassionate access’ requests to the pharmaceutical company.
‘Some patients with BRCA do exceptionally well,’ says Professor Starling, living ‘many years’ rather than just a few months.
But there is still a long way to go, says Diana Jupp, CEO of Pancreatic Cancer UK: ‘Decades of underinvestment in research and appallingly low numbers of patients able to access clinical trials are holding us back.’
In May, a survey by the charity, involving 1,117 people with pancreatic cancer, found just 12 per cent had the chance to take part in a clinical trial.
Tragically, because pancreatic cancer is typically diagnosed late, many patients deteriorate so quickly they are too ill to qualify.
One reason for this is that early-stage pancreatic cancer can be virtually symptomless.
The pancreas, which produces digestive enzymes and hormones, is located behind the stomach.
Symptoms – including indigestion (the tumour interferes with the production of digestive enzymes, so food is not properly broken down); back pain; fatigue and weight loss – are so vague the cancer is often advanced before it’s detected. More than 90 per cent of pancreatic cancer patients visit their GP multiple times in the two years before getting a diagnosis, according to Pancreatic Cancer UK.
This was certainly true for Roxane. She began feeling lethargic after eating in 2021 but, working full-time as a digital marketing consultant and running around after her children, she put it down to normal tiredness.
But she continued to have a ‘strange reaction’ to certain foods – including bread, chilli and alcohol – which made her feel ‘warm and shaky’. Indigestion and food intolerances can develop, again due to enzyme dysfunction.
Assuming a food intolerance, she didn’t see her GP for the first time until late 2023. But blood tests were normal.
Three months later, Roxane developed back pain ‘so strong I couldn’t hold myself upright’, she recalls, but blamed hours of computer work. In fact, the tumour was pressing on to nerve endings in the middle of her back.
By January 2024, as well as the back pain she was barely eating and felt exhausted all the time. Things came to a head when she nearly passed out with dizziness after a bite of a croissant in April.
Roxane went to A&E, where blood tests showed her liver function was poor; a subsequent MRI found a 3.5cm cancer on her pancreas. The disease had also spread to her liver.
‘I broke down in tears,’ she says. ‘After phoning my husband, I was immediately consumed with how best to tell the children.’
She was ‘surprised but relieved’ to learn that her faulty BRCA gene gave her treatment options not available to all patients.
Roxane had ten sessions of chemotherapy between May and October 2024: ‘It was horrific,’ she recalls. ‘I crawled from bed to sofa to hospital and back again. I lost 8kg, going from 62kg to 54kg [she is 5ft 9in].’
That September, she also had ablation, where heat was used to destroy the three cancerous patches on her liver, followed by radiotherapy in December.
Since January 2025 she’s taken olaparib and a daily oral chemotherapy tablet – scans show she remains cancer-free. Roxane lives with uncertainty but knows she’s one of the lucky ones.
But there is real hope that things could be changing for patients with pancreatic cancer.
A recent breakthrough trial found that a new oral drug, daraxonrasib, extended the time people with advanced pancreatic cancer survived. The drug blocks the KRAS protein which drives most pancreatic cancers.
Two years after being diagnosed, Roxane is cancer-free. She knows she’s one of the lucky ones, as pancreatic cancer claims the lives of half of those affected within three months of diagnosis
Professor Naureen Starling is a reader at the Institute of Cancer Research and the NHS consultant medical oncologist who treated Roxane
In a trial, published in the New England Journal of Medicine, it nearly doubled the survival time for people with advanced pancreatic cancer compared with standard chemotherapy – from seven to 13 months, with manageable side-effects.
‘Around 90 per cent of pancreatic cancer patients have a mutation in the KRAS gene,’ explains Michelle Garrett, a professor of cancer therapeutics at the University of Kent.
‘This means that the KRAS protein is always “on” so the signal for pancreatic cancer cells to grow and divide is always on.’
‘Daraxonrasib provides hope for those whose cancer has spread and could potentially be used at earlier stages of the disease.’
The discovery received an emotional reception at the annual conference of the prestigious American Society of Clinical Oncology when unveiled in May.
‘It was a spine-tingling moment because the research demonstrates that what was previously undruggable is now druggable,’ says Professor Starling.
It is not yet available on the NHS but has just been approved by the US regulator, the Food and Drug Administration.
Research is also under way into new diagnostic tests to catch the disease sooner.
A team at Imperial College London is working on a breath test to identify compounds released by the cancer which get expelled in breath in early stages of the disease. It’s hoped this could form the basis of a test for GPs.
Scientists at the University of Essex are also studying blood biomarkers for the disease.
But more needs to be done: Pancreatic Cancer UK has launched a campaign calling on the Government to increase the number of clinical trials and to widen their accessibility, as well as funding research.
‘Who knows what other discoveries may be just around the corner if only scientists can get the funding?’ says Roxane.
pancreaticcancer.org.uk
