In November 2020, on the Tuesday before Thanksgiving, 69-year-old Thomas Paben found himself in the Emergency Center at Memorial Hermann Katy Hospital after experiencing severe nausea and lower abdominal pain. He was quickly admitted and connected to IV fluids. The emergency medicine doctor on call examined Thomas and probed the painful area. Since Thomas had his appendix removed a decade earlier, the doctor ruled out appendicitis. Suspecting an issue with the pancreas, he ordered an ultrasound and X-rays that night.
Those initial tests continued to indicate that Thomas’ symptoms were likely a result of problems with his pancreas, so he was scheduled for a full diagnostic scan first thing the next morning. While the doctor refrained from alarming Thomas, he did mention the possibility of pancreatic cancer. Thomas, aware of the grim prognosis associated with this type of cancer, could barely sleep that night.
The next morning, Thomas underwent the scan. Not long after, the same emergency medicine doctor reviewed the results with him and confirmed what he had feared: Thomas had pancreatic cancer.
“It was a shock, and I’d be lying if I said I wasn’t worried,” Thomas said.
The doctor told Thomas that he would contact a surgeon to discuss the next steps, and just a few hours later, Thomas received a call from Curtis Wray, MD, a surgical oncologist affiliated with Memorial Hermann.
Within the week, Thomas met with Dr. Wray and two other physicians, who would become critical members of his medical team: gastroenterologist Nirav Thosani, MD, and oncologist Putao Cen, MD, both affiliated with Memorial Hermann. The team performed a biopsy, confirming that Thomas had a localized 3.2 cm mass, identified as Stage II adenocarcinoma. Dr. Cen also performed genetic testing, which revealed that the tumor tissue had a BRCA2 mutation, which is part of the family of HRD mutations.
On December 9, Thomas had a port placed to begin chemotherapy shortly after. This was the recommended course of action, since initial tests, which measured the tumor’s size and location, indicated that it was too close to an artery for immediate surgery.
Dr. Cen started Thomas on a regimen that included chemotherapy and an oral cancer fighting drug called Olaparib, which targets for patients with BRCA2 mutated cancer like Thomas.
“While this is not the standard protocol, I found in our past experience that in tumors with HRD mutations, starting patients on Olaparib and chemotherapy prior to surgery can help substantially shrink the cancer,” Dr. Cen explained.
The original plan was to use the chemotherapy and Olaparib combination for six months to shrink the tumor before considering surgical removal, but Thomas was also an ideal candidate for an innovative procedure using radiofrequency that the team was currently testing in clinical trials. After multiple examinations and discussions about the risks and benefits, he enthusiastically agreed.
With the port in place, Thomas started chemotherapy, and over the course of a few months, he underwent three radiofrequency ablation (RFA) procedures, performed by Dr. Thosani.
“Radiofrequency ablation is a minimally invasive procedure that uses heat generated by radio waves to destroy abnormal tissues like cancer cells,” Dr. Thosani said. “Through clinical trials, we are showing that it is a highly effective treatment option with reduced recovery times compared to traditional surgical methods.”
For Thomas, the combination of the medical therapy and RFA was highly successful, shrinking the tumor substantially and allowing Dr. Wray to perform a Whipple procedure in May 2021.
“The Whipple procedure, also known as pancreaticoduodenectomy, is a complex surgery commonly performed to treat pancreatic cancer located in the head of the pancreas,” said Dr. Wray. “The procedure involves removing the head of the pancreas, part of the small intestine, the gallbladder and the bile duct. By doing so, we aim to eliminate the cancerous tissue and improve the patient’s chances of survival. Although it’s a major operation, advancements in surgical techniques and post-operative care have greatly improved patient outcomes.”
As soon as Thomas recovered from the surgery, he resumed the Olaparib and chemotherapy treatments for three more months, and in November 2022, Dr. Cen informed Thomas that she believed he was cancer-free and no longer required oral Olaparib maintenance medication. By February 2024, he remained cancer-free, and he is now seen for monitoring every seven months. Like many patients, he has chemotherapy-induced neuropathy in his hands and feet, but he is on medication for his digestion and can eat a diet free of restrictions.
“Thomas’s determination and his trust in our treatment plan were vital to his recovery,” said Dr. Cen. “His participation in this trial also provided valuable insights and showcased the potential of targeted therapies in treating pancreatic cancer. He’s done remarkably well in his recovery and is a true success story.”
Today, Thomas and his wife stay busy on their ranch in Waller County, tending to their cattle and hay crop. They are active in local farming organizations, and his wife, looking for opportunities to stay active, had pickleball courts built in their barn. With one of the only pickleball courts in the area, their ranch has become a popular spot, and since opening it, nearly 70 people have visited for an opportunity to play.
“I am so grateful for the incredible medical care I received,” Thomas said. “The dedication and expertise of Dr. Cen, Dr. Thosani, and Dr. Wray truly saved my life, and I’m thankful for their efforts and support and the personal concern they showed for me.”
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