Fungal infections and pancreatic cancer risk

Jacob Schor ND, FABNO

A recent paper has me second guessing and pondering what if’s regarding a patient from years ago. The new paper was published October 2 in Nature. [i]  The researchers reported that fungi can invade the pancreas and dramatically increase risk for pancreatic cancer and trigger these cancers to proliferate faster.

This is surprising as until recently the pancreas was considered a sterile organ.  Apparently though, some microbes, including fungi, can sneak by the sphincter of Oddi, to reach the pancreas.

Study lead, George Miller, along with his colleagues, fed mice brewer’s yeast that had been labeled with fluorescent dye.  The marker showed that the yeast moved into the pancreas within minutes. In mice, only specific types of fungi could make the journey and reach the pancreas; they were not fungi normally found in the intestine. Only Ascomycota and Basidiomycota seemed able to colonize pancreatic tissue. One particular fungus, a genus of Basidiomycota called Malassezia, which is typically found on the skin causing skin irritation and dandruff, appears particularly adept at this and appears to be associated with pancreatic cancer. The pancreatic microbiome of both mice and humans with pancreatic cancer had far greater concentrations of Malassezia,3,000-fold higher, than found in those with a healthy pancreas. A few studies have also linked the yeast to inflammatory bowel diseases, but this new study seems to be the first to link it to cancer.

Giving mice antifungal medications to get rid of the fungi prevented tumors from developing or halted disease progression. If these mice were again infected with the yeast, their tumors started to grow once more; Malasseziafungal cells appear to drive tumor growth. “Malasseziaspecies-but not species in the genera Candida, Saccharomyces or Aspergillus-accelerated oncogenesis.” This is probably an example of that whole micro-environment thing, the fertile field approach to understanding disease, that we naturopaths like to talk about.

As compelling as these association appears to be, Miller and his researchers aren’t ready to prescribe antifungal drugs to pancreatic cancer patients.  Researchers do tend to be a conservative.

There is something else interesting about this is that it may explain why so many antifungal drugs have anticancer action. If we look at the 2015 review on itraconazole and cancer written by Pan Pantziarka et al from the ReDo Project, we find a series of compelling studies suggesting we should prescribe this drug for a host of cancer types.  [ii]

  One case history Pantziarka included in the review caught my attention:

“A report has also been published detailing a case of pancreatic cancer which showed response to ITZ treatment. The patient was a heavily pre-treated 64-year- old male with unresectable stage III pancreatic adenocarcinoma who developed disseminated histoplasmosis following his third cycle of gemcitabine. He was treated with ITZ [Itraconazole] for nine months, without concurrent chemotherapy or other treatment, at which point his pancreatic cancer was reassessed and found to be resectable. Following successful surgical resection, the patient was followed for a period of four years and showed no signs of recurrence or metastatic disease. However, he later reported weight-loss and ill-health and a scan revealed a new primary cancer, shown to be NSCLC. The treating physicians assessed that the reduction in pancreatic tumour had been caused by the ITZ treatment.”

I have only seen one patient over my years in practice with a Malassezia infection.[iii]  The patient had been traveling in Asia years earlier and suddenly developed severe seborrhea.  A course of Nystatin provided significant but short-lasting relief.  A retired dermatologist, a friend of the patient, recognized the etiology and prescribed a short course on Itraconazole.  The patient experienced full relief of his symptoms and remained well for a decade.  Then just last summer, he was diagnosed with pancreatic cancer and survived only about 4 months.  Perhaps this was coincidence but if I had to do it over, I would have argued for itraconazole after he was diagnosed, regardless whether the evidence is relatively weak. 

[i]Aykut B, Pushalkar S, Chen R, et al. The fungal mycobiome promotes pancreatic oncogenesis via activation of MBL. Nature. 2019 Oct 2. 

[ii]Pantziarka P, Sukhatme , Bouche G, Meheus L, Sukhatme VP. Repurposing Drugs in Oncology (ReDO)-itraconazole as an anti-cancer agent. Ecancermedicalscience. 2015 Apr 15;9:521. 

[iii]Gupta AK, Batra R, Bluhm R, Boekhout T, Dawson TL Jr.  Skin diseases associated with Malassezia species. J Am Acad Dermatol. 2004 Nov;51(5):785-98.