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/ Source: TODAY
By A. Pawlowski

Alex Trebek is not done with chemotherapy yet. The "Jeopardy!" host, who has been receiving treatment for stage 4 pancreatic cancer, shared a more sobering health update on Tuesday.

“This summer, because I was making such good progress, we thought I was finished with chemo," Trebek said in a video posted on YouTube. "That was a bit premature and certainly overoptimistic. I began immunotherapy, but that didn't go well. My numbers went south — dramatically and quickly.”

“The doctors are now re-examining my situation and, it appears, I will be having more chemo treatments ahead of me," he continued. "Hey, they worked very well the first time, so we're expecting good results again.”

Trebek, 79, revealed his diagnosis in March and vowed to beat the odds for surviving pancreatic cancer, which often comes with a grim prognosis. More than 90% of patients die within five years of learning they have the disease, according to the American Cancer Society.

In May, Trebek said his doctors told him he was in “near remission.” He returned to work last month after announcing he was done with chemo and “on the mend.”

Trebek addressed the ups and downs of his diagnosis in his latest update.

“One of the things I have learned in the past six months is that the course of pancreatic cancer treatment is not a straightforward affair," he said. "There are always curves and unexpected events."

Feelings of depression, anxiety and fear are very common for cancer patients, who are dealing with changes in their body, physical symptoms and an uncertain prognosis, the American Cancer Society noted.

However, patients with more social support tend to feel less anxious and depressed, the organization added, and Trebek has been outspoken about how the many warm messages from his fans have kept his spirits up.

“Please keep me in your good thoughts and prayers," he said. "It really means a lot."

It’s common for pancreatic cancer patients to receive chemotherapy. Immunotherapy — which tries to activate the patient's own immune system to attack cancer cells — has been “underwhelming” in treating this kind of cancer, said Dr. Suneel Kamath, a gastrointestinal oncologist at Cleveland Clinic. He is not involved in Trebek case.

Only 1 to 2% of people with pancreatic cancer have a particular gene change in a tumor, which is when treatment with immunotherapy is more successful, Kamath added.

When Trebek noted his “numbers went south,” he may have been talking about tumor markers such as CA 19-9. About 85% of pancreatic cancers will show this blood marker, so doctors follow that number along with monitoring imaging tests, Kamath noted.

“It’s not a good sign,” he told TODAY. “That blood marker is often the first sign … the cancer has really come back.

“Even if you treat it and everything on the scan is gone — you don’t see a tumor there — we know it’s a microscopic disease, so it’s lurking in the blood," he continued. "That tumor marker, when it goes up, it’s the first sign the cancer is getting really active in the blood.”

It’s standard for patients to receive more chemotherapy when this happens to get cancer back under control, he noted. It could be the same type of chemo Trebek received the first time, or a different kind.

“This is a time where he probably needs a really good response,” Kamath said.

Why pancreatic cancer is so deadly:

The early stage of the disease often causes no symptoms, so it's usually caught only when the cancer becomes large and spreads outside of the gland — as was the case with Trebek. The gland is also hidden behind other organs including the stomach, small intestine, liver, gallbladder, spleen and bile ducts.

"Unfortunately, pancreatic cancer is one of the most aggressive cancers," said Dr. Dae Kim, a gastrointestinal oncologist at Moffitt Cancer Center in Tampa, Florida.

He was also not involved in Trebek's case, but noted the game show host may have tried immunotherapy as part of a clinical trial or because he may be one of the 1 to 2% of patients who have that special genetic mutation.

When tumors come back after a round of treatment, people often experience loss of appetite and weight loss, he added.

The average survival time for a patient with pancreatic cancer that has spread is a year or less after diagnosis, Kamath said.

"Most patients just want to know what's happening so that they can prepare for the time they have," he noted.