AACR 2019—Rucaparib maintenance shows benefit in pancreatic cancer


  • Keren Landman, MD
  • Univadis
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Takeaway

  • In patients with pancreatic cancer with BRCA or PALB2 mutations, the poly (ADP-ribose) polymerase (PARP) inhibitor rucaparib demonstrated promising antitumor activity and low toxicity.

Why this matters

  • 5%-8% of patients with pancreatic cancer have BRCA or PALB2 mutations associated with tumor susceptibility to cumulatively toxic platinum chemotherapies and, possibly, PARP inhibitors. 
  • Germline testing is now recommended for all pancreatic cancers.

Study design

  • Interim analysis of data from 19 of 24 enrollees in a single-arm, phase 2 rucaparib maintenance trial (42 patients planned).
  • All had received ≥16 weeks of platinum chemotherapy without progression.
  • Funding: Clovis Oncology, Basser Young Leadership Council/Center for BRCA.

Key results

  • Median PFS was 9.1 months at median 8.5-month follow-up.
  • Median OS not reached at 8.1-month follow-up.  
  • Overall response rate was 37.8% (6 partial responses [PRs], 1 complete response), representing 41.1% of those with measurable baseline disease.
  • Disease control rate (response + stable disease) was 89.5% for at least 8 weeks.
  • For some patients, threshold of PR not reached until 4-6 months, suggesting true rucaparib response rather than delayed platinum effect.
  • The most common toxicities were nausea, fatigue, dysgeusia, alanine aminotransferase increase, and diarrhea.
    • Unclear whether due to rucaparib or preceding chemotherapy.
  • No grade ≥3 toxicities. 

Limitations

  • Small sample size, no control group.

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