ASCO 2019 — Expert Commentary: Always test for BRCA in metastatic pancreatic cancer

  • Debra Gordon
  • Oncology Conference reports
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Below is an excerpt from an on-site interview with Hedy L. Kindler, MD, professor of medicine, University of Chicago Medicine, Illinois, regarding the study she presented at ASCO demonstrating that olaparib delays progression in BRCA+ pancreatic cancer.

  • "This is the first biomarker-directed, targeted therapy that has shown activity in a randomized trial for this disease. Now we can finally target a very specific select biomarker in a subset of patients and provide them with a strategic approach of front-line therapy followed by maintenance olaparib to help maintain quality of life and really offer benefit."
  • "What I find truly remarkable in this study is that a quarter of patients had a complete or partial response to olaparib, and for those patients, the median duration of response was more than 2 years. This is a disease where the median survival is under 1 year with the most active contemporary chemotherapy regimens. That is truly remarkable."
  • "I have a patient diagnosed with metastatic pancreatic cancer, which his brother died from. His prognosis was less than a year. He came to me and said, 'I don't want my family to watch me die. Can we do something better?' He had the germline mutation and enrolled in the trial. That was 2 and a half years ago. [On] every CT scan we see his tumor shrinking more and more. He’s leading a normal life and takes his pills twice a day. He feels he has transformed his cancer into a chronic disease."
  • "This study demonstrates a new way of thinking about drug development. We screened 3315 patients in 12 countries for this study, to find the 7.5% of patients who had this biomarker. They do that [type of screening] in lung and other cancers all the time. But this is the first true precision medicine approach in this disease. Yes, it takes effort. But maybe we need to rethink how we look at pancreatic cancer and try to target other biomarkers."
  • "The first change in practice is that all patients with metastatic pancreatic cancer should have germline testing at diagnosis. This has already changed our practice. It used to be that the patient came to the clinic and as part of the discussion we took a family history. If there was a strong family history, we suggested seeing the genetic counselor. Now that we know a germline mutation will impact both frontline and maintenance therapy, since these tumors are much more sensitive to platinum drugs, someone at our clinic does germline testing at diagnosis to help us plan treatment."