In PDAC with BRCA mutation, neoadjuvant platinum-based treatment shows promise

  • Golan T & al.
  • Ann Surg Oncol
  • 20 Apr 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Neoadjuvant treatment with FOLFIRINOX (folinic acid, fluorouracil, irinotecan, oxaliplatin) is associated with a better pathologic complete response rate among patients with borderline resectable pancreatic ductal adenocarcinoma (PDAC) positive for BRCA2 mutation vs mutation negative.

Why this matters

  • The results suggest that resectable PDAC with BRCA mutations should be considered for platinum-based therapy early in the course of disease.

Study design

  • Dual-center retrospective analysis of 61 patients who underwent surgery after neoadjuvant treatment with FOLFIRINOX.
  • Funding: Authors report various financial associations with the pharmaceutical industry.

Key results

  • 39 patients underwent BRCA testing; 9 had BRCA2 germline mutations.
  • Those with germline BRCA mutations had a higher pathologic complete response than non-BRCA carriers (44.4% vs 10%; P=.009).
  • Median DFS was not reached among those with BRCA mutations, however, compared with 7 months for those without them (P=.03).
  • Median OS did not differ significantly between carriers and noncarriers.
  • During a mean follow-up of 33.7 months, 8 patients who had a pathologic complete response remained disease free.

Limitations

  • Retrospective.
  • Small population.