Can Precision Medicine Work for Pancreatic Cancer

By Staff Writer - April 03, 2019

Precision Medicine is a hot topic in the cancer community. Clinicians and researchers are shifting their treatment approach to provide the right treatment to the right patient at the right time and with the right dose. Immunotherapies and drugs that target specific genetic mutations are an example of this approach.

Melanoma and lung cancer have had success with PD-L1 targeted therapies, and breast cancer therapies can target BRCA genes. Now, scientists are trying to determine if this approach will work for pancreatic cancer.

Pancreatic cancer is a rare cancer, but is one that is difficult to treat. One of the reasons is that there are several subtypes of the disease, including a homologous recombination deficient (HRD) which exhibits mutations in BRCA1, BRCA2 and PALB2 genes. But this HRD subtype, which represents five to eight percent of pancreatic cancer patients, could provide potential for a more targeted therapy.   

A new study presented at the American Association for Cancer Research Annual Meeting investigated the use of PARP inhibitors as a maintenance therapy for pancreatic cancer patients with BRCA1, BRCA2 or PALB2 mutations.

PARP inhibitors are a type of targeted therapy that block a protein that helps repair DNA when it becomes damaged. This can keep cancer cells from repairing themselves once they’ve been damaged by chemotherapy, resulting in cancer cell death. Since the therapy is targeted, healthy cells are not affected. The Food and Drug Administration has approved PARP inhibitors as a maintenance therapy in breast and ovarian cancers.

In the pancreatic cancer study, led by the University of Pennsylvania Abramson Cancer Center, patients were given four months of a platinum-based chemotherapy. If disease did not progress, chemotherapy was stopped and patients were given the PARP inhibitor rucaparib.  Results found that patients were able to maintain disease control and some saw their tumors continue to shrink.

Dr. Dae Won Kim, medical oncologist

“The standard of care for patients in this group would be platinum-based chemotherapy for an extended period of life. While it works to shrink tumors, it can be toxic and affect a patient’s quality of life,” said Dr. Dae Won Kim, a medical oncologist in Moffitt Cancer Center’s Gastrointestinal Oncology Program. “This study is proposing a new approach to treating pancreatic patients with the HDR subtype. While the results have shown patients respond to the therapy with less side effects and toxicity, it is important to point out this is a small study with only 30 patients. More study of this therapy is needed.”

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