ICARE Newsletter Winter 2013

The Selection of Chemotherapy in BRCA Patients with Pancreatic Cancer

Some evidence suggests that individuals with BRCA mutations who develop pancreatic cancer may benefit from specific chemotherapy regimens. In a recent review of this topic, Kim et al reported on a study of 5 patients with BRCA mutations (4 BRCA2 and 1 BRCA1) who were treated with a platinum-based chemotherapy regimen.1 Of these patients, 3 had advanced disease and all had some response to platinum; an additional 2 patients had resectable and locally advanced disease, both of whom were downstaged after receiving platinum as part of their treatment and eventually underwent resection of their tumor. Another study was conducted based on 15 BRCA carriers with pancreatic cancer.2 Of these patients, 4 received a PARP inhibitor alone or in combination with chemotherapy, of which 3 demonstrated an initial radiographic response and one patient had stable disease for 6 months. Six patients received platinum-based chemotherapy as first line treatment for metastatic disease, of whom five had a radiographic partial response.

These studies add to the limited literature to suggest that therapeutic agents that target DNA repair (e.g., PARP inhibitors, Platinum-based agents) may offer benefit when treating BRCA-associated pancreatic cancers, even in advanced stages. However, the numbers reported remain very small and it is critical to perform prospective studies in individuals with BRCA-associated pancreatic cancers to truly determine the efficacy of targeted therapies.   

1. Kim R, et al. JOP. 2012 Mar 10;13(2):180-1. 2. Lowery MA, et al. Oncologist. 2011;16(10):1397-402.