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- Title
An Emerging Entity: Pancreatic Adenocarcinoma Associated with a Known BRCA Mutation: Clinical Descriptors, Treatment Implications, and Future Directions.
- Authors
Lowery, Maeve A.; Kelsen, David P.; Stadler, Zsofia K.; Yu, Kenneth H.; Janjigian, Yelena Y.; Ludwig, Emmy; D'Adamo, David R.; Salo-Mullen, Erin; Robson, Mark E.; Allen, Peter J.; Kurtz, Robert C.; O'Reilly, Eileen M.
- Abstract
Background. BRCA1 and BRCA2 germline mutations are associated with an elevated risk for pancreas adenocarcinoma (PAC). Other BRCA-associated cancers have been shown to have greater sensitivity to platinum and poly-(ADP-ribose) polymerase (PARP) inhibitors with better clinical outcomes than in sporadic cases; however, outcomes in BRCA-associated PAC have not been reported. Methods. Patients with a known BRCA1 or BRCA2 mutation and a diagnosis of PAC were identified from the Gastrointestinal Oncology Service, Familial Pancreas Cancer Registry, and Clinical Genetics Service at Memorial Sloan-Kettering Cancer Center. Results. Fifteen patients, five male, with aBRCA1(n=4) or BRCA2 (n =11) mutation and PAC and one patient with a BRCA1 mutation and acinar cell carcinoma of the pancreas were identified. Seven female patients (70%) had a prior history of breast cancer. Four patients received a PARP inhibitor alone or in combination with chemotherapy; three demonstrated an initial radiographic partial response by Response Evaluation Criteria in Solid Tumors whereas one patient had stable disease for 6 months. Six patients received platinum-based chemotherapy first line for metastatic disease; five of those patients had a radiographic partial response. Conclusion. BRCA mutation-associated PAC represents an underidentified, but clinically important, subgroup of patients. This is of particular relevance given the ongoing development of therapeutic agents targeting DNA repair, which may potentially offer a significant benefit to a genetically selected population. We anticipate that further study and understanding of the clinical and biologic features of BRCA-mutant PAC will aid in the identification of tissue biomarkers indicating defective tumor DNA repair pathways in sporadic PAC.
- Subjects
ADENOCARCINOMA; ENZYME inhibitors; PANCREATIC tumors; LONGITUDINAL method; GENETIC mutation; SURVIVAL analysis (Biometry); BRCA genes; CONTINUING education units; RETROSPECTIVE studies; GENETICS
- Publication
Oncologist, 2011, Vol 16, Issue 10, p1397
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2011-0185