Therapeutic Opportunities Often Missed In Pancreatic Cancer

Although a substantial minority of patients with pancreatic cancer are candidates for survival-enhancing molecularly tailored therapy, few currently receive such treatment, according to a new analysis.

"Over the last few years, several groups, including ours, have thought that about 25% of pancreatic cancer patient tumors harbor 'actionable' mutations," Dr. Michael J. Pishvaian of The University of Texas MD Anderson Cancer Center, in Houston, told Reuters Health by email.

"We now show," he added, "that if those patients are treated with the appropriately targeted therapy, they live a full year longer, when compared to similar patients who do not receive appropriately targeted therapy."

Dr. Pishvaian and colleagues examined data on more than a thousand participants in the Know Your Tumor (KYT) program who had received molecular-testing results.

Actionable molecular alterations were identified in 282 (26%) of 1,082 samples, the team reports in The Lancet Oncology. Of the 677 patients for whom outcomes were available, 189 had such alterations. But only 46 of these patients (26%) received molecularly matched therapy.

Median survival in the latter group was significantly greater than in those who did not receive matched therapy (2.58 vs 1.51 years). There were similar findings when the 46 patients were compared with 488 patients who did not have an actionable molecular alteration.

"What this tells us," continued Dr. Pishvaian, "is that in the face of a devastating disease, we have to test all of our pancreatic-cancer patients. And for the 25% of patient who have these actionable alterations, we have to get them on the right therapy, whether on label, off label, or through a clinical trial."

"We as clinical researchers also need to design trials that are focused just on the specific biomarker subgroups of pancreatic-cancer patients, in the hopes of getting rapid therapy approval—so that doctors don't have to fight so hard to get their patients the right treatment," he concluded.

Dr. Joerg Kleeff of Martin-Luther University Halle-Wittenberg, in Germany, the coauthor of an accompanying editorial in The Lancet Oncology, told Reuters Health by email, "These findings are important in that they define an estimation of the current number of potentially actionable targets and in that they provide a rather disappointing real-world assessment of the number of pancreatic-cancer patients who actually received molecularly targeted treatment."

—David Douglas

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