Comment: It is essential to identify the BRCA gene in pancreatic cancer patients allowing them to be treated with an oral agent

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Published: 2 Jun 2019
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Dr Suzanne Cole - UT Southwestern Medical Center, Dallas, USA

Dr Suzanne Cole comments on data, during a press conference at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting, from the Polo trial.

This was a phase III randomised trial in which olaparib was administered to patients with BRCA-related pancreatic cancer who had not progressed after initial chemotherapy and compared with placebo.

Watch Dr Kindler's press conference here, and interview here

This is a really huge step forwards for patients with metastatic pancreatic cancer. This is the first time that a targeted medication has been successful in stopping the growth of metastatic pancreatic cancer in people who carry the BRCA mutation. More patients with metastatic pancreatic cancer who also had a BRCA mutation saw their disease go dormant when they received the olaparib. At two years 20% of patients were still alive with excellent disease control because they were taking the olaparib.

Now that we have a targeted medication that can benefit patients who have the BRCA mutation when they present with metastatic pancreatic cancer it is our duty to search for this genetic mutation in all patients with metastatic pancreatic cancer so that we can identify those people who have the BRCA mutation and can benefit from being treated with an oral agent that can extend their life.

Just to put this into context for you, I’d like to tell you about a patient of Dr Kindler’s who enrolled on the POLO study. He was diagnosed with pancreatic cancer and at the time of diagnosis it had already spread into his liver. He had inherited the BRCA mutation, as had his brother, and he had recently seen his brother die of metastatic pancreatic cancer within a few months of his diagnosis. Because this patient wanted to have a different outcome than what had happened to his brother he decided to enrol on a clinical trial to see if he could get a better outcome. So he got onto the POLO study, he received chemotherapy for about four months and then he was able to move over to the olaparib, which is a pill, and he has now been alive for 2½ years and not only have the tumours in his liver stabilised they’ve actually decreased in size. He has had really excellent quality of life because he has been free of taking IV chemotherapy over this time.

So this is practice changing for people who have the BRCA mutation. I can’t wait to go back to clinic on Tuesday and look for it in my own patients. And congratulations, I think this is a fantastic step forward.

Dr Richard Schilsky

Thank you so much, Suzanne. I just want to ask you one quick question before we… A couple of housekeeping issues. So, first of all, when we open the questions we’re going to take questions about the POLO trial first because Dr Cole has to leave for another engagement. So I’m going to ask those of you who want to ask a question about the POLO trial to come to a microphone now while I’m asking you one other question about what is the role of ascertaining the family history in determining whether or not to do germline BRCA testing in these patients?

Dr Suzanne Cole

I think that it’s good medical practice to pay attention to what’s going on in the family and whether there are cancers that we know are related to BRCA mutations such as breast cancer, ovarian cancer or prostate cancer and now pancreatic cancer to tip you off that you may need to be searching for the BRCA mutation in your own patient, especially in light of this new data that may really extend their time alive.