One of the most exciting trials was actually the study in metastatic pancreas cancer. We all know pancreas cancer is very difficult to treat, most patients do not survive one year. In pancreas cancer we are missing very new targeted agents so this trial looked for patients who had a mutation in BRCA1 or BRCA2, germline. Only a few percentages of patients do have it but that may be very important for outcome. We already know that they are more sensitive to platinum based chemotherapies but this study took, for the first time, a targeted agent and integrated it into the treatment of these patients with metastatic disease.

What they did was very smart, they used chemotherapy first and then randomised to a PARP inhibitor, because PARP inhibitors are very well known to be very effective when you have a BRCA1 or a BRCA2 mutation; they use it as a maintenance. Now, this is smart for a lot of reasons because it’s an easy treatment to give, it’s a pill, and the side effects are not a lot. So these patients will have not only a break from cytotoxic chemotherapy but potentially a very powerful treatment.

It was randomised to placebo and what was shown was that the time to progression using these PARP inhibitors was twice as much – from 3.9 to 7.8 months which is amazing in metastatic pancreas cancer. Then you could go back to chemotherapy.

So this is the first biomarker driven clinical trial using information of the genetic make-up of the tumour and using a targeted agent to extend the potential efficacy profile of metastatic colon cancer in addition to chemotherapy.