ASO Author Reflections: Pancreatic Cancer Patients with Germline BRCA Mutations Benefit from Early Introduction of Plati
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Pancreatic Cancer Patients with Germline BRCA Mutations Benefit from Early Introduction of Platinum-Based Chemotherapy Talia Golan1,2, Alex Barenboim2,3, and Nir Lubezky2,3 Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel; 2Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; 3Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
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PAST The best chance for prolonged survival or cure in patients with pancreatic ductal adenocarcinoma (PDAC) is multimodal treatment that includes chemotherapy and curative resection. In recent years, FOLFIRINOX has proved to be the most efficacious chemotherapeutic regimen, with an unprecedented median survival rate of 54% when administered as adjuvant treatment following curative resection.1 Recent data also indicate that some patients with borderline-resectable pancreatic cancer (BRPC) benefit from neoadjuvant FOLFIRINOX, and that surgical resection in patients who exhibit significant response to chemotherapy is more likely to result in margin-negative resection and improved survival.2,3 However, there are currently no identifiable biomarkers that predict which patients will respond to neoadjuvant treatment. PRESENT In the present study,4 we show that patients with BRPC who are germline BRCA mutation carriers have an increased response to neoadjuvant FOLFIRINOX, with 44.4% of our study group exhibiting pathologic complete response (PCR). This is one of the highest percentages of response to neoadjuvant treatment reported to date, being significantly higher than that reported in patients with sporadic PDAC (10%). The improved pathologic response
Ó Society of Surgical Oncology 2020 First Received: 3 April 2020 N. Lubezky e-mail: [email protected]
rate translated into prolonged disease-free survival (DFS) and overall survival (OS), as all patients with PCR were disease free after a mean follow-up interval of 33.7 months (range 11–53 months). FUTURE The role of neoadjuvant chemotherapy in resectable pancreatic cancer needs to be further evaluated in ongoing randomized controlled studies. Until such studies confirm the advantage of neoadjuvant FOLFIRINOX in all resectable PDAC patients, we need to select patients who are more likely to benefit from neoadjuvant treatment. Anatomic criteria, such as those that limit our ability to perform margin-negative resection, are an example of such criteria. Based on our data, we conclude that patients with BRCA germline mutation are a unique group who are likely to benefit from early introduction of platinum-based chemotherapy in the course of their disease.
AUTHOR CONTRIBUTIONS Talia Golan: receipt of grants/research supports: Astra Zeneca and MSD Merck; receipt of consultation fees: Abbvie, Astra Zeneca, Teva. Bayer, and MSD Merck; receipt of speakers bureau: Abbvie and Bioline; travel: Astra Zeneca and MSD Merck.
REFERENCES 1. Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 20
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