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  • Pancreas cancer and BRCA: A...
    Momtaz, Parisa; O’Connor, Catherine A.; Chou, Joanne F.; Capanu, Marinela; Park, Wungki; Bandlamudi, Chaitanya; Berger, Michael F.; Kelsen, David P.; Suehnholz, Sarah P.; Chakravarty, Debyani; Yu, Kenneth H.; Varghese, Anna M.; Zervoudakis, Alice; Li, Jia; Ku, Geoffrey Y.; Park, Jennifer S.; Shcherba, Marina; Harding, James J.; Goldberg, Zoe; Abou‐Alfa, Ghassan K.; Salo‐Mullen, Erin E.; Stadler, Zsofia K.; Iacobuzio‐Donahue, Christine A.; O’Reilly, Eileen M.

    Cancer, December 1, 2021, Letnik: 127, Številka: 23
    Journal Article

    Background Patients with germline/somatic BRCA1/BRCA2 mutations (g/sBRCA1/2) comprise a distinct biologic subgroup of pancreas ductal adenocarcinoma (PDAC). Methods Institutional databases were queried to identify patients who had PDAC with g/sBRCA1/2. Demographics, clinicopathologic details, genomic data (annotation sBRCA1/2 according to a precision oncology knowledge base for somatic mutations), zygosity, and outcomes were ed. Overall survival (OS) was estimated using the Kaplan‐Meier method. Results In total, 136 patients with g/sBRCA1/2 were identified between January 2011 and June 2020. Germline BRCA1/2 (gBRCA1/2) mutation was identified in 116 patients (85%). Oncogenic somatic BRCA1/2 (sBRCA1/2) mutation was present in 20 patients (15%). Seventy‐seven patients had biallelic BRCA1/2 mutations (83%), and 16 (17%) had heterozygous mutations. Sixty‐five patients with stage IV disease received frontline platinum therapy, and 52 (80%) had a partial response. The median OS for entire cohort was 27.6 months (95% CI, 24.9‐34.5 months), and the median OS for patients who had stage IV disease was 23 months (95% CI, 19‐26 months). Seventy‐one patients received a poly(adenosine diphosphate ribose) polymerase (PARP) inhibitor (PARPi), and 52 received PARPi monotherapy. For maintenance PARPi, 10 patients (36%) had a partial response, 12 (43%) had stable disease, and 6 (21%) had progression of disease as their best response. Six patients (21%) received maintenance PARPi for >2 years. For those with stage IV disease who received frontline platinum, the median OS was 26 months (95% CI, 20‐52 months) for biallelic patients (n = 39) and 8.66 months (95% CI, 6.2 months to not reached) for heterozygous patients (n = 4). The median OS for those who received PARPi therapy was 26.5 months (95% CI, 24‐53 months) for biallelic patients (n = 25) and 8.66 months (95% CI, 7.23 months to not reached) for heterozygous patients (n = 2). Conclusions g/sBRCA1/2 mutations did not appear to have different actionable utility. Platinum and PARPi therapies offer therapeutic benefit, and very durable outcomes are observed in a subset of patients who have g/sBRCA1/2 mutations with biallelic status. In a cohort of 136 patients with pancreas cancer and a germline or somatic BRCA mutation, the median overall survival is 27.6 months (95% CI, 24.9‐34.5 months) for the entire cohort and 23 months for the stage IV cohort (n = 81). Biallelic zygosity enriches the response to platinum and poly(adenosine diphosphate ribose) polymerase inhibitor therapies.