Multimodality therapy in metastatic pancreas cancer with a BRCA mutation and durable long-term outcome: biology, intervention, or both?

Thomas L. Sutton, Aaron Grossberg, Frederick Ey, Eileen M. O’Reilly, Brett C. Sheppard

Research output: Contribution to journalArticlepeer-review

Abstract

Metastatic pancreatic adenocarcinoma (PDAC) is a rapidly lethal disease, with less than half of patients surviving 12 months, and 5-year survival approximately 3%. These outcomes are in large part due to a lack of effective medical and surgical therapies for metastatic PDAC. Herein, we present the case of a patient with oligometastatic liver recurrence of BRCA2-mutated PDAC following a curative-intent resection. Through a combination of systemic chemotherapy, metastasectomy, radiotherapy, and subsequent targeted therapy with olaparib, the patient is asymptomatic four years following metastatic diagnosis with stable low-volume disease. This patient’s excellent outcome is attributable to the multi-disciplinary care received, all aspects of which were informed by new evidence surrounding metastasectomy for metastatic PDAC, the unique biology and medical treatment of BRCA-mutated PDAC, and the role of radiotherapy in controlling locoregional recurrence. We provide a review of this evidence, while highlighting the importance of evaluating disease biology through somatic and germline genetic testing as well as monitoring response to systemic chemotherapy.

Original languageEnglish (US)
Pages (from-to)532-536
Number of pages5
JournalCancer Biology and Therapy
Volume22
Issue number10-12
DOIs
StatePublished - 2021

Keywords

  • BRCA2
  • Pancreatic adenocarcinoma
  • cancer biology
  • complete radiographic response
  • long-term survival
  • metastasectomy
  • olaparib
  • radiotherapy

ASJC Scopus subject areas

  • Molecular Medicine
  • Oncology
  • Pharmacology
  • Cancer Research

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