56-Year-Old Male
BRCA SOMATIC RESULTS

 “This case brings up two treatment decisions. What chemotherapy and what, if any, maintenance therapy?” – Dr. Paul Walker, Chief Medical Officer, Former Director of Thoracic Oncology at East Carolina University

 In germline BRCA-mutated advanced pancreatic cancers, it is clearly established that platinum-based chemotherapy and maintenance PARP inhibitors can be notably effective. In the POLO trial published in the NEJM July 2019 issue, there was a significant progression-free survival and prolonged median duration of response of 25 months with the use of the maintenance PARP inhibitor Olaparib. FOLFIRINOX or cisplatin-gemcitabine with notable response and disease control rates of 70% and 100% in germline BRCA patients would be the recommended chemotherapy approaches over gemcitabine-abraxane.

 In this case, there is a somatic BRCA1 mutation along with three other ctDNA mutations not yet having any known effective targeted therapy approach. Somatic BRCA-mutated patients showed a similar PR with one CR benefit of the PARP inhibitor Rucaparib after previous chemotherapy in platinum-sensitive disease supporting the use of maintenance PARP inhibitor in this patient.

 “Not to be overlooked is the benefit of plasma NGS monitoring of treatment response and potential actionable resistance pathways to keep going forward with his best possible treatment and outcome.”

 Sources:
– Dr. Paul Walker, Chief Medical Officer, Former Director of Thoracic Oncology at East Carolina University
– J Clin Oncol 38:1378-1388. © 2020 by American Society of Clinical Oncology
– N Engl J Med 2019;381:317-27. DOI: 10.1056/NEJMoa1903387
– ascopubs.org/journal/po JCO™ Precision Oncology