Not All Pancreatic Cancers are the Same: Some Have Treatable Mutations

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https://medicalresearch.com/cancer-_-oncology/not-all-pancreatic-cancers-are-the-same-some-have-treatable-mutations/42910/

MedicalResearch.com Interview with:

Michael J. Pishvaian, MD, PhD Phase I Program Director Assistant Professor Lombardi Comprehensive Cancer Center Washington, DC 20007

Dr. Pishvaian

Michael J. Pishvaian, MD, PhD
Phase I Program Director
Assistant Professor
Lombardi Comprehensive Cancer Center
Washington, DC 20007

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: Pancreatic cancer is a deadly disease and will soon be the second leading cause of cancer-related death.

We have made some progress in the last few years….but despite this, patients with advanced, inoperable pancreatic cancer (which represents about 80% of pancreatic cancer patients) still only live 12 months, on average. We desperately need new therapies, AND to think “outside the box” for the treatment of pancreatic cancer.

In that context, we have been learning that there are subgroups of patients with cancer whose tumors are particularly susceptible to certain therapies – either new therapies, or in some cases, approved therapies that would have not normally been used for that disease.  These specific patient subgroups with “actionable” findings have been identified through extensive genetic and molecular characterization of a patient’s tumor.

In the past there was a cynical perspective that pancreatic cancer did not harbor any “actionable” molecular abnormalities.

We have now demonstrated that:

1) There are clearly and undeniably patients with pancreatic cancer whose tumors do indeed harbor “actionable” findings.  This represents at least 27% of pancreatic cancer patients, but may represent up to 50% as new therapies evolve.  These percentages are also highly consistent with similar publications in the pancreatic cancer field over the last few years; and

2) Importantly, we have been following our patients longitudinally for outcomes, and while it is still early, there is a statistically significant improvement in progression-free survival when a patient with a specific actionable molecular abnormality is treated with the appropriately “targeted” therapy.  This finding is also consistent with findings that have been observed in other cancer types.  

MedicalResearch.com: What should readers take away from your report? 

Response: That there are unquestionably pancreatic cancers that harbor molecular abnormalities that may predict for a benefit to response to therapy – including and especially therapies that might not have otherwise been considered for a typical pancreatic cancer patients.  So….it is imperative that physicians actually test patient’s tumors. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: There are an infinite number of additional scientific questions that should be asked and explored as a result of our findings.  But the most important is, can we prove that molecular testing actually improves patient survival.

Another important question is what about the 50-75% of patients whose tumors do not have highly actionable abnormalities?  There must be something “driving” those cancers…..maybe we need to expand our testing platforms to reveal potentially more “actionable” findings.

Disclosures: My primary disclosure is that I am a paid consultant for Perthera, in addition to my academic role as a GI medical oncologist, and pancreatic cancer specialist.

Citation:

CCR: Personalized Medicine and Imaging

Molecular Profiling of Pancreatic Cancer Patients: Initial Results from the Know Your Tumor Initiative

Michael J. Pishvaian, Robert J Bender, David Halverson, Lola Rahib, Andrew E. Hendifar, Sameh Mikhail, Vincent Chung, Vincent J Picozzi, Davendra Sohal, Edik M Blais, Kimberly Mason, Emily E. Lyons, Lynn M Matrisian, Jonathan R. Brody, Subha Madhavan and Emanuel F. Petricoin

DOI: 10.1158/1078-0432.CCR-18-0531 

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