An emerging entity: pancreatic adenocarcinoma associated with a known BRCA mutation: clinical descriptors, treatment implications, and future directions.

Published

Journal Article

BACKGROUND: BRCA1 and BRCA2 germline mutations are associated with an elevated risk for pancreas adenocarcinoma (PAC). Other BRCA-associated cancers have been shown to have greater sensitivity to platinum and poly(ADP-ribose) polymerase (PARP) inhibitors with better clinical outcomes than in sporadic cases; however, outcomes in BRCA-associated PAC have not been reported. METHODS: Patients with a known BRCA1 or BRCA2 mutation and a diagnosis of PAC were identified from the Gastrointestinal Oncology Service, Familial Pancreas Cancer Registry, and Clinical Genetics Service at Memorial Sloan-Kettering Cancer Center. RESULTS: Fifteen patients, five male, with a BRCA1 (n = 4) or BRCA2 (n = 11) mutation and PAC and one patient with a BRCA1 mutation and acinar cell carcinoma of the pancreas were identified. Seven female patients (70%) had a prior history of breast cancer. Four patients received a PARP inhibitor alone or in combination with chemotherapy; three demonstrated an initial radiographic partial response by Response Evaluation Criteria in Solid Tumors whereas one patient had stable disease for 6 months. Six patients received platinum-based chemotherapy first line for metastatic disease; five of those patients had a radiographic partial response. CONCLUSION: BRCA mutation-associated PAC represents an underidentified, but clinically important, subgroup of patients. This is of particular relevance given the ongoing development of therapeutic agents targeting DNA repair, which may potentially offer a significant benefit to a genetically selected population. We anticipate that further study and understanding of the clinical and biologic features of BRCA-mutant PAC will aid in the identification of tissue biomarkers indicating defective tumor DNA repair pathways in sporadic PAC.

Full Text

Duke Authors

Cited Authors

  • Lowery, MA; Kelsen, DP; Stadler, ZK; Yu, KH; Janjigian, YY; Ludwig, E; D'Adamo, DR; Salo-Mullen, E; Robson, ME; Allen, PJ; Kurtz, RC; O'Reilly, EM

Published Date

  • January 2011

Published In

Volume / Issue

  • 16 / 10

Start / End Page

  • 1397 - 1402

PubMed ID

  • 21934105

Pubmed Central ID

  • 21934105

Electronic International Standard Serial Number (EISSN)

  • 1549-490X

International Standard Serial Number (ISSN)

  • 1083-7159

Digital Object Identifier (DOI)

  • 10.1634/theoncologist.2011-0185

Language

  • eng