In an interview during the 2017 OncLive® State of the Science SummitTM on Gastrointestinal Cancers, Eileen O’Reilly, MD, associate director for Clinical Research, David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, discussed novel therapeutic approaches for the treatment of patients with pancreatic cancer.
The last part of my talk was about where the field is going and the promising areas. The whole field of immunotherapy is a huge focus in pancreas cancer. We are trying to understand the microenvironment, why the T cells are not effective, and if we can make a tumor immune-responsive by combining immunotherapies together or combining immunotherapy with chemotherapy. There are many studies addressing these questions so that, over the next couple of years, we will understand whether there are opportunities.
Going back to the genomic story, the subset of patients with DNA-repair deficiencies that drugs, such as platinum agents and other DNA-damaging agents such as PARP inhibitors, may have a role. That concept is being developed now in pancreas cancer. There is a registrational study beyond the frontline setting looking at olaparib [Lynparza] in patients with germline-mutated pancreas cancer who have been treated with platinum-based therapy.
Germline testing is interesting. It is an emerging story in pancreas cancer. In solid tumors, we are finding that somewhere between 10% to 15% of patients with germline mutations are actionable and therapeutically important. For example, testing for BRCA, ATM, and NBN is something that we are increasingly thinking about; should we be doing this on a routine basis with pancreas cancer?
The second part of my talk touched on genomic sequencing in pancreatic cancer from the tumor perspective, meaning somatic profiling. We also discussed it from the germline perspective, meaning the family lineage opportunity. Are there findings that can have an impact in terms of treatment decision making?