COMMENTARY

PARP Inhibitors Hold Promise in Pancreas Cancer

Eileen O'Reilly, MD, MB BCh

Disclosures

June 17, 2013

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Pancreas Cancer Increasing Worldwide

Hello. I am Dr. Eileen O'Reilly, a gastrointestinal medical oncologist at Memorial Sloan-Kettering Cancer Center in New York, and Associate Professor of Medicine at Weill Cornell Medical College. Welcome to this edition of Medscape Oncology Insights, presented in association with Memorial Sloan-Kettering Cancer Center.

Here at the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO®), we continue to investigate new strategies to improve outcomes in gastrointestinal cancers. Today I want to speak to you about pancreatic cancer.

About 45,000 people are anticipated to be diagnosed with pancreas cancer in the United States in 2013, and about 200,000 people will be diagnosed worldwide. This cancer is increasing in incidence at the rate of about 1.5% per year. It is currently predicted to be an ever more increasing public health problem because of these rising incidence rates and mortality rates. This is in contradistinction to many of the other common solid tumors, such as breast, colorectal, and prostate cancer, where incidence rates have leveled off and even in some cases have started to decline.

BRCA Mutations Contribute to Risk

Risk factors for pancreas cancer are relatively few, and some are well defined, such as older age. The average age at diagnosis in North America is 72 years, and the risk increases substantially after the age of 50 years. Smoking is also associated with pancreas cancer. Long-standing conditions of the pancreas --diabetes and chronic pancreatitis -- account for a small percentage increase in pancreas cancer.

For most people, we don't know why they develop this disease. For about 7%-10%, there may be a genetic predisposition to this cancer. The BRCA1 and BRCA2 genes are associated with an increased risk for pancreas cancer. These genes probably account for 5%-8% of pancreas cancer, and their association with pancreas cancer is not as well known as it is for breast and ovary cancer and other malignancies. There are implications for familial screening for this disease for carriers of BRCA1 and BRCA2 mutations, particularly if pancreas cancer has been present in the family. There may also be emerging therapeutic implications for this disease.

People with pancreas cancer who might harbor a BRCA mutation are those with a family history of pancreas cancer, ovarian cancer, breast cancer, and other malignancies. People who have eastern European Ashkenazi Jewish heritage also have a higher chance of carrying a BRCA mutation.

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