COMMENTARY

PARP Inhibitors Hold Promise in Pancreas Cancer

Eileen O'Reilly, MD, MB BCh

Disclosures

June 17, 2013

In This Article

Now, 2 Options in Advanced Disease

Moving now to the bigger landscape of pancreas adenocarcinoma, there were some exciting developments at this meeting. Dr. Von Hoff and colleagues[3] updated their data on a randomized phase 3 trial looking at gemcitabine and nab-paclitaxel compared with gemcitabine alone in patients with newly diagnosed, untreated metastatic pancreas cancer who have a good functional status and a Karnofsky Performance Status score of 70 or higher. These data were presented earlier this year and showed an improved tumor response disease control and extension of life for the cytotoxic combination of gemcitabine and nab-paclitaxel. That is an exciting development in this field because it leads to a new option for treatment for patients with pancreas cancer.

The recent development of a combined infusion of 5FU, irinotecan, oxaliplatin, and leucovorin (FOLFIRINOX) has also shown significant activity in advanced pancreas cancer.[4,5]We now have 2 active treatment choices to weigh out for patients. Another point of interest with gemcitabine and nab-paclitaxel is that these agents may provide cytotoxic building blocks on which to add novel agents in this disease, and there are multiple non-oncolytic agents in development in pancreas cancer targeting a variety of pathways.

Summary

To sum up, we have reviewed the role of BRCA mutations and the relationship with pancreas cancer in terms of increased risk for this disease, the screening implications for families who have the BRCA mutations, and the possible therapeutic opportunities using platinum, topoisomerase inhibitors, and PARP inhibitors (not yet approved by the US Food and Drug Administration). We have also reviewed some of the emerging developments in the treatment of metastatic pancreas cancer, in particular the data supporting gemcitabine and nab-paclitaxel. Combined with the recently presented data on FOLFIRINOX in advanced disease, we have a new array of treatment options for patients with advanced pancreas cancer.

We have also reviewed possible opportunities for adding novel targeted agents to some of these cytotoxic backbones, and there is a series of trials in advanced pancreas cancer exploring, for example, the addition of notch inhibitors, anti-metastatic agents, and other agents in late-stage disease.

Thank you for joining me for this edition of Medscape Oncology Insights. This is Eileen O'Reilly at ASCO 2013.

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