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Precision Medicine and the Future of Pancreatic Cancer

Panelists: Johanna Bendell, MD, Sarah Cannon Research Institute; Eileen O’Reilly, MD, Memorial Sloan-Kettering Cancer Center; John Marshall, MD, Ruesch Cancer Center at the Lombardi Comprehensive Cancer Center; George Kim, MD, University of Florida Health Oncology; Caio Max S. Rocha Lima, MD, Gibbs Cancer Center
Published: Thursday, Mar 30, 2017



Transcript:

Johanna Bendell, MD:
Eileen, you’ve done some amazing research with the BRCA patients. Tell us a little bit about BRCA mutations in pancreas cancer, of all things.

Eileen O’Reilly, MD: I think this is another exciting area that applies, at least to a subset of people with pancreas cancer. So, we know that in an unselected 100 patients with pancreas cancer, anywhere from 5 to 8 will have an underlying germline BRCA mutation. Maybe an additional 3%, 4%, or 5% will have a somatic BRCA mutation. And 2 observations have been made: one is that platinum drugs have an important role here. I think that based on expert opinion, not randomized data, this would suggest that using those drugs in patients whom we know harbor one of these mutations might be therapeutically important. I think the other area where there’s a lot of development is PARP inhibitors. We have PARP inhibitors being evaluated frontline in combination with platinum-based therapy, but also being evaluated as a maintenance strategy in germline BRCA following disease control with platinum-based treatment. But just thinking about the broader group of patients with pancreas cancer, we know there are a number of other germline defects that occur, and ATM is pretty common, as well as ATR, and other genes. And it’s possible that maybe combinations of PARP inhibitors, and other strategies or PARP in immune therapies, may have a role in this subset.

So, I think there’s a lot of interest in exploring this theme in pancreas cancer. We’re clearly not there yet, but, again, I think we’ll hopefully begin to identify some groups of patients where we can refine treatment choices that are rational based on characteristics of their disease or genomics in pancreas cancer. That will be, in my opinion, an important step in this disease.

Johanna Bendell, MD: There’s so much happening. Lots of research going on. Different targets. I’ve also heard about STAT-free inhibitors trying to target the cancer stem cells being looked at for pancreas cancer—so trying to approach it from all different angles and aspects. George, any last thoughts on trials that you think are interesting?

George Kim, MD: Well, it’s what we said earlier. I think we still have a lot of work to do. We’ve got to get these trials accrued. We’ve got to support the Intergroup trials and continue to move the field forward. I think we still have a lot of work to do. Patients are demanding it, and we need to come to the plate.

Johanna Bendell, MD: Well, I think this has been extremely informative. Before we end this discussion, I’d like to get some final thoughts from each of our panelists. So, George, I’m going to hit back to you again. Any last thoughts, outside of what you just said?

George Kim, MD: I enjoyed being here. It’s fun. There’s a lot of banter and a lot of expertise, but I hope it’s helpful. And, again, hopefully we’re helping our patients. I’d just like to remind everybody that you’ve got to manage these folks—nutrition, pain control, diabetes, intestinal issues, and psychosocial issues. This is all very important. And then, it’s important to run with the drugs as best you can and try to get the most benefit out of these agents.

Johanna Bendell, MD: Excellent. Dr. Rocha Lima?

Caio Max S. Rocha Lima, MD: It’s a pleasure being here and in such great company. One other issue that I want to bring up is that, being in academia before and now being in private practice, it is important to consider “subspecialization.” As I moved on from academia—where we are all subspecialists—and went into private practice, I realized the importance of continuing to be a subspecialist. I think that the community has to realize that not every pancreatic cancer is the same. And I’m still learning, with every single patient that I see, that I feel much more comfortable seeing a GI cancer than any other subspecialties. We can take better care of the patients that I see more often.

Johanna Bendell, MD: There’s so much to know now.

Caio Max S. Rocha Lima, MD: Absolutely.

Johanna Bendell, MD: Incredible. Dr. Marshall?

John Marshall, MD: You could go on any angle with pancreas cancer as to what we need—everything from a screening tool maybe to find early detection for this cancer. But clearly, it’s finding the systemic disease early and the development of new agents. We need to understand the biology of this cancer. We need to get in to this thing, study it, and invest more money in it. I feel very strongly about the imbalance of research funding in our country, and organizations like PanCAN and others have really helped change that lost garden. We need more of that if we’re going to do that. I think Eileen referred to it earlier, that this will soon be the second leading killer, because we are doing other things better, even though it’s not as common of a disease. So, let’s do everything we can to not meet that mark.

Johanna Bendell, MD: I love that. Dr. O’Reilly?

Eileen O’Reilly, MD: I echo all of the sentiments that have been presented. But just to endorse what has been said: I think moving the field forward means new drugs for our patients and clinical trials. I really believe that’s going to someday hold high gain for this patient population and that we can’t get discouraged, even though it’s hard. It’s so important that we really focus our efforts in terms of understanding this disease, in terms of clinical trials, and, as John said, funding. I couldn’t agree more that there are many opportunities that I think need to come the way of pancreas cancer. But there’s a move, I feel it.

Johanna Bendell, MD: Thank you all for your contributions to this discussion. On behalf of our panel, we thank you for joining us, and we hope you found this Peer Exchange® discussion to be useful and informative.

Transcript Edited for Clarity

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Transcript:

Johanna Bendell, MD:
Eileen, you’ve done some amazing research with the BRCA patients. Tell us a little bit about BRCA mutations in pancreas cancer, of all things.

Eileen O’Reilly, MD: I think this is another exciting area that applies, at least to a subset of people with pancreas cancer. So, we know that in an unselected 100 patients with pancreas cancer, anywhere from 5 to 8 will have an underlying germline BRCA mutation. Maybe an additional 3%, 4%, or 5% will have a somatic BRCA mutation. And 2 observations have been made: one is that platinum drugs have an important role here. I think that based on expert opinion, not randomized data, this would suggest that using those drugs in patients whom we know harbor one of these mutations might be therapeutically important. I think the other area where there’s a lot of development is PARP inhibitors. We have PARP inhibitors being evaluated frontline in combination with platinum-based therapy, but also being evaluated as a maintenance strategy in germline BRCA following disease control with platinum-based treatment. But just thinking about the broader group of patients with pancreas cancer, we know there are a number of other germline defects that occur, and ATM is pretty common, as well as ATR, and other genes. And it’s possible that maybe combinations of PARP inhibitors, and other strategies or PARP in immune therapies, may have a role in this subset.

So, I think there’s a lot of interest in exploring this theme in pancreas cancer. We’re clearly not there yet, but, again, I think we’ll hopefully begin to identify some groups of patients where we can refine treatment choices that are rational based on characteristics of their disease or genomics in pancreas cancer. That will be, in my opinion, an important step in this disease.

Johanna Bendell, MD: There’s so much happening. Lots of research going on. Different targets. I’ve also heard about STAT-free inhibitors trying to target the cancer stem cells being looked at for pancreas cancer—so trying to approach it from all different angles and aspects. George, any last thoughts on trials that you think are interesting?

George Kim, MD: Well, it’s what we said earlier. I think we still have a lot of work to do. We’ve got to get these trials accrued. We’ve got to support the Intergroup trials and continue to move the field forward. I think we still have a lot of work to do. Patients are demanding it, and we need to come to the plate.

Johanna Bendell, MD: Well, I think this has been extremely informative. Before we end this discussion, I’d like to get some final thoughts from each of our panelists. So, George, I’m going to hit back to you again. Any last thoughts, outside of what you just said?

George Kim, MD: I enjoyed being here. It’s fun. There’s a lot of banter and a lot of expertise, but I hope it’s helpful. And, again, hopefully we’re helping our patients. I’d just like to remind everybody that you’ve got to manage these folks—nutrition, pain control, diabetes, intestinal issues, and psychosocial issues. This is all very important. And then, it’s important to run with the drugs as best you can and try to get the most benefit out of these agents.

Johanna Bendell, MD: Excellent. Dr. Rocha Lima?

Caio Max S. Rocha Lima, MD: It’s a pleasure being here and in such great company. One other issue that I want to bring up is that, being in academia before and now being in private practice, it is important to consider “subspecialization.” As I moved on from academia—where we are all subspecialists—and went into private practice, I realized the importance of continuing to be a subspecialist. I think that the community has to realize that not every pancreatic cancer is the same. And I’m still learning, with every single patient that I see, that I feel much more comfortable seeing a GI cancer than any other subspecialties. We can take better care of the patients that I see more often.

Johanna Bendell, MD: There’s so much to know now.

Caio Max S. Rocha Lima, MD: Absolutely.

Johanna Bendell, MD: Incredible. Dr. Marshall?

John Marshall, MD: You could go on any angle with pancreas cancer as to what we need—everything from a screening tool maybe to find early detection for this cancer. But clearly, it’s finding the systemic disease early and the development of new agents. We need to understand the biology of this cancer. We need to get in to this thing, study it, and invest more money in it. I feel very strongly about the imbalance of research funding in our country, and organizations like PanCAN and others have really helped change that lost garden. We need more of that if we’re going to do that. I think Eileen referred to it earlier, that this will soon be the second leading killer, because we are doing other things better, even though it’s not as common of a disease. So, let’s do everything we can to not meet that mark.

Johanna Bendell, MD: I love that. Dr. O’Reilly?

Eileen O’Reilly, MD: I echo all of the sentiments that have been presented. But just to endorse what has been said: I think moving the field forward means new drugs for our patients and clinical trials. I really believe that’s going to someday hold high gain for this patient population and that we can’t get discouraged, even though it’s hard. It’s so important that we really focus our efforts in terms of understanding this disease, in terms of clinical trials, and, as John said, funding. I couldn’t agree more that there are many opportunities that I think need to come the way of pancreas cancer. But there’s a move, I feel it.

Johanna Bendell, MD: Thank you all for your contributions to this discussion. On behalf of our panel, we thank you for joining us, and we hope you found this Peer Exchange® discussion to be useful and informative.

Transcript Edited for Clarity
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Online CME Activities
TitleExpiration DateCME Credits
Oncology Briefings™: Integrating Novel Targeted Treatment Strategies to Advance Pancreatic Cancer CareNov 30, 20181.0
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