With that being said, 1 of the elements that is important to keep in mind is that many physicians confuse performance status with symptoms that are not well controlled. Once you optimize the symptom control for patients, then you can better assess performance status. If a patient has a poor performance status, they often have pain and are not eating well. However, if they are put on enzymes, pain medications, and occasionally steroids, it can improve their appetite and activity.
Some patients went from a performance status of 2 or 3 to a performance status of 0 or 1. Many of them benefitted from treatment so it is important to keep in mind that performance status is a big detriment of who should get aggressive therapy versus no therapy. However, we don't make conclusions about performance status until we optimize the symptoms of the patient.
What targeted therapies and immunotherapy agents are coming down the pipeline?
Pancreatic cancer is now seeing more of an understanding of the molecular and genetic drivers. We are understanding what subsets of patients may benefit from certain treatments. For patients with microsatellite instability-high (MSI-H) tumors, immunotherapy works best. That subgroup was included in the study that led to the approval of pembrolizumab (Keytruda) in MSI-H cancers. There were a few patients with pancreatic cancer who had incredible responses. One patient continues to be in a complete remission from that treatment.
mutations and homologous recombination deficiency (HRD) as they may benefit from platinum-based treatment and PARP inhibitors. There are studies evaluating different PARP inhibitors in pancreatic cancer.
Can you hone in on the PARP inhibitor approaches in these patients?
The 3 PARP inhibitors that have been studied the most are veliparib, olaparib, and rucaparib. Veliparib appears to be the least potent. There are rare reports of any single-agent activity of this drug in pancreatic cancer. I don't think that this agent should be developed for pancreatic cancer. I am not even sure that it has enough potency as a PARP inhibitor.
... to read the full story