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Medical Oncology Clinical Scenario

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Medical Oncology Clinical Scenario

Kira Laskin, MS, CGC

Is this patient appropriate for genetic testing?

    Joanna was diagnosed with pancreatic adenocarcinoma at the beginning of the year, at age 64.
    By the time the diagnosis was made, she had been told that the cancer had already spread to her liver.
    Although Joanna remembers a distant cousin having dealt with lung cancer, no one else in her family had ever been diagnosed with cancer.

Does this patient meet genetic testing criteria? YES!

Guideline Overview

Approximately 10% of pancreatic cancers are hereditary1. Several genes, including BRCA1 and BRCA2, have been identified in association with hereditary pancreatic cancer. Studies have shown 4-7% of patients with pancreatic adenocarcinomas will harbor an actionable pathogenic variant in BRCA1/2.2,3

Per the National Comprehensive Cancer Network (NCCN), germline multi-gene panel testing is recommended for any patient with confirmed pancreatic cancer, regardless of age, grade or family history.4

If Joanna undergoes genetic testing and a hereditary cancer syndrome is identified, this important information can be shared with her at-risk family members. Genetic counseling can help identify appropriate genetic testing candidates and determine who in the family is at increased risk for developing pancreatic, and possibly other types of, cancer.

Genetic testing may also help guide Joanna’s treatment plan. Recent clinical data from the phase III POLO trial showed promising efficacy in lengthening progression-free survival in metastatic pancreatic adenocarcinoma when using olaparib as maintenance therapy.2 The randomized trial specifically included patients with metastatic disease, germline BRCA1/2 mutations, and whose disease had not progressed during first-line platinum-based chemotherapy. As a result of this study, NCCN now recommends consideration of olaparib as maintenance treatment for patients with germline BRCA1/2 mutations, metastatic disease, good performance status, and lack of disease progression during >16 weeks of first-line, platinum-based chemotherapy.4

References:

    • American Society of Clinical Oncology: Pancreatic Cancer (https://www.cancer.net/cancer-types/pancreatic-cancer/risk-factors) Accessed July 11, 2019.
    • Golan T et al. (2019). Maintenance Olaparib for Germline BRCA-Mutated Metastatic Pancreatic Cancer. New England Journal of Medicine. doi:10.1056/nejmoa1903387
    • Holter s, et al. Germline BRCA mutations in a large clinic-based cohort of patients with pancreatic adenocarcinoma. J Clin Oncol. 2015;33(28):3124-9.
    • NCCN Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma (Version 3.2019). https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed July 11, 2019.