Dr. Gulhati on Current Treatment Approaches in Pancreatic Cancer

Prateek Gulhati, MD, PhD, medical oncologist, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, discusses current treatment approaches in pancreatic cancer and strategies under investigation within the space.

Treatment options such as FOLFIRINOX and gemcitabine plus nab-paclitaxel (Abraxane) are the backbone of current pancreatic cancer treatment options for patients receiving systemic chemotherapy, Gulhati begins. In the adjuvant setting, both FOLFIRINOX and gemcitabine plus capecitabine are commonly used, Gulhati says.

Other trials have explored the use of immunotherapy as a treatment option for pancreatic cancer; however, these approaches are not currently used as a standard-of-care approach for patients with pancreatic cancer, outside of patients with microsatellite instability–high tumors, who account for less than 1% of those with pancreatic cancer, Gulhati continues. Despite the lack of efficacy displayed by immunotherapy in the pancreatic cancer space thus far, investigators are still aiming to develop ways to incorporate these agents into the treatment landscape for different subgroups of patients within this population, Gulhati explains.

Other clinical trials have examined PARP inhibitors in pancreatic cancer, including the phase 3 POLO trial (NCT02184195). The phase 3 randomized, double-blind, placebo-controlled, multicenter study evaluated maintenance olaparib (Lynparza) monotherapy vs placebo in patients with BRCA-mutant metastatic pancreatic cancer whose disease had not progressed on first-line, platinum-based chemotherapy. In December 2019, the FDA approved olaparib for the maintenance treatment of adult patients with germline BRCA-mutated metastatic pancreatic adenocarcinoma, based on data from POLO.

Investigators continue to attempt to expand on the use of PARP inhibitors in pancreatic cancer, and research is focusing on how these agent could be moved to earlier settings, as well as how to identify which which patients specifically respond to PARP inhibitors, Gulhati notes. Conducting testing for patients with pancreatic cancer to identify those with underlying BRCA mutations or other DNA damage repair alterations can help inform treatment decisions, Gulhati concludes.