Dr Malalur on Addressing Unmet Needs in Pancreatic Cancer

Pannaga G. Malalur, MBBS, medical oncology specialist, Gastrointestinal Cancers, The Ohio State University Comprehensive Cancer Center (OSUCCC) - James Cancer Hospital & Solove Research Institute, discusses several unmet needs within pancreatic cancer, including the implementation of updated germline genetic testing guidelines, increased screening of high-risk patients, and improved sequencing of available therapeutics.

In 2019, the National Comprehensive Cancer Network released updated guidelines for the use of germline and somatic testing, Malalur begins. Among other changes, these guidelines expanded the recommendation for germline genetic testing to all patients with pancreatic adenocarcinoma, rather than just those with a family or personal history of cancer, she explains.

However, a retrospective review presented at the 2023 ASCO Gastrointestinal Cancers Symposium found that the uptake rates and compliance for germline testing in clinical practice were low both 12 months before and after the updated guidelines were released, Malalur reports. These data not only show that guideline adherence is poor, but indicate that the overall use of germline genetic testing remains insufficient. Therefore, efforts to increase awareness of how genetic testing can allow for a personalized approach to treatment, the benefits of cascade testing, and opportunities for enrollment in pancreatic cancer surveillance programs continue to be necessary, according to Malalur.

Additionally, many patients with pancreatic cancer display high-risk clinical features that may preclude them from receiving aggressive treatment options, Malalur adds. These factors include advancing age, frailty, and comorbid conditions. Screening tools should be utilized to immediately assess the robustness of all patients and modify treatment approaches accordingly, Malalur says.

Lastly, the increase in novel actionable targets and available treatment options for patients with pancreatic cancer has substantially improved patient outcomes in pancreatic cancer, Malalur notes. However, this expansion has led to confusion regarding the navigation and selection of the optimal approach. Using next-generation sequencing could improve the identification of patients who would benefit from specific treatments, Malalur concludes.