Dr. Simeone on Emerging Subtypes of Pancreatic Cancer

Diane Simeone, MD, director, Pancreatic Cancer Center, associate director, Translational Research, NYU Langone’s Perlmutter Cancer Center, discusses emerging subtypes of pancreatic cancer.

Physicians have yet to sort out all of the subtypes of pancreatic cancer, but several are coming to the forefront. One subtype, which is only a small percentage of patients, is microsatellite instability (MSI). Though this subgroup only accounts for 1% of pancreatic cancers, there is some data that suggest that this population may respond to immuno-oncology drugs. Based on the lethality of the disease, every patient with pancreatic cancer should be tested for MSI, says Simeone.

The second are mutations in the DNA-damage response (DDR) signaling pathway, including BRCA1/2, ATM, and CHEK2. These are also genes that have been found to be present in germline DNA. These tumors respond differently than other pancreatic cancers, and physicians should tailor therapy with that knowledge, says Simeone. DDR-mutant cancers make up approximately 20% of all pancreatic cancers. Therefore, every patient with pancreatic cancer should have germline and somatic mutational analysis, states Simeone.