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Top Line: There are only a limited number of treatment lines for pancreatic cancer.
The Study: A small proportion of patients with BRCA-mutation are eligible for the PARP inhibitor olaparib. Otherwise, how do patients with advanced pancreatic cancer fare with a precision medicine approach? The Know Your Tumor (KYT) program, sponsored by the Pancreatic Cancer Action Network (PanCAN), provides molecular testing for actionable mutations with associated therapeutic and clinical trial options. Importantly, it’s not a clinical trial. Over 1800 patients were referred to the program and over 1000 (58%) underwent molecular testing with a total of 677 also having survival outcomes. Among these, one-quarter had an actionable mutation. Surprisingly, only 46 patients (24% of those with actionable mutations) received matched therapy. Among these 46 patients, median overall survival was double (2.6 years) that of the 488 patients without actionable mutations (1.3 years). At the same time, there was no difference in median survival between those with actionable mutations with unmatched therapy and those without actionable mutations at all. The problem here is that the graphics on pancan.org showing a massive survival benefit from the precision medicine approach could be misleading to patients. The fact is that the 6% of patients (46/677) who used the KYT program had excellent survival outcomes without accounting for numerous clinical and treatment confounders.
TBL: While it’s a leap to suggest from this data alone that precision medicine and matched therapy results in a >1 year improvement in overall survival, it does seem promising to enroll such patients on basket trials. | Pishvaian, Lancet Oncol 2020