Should cisplatin, gemcitabine, and veliparib be the standard of care in treating metastatic/unresectable pancreatic cancer with BRCA or PALB2 mutation?
Does this also apply to somatic mutations?
Answer from: Medical Oncologist at Academic Institution
In a recent publication (O’Reilly et al. JCO 2020), the authors reported high response rates (74.1% vs. 65.2%, respectively) of both study arm (gemcitabine + cisplatin + veliparib) and control arm (gemcitabine + cisplatin) from a phase II open-label, randomized multicenter trial. Despite the u...
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Answer from: Medical Oncologist at Community Practice
I agree the study by @Eileen M. O'Reilly and colleagues was well done and eye opening in terms of response rate for patients with pancreatic cancer and germline mutations. The upfront addition of the PARP inhibitor did not improve efficacy, while we have data from the POLO trial that maintenanc...
Answer from: Medical Oncologist at Academic Institution
Perhaps to add a clarification—cisplatin/gemcitabine is an acceptable standard for gBRCA/PALB2 related pancreas cancer. The concurrent addition of veliparib is not recommended. However, the sequential use of the PARPi olaparib (FDA approved in this setting) is a very reasonable follow on to ci...
Answer from: Medical Oncologist at Academic Institution
No. Absolutely not. This study is not definitive.
Veliparib is one of the least active BRCA inhibitors. We already have a phase 3 trial using olaparib as maintenance. And olaparib is an FDA approved drug.