Should cisplatin, gemcitabine, and veliparib be the standard of care in treating metastatic/unresectable pancreatic cancer with BRCA or PALB2 mutation?

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 unprece...

I agree the study by @Dr. First Last 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 maintenance therapy...

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 cisplati...

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.