Would you consider using a PARP inhibitor as maintenance therapy after initial platinum chemotherapy in a patient with metastatic pancreatic cancer who has a somatic non-BRCA DNA damage repair gene alteration?

This is an important question regarding the use of a PARPi as maintenance therapy in HRD genes beyond BRCA1/2, including, PALB2, FANC, CHEK, ATM, NBN, RAD51, MRE11, BARD, etc. As of now, there are limited data to confirm value, however, this is the subject of several ongoing trials evaluating the role of PARPi alone and with other agents in this setting. Outside of a clinical trial- the biomarker of good/durable response to platinum is suggestive of potential value and I would consider. Regarding oncogenicity of specific mutations - cross-referencing somatic databases can help- Clinvar, Cosmic, Oncokb. Allelic status may also add.