Study Finds Benefit of Surveillance for Pancreatic Cancer in High-Risk Individuals


Key Points

  • Pancreatic ductal adenocarcinoma was detected in 7% of CDKN2A mutation carriers, with a resection rate of 75% and a 5-year survival of 24%.
  • A pancreatic tumor was found in two individuals (0.9%) in the familial pancreatic cancer group.

As reported by Vasen et al in the Journal of Clinical Oncology, surveillance for pancreatic ductal adenocarcinoma in high-risk individuals appears to be of benefit in individuals at risk due to CDKN2A mutation, with the advantage being less clear among individuals at risk due to familial clustering of pancreatic cancer.

Study Details

The study was a long-term prospective follow-up from three European expert centers. A total of 411 asymptomatic individuals, including 178 CDKN2A mutation carriers, 214 individuals with familial pancreatic cancer, and 19 BRCA1/2 or PALB2 mutation carriers, participated in a surveillance program consisting of annual magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography, or endoscopic ultrasound (EUS).

Individuals had a mean age of 56 years at the start of the program, and mean follow-up was 53 months (range = 0–169 months). In total, 866 MRIs and 106 EUSs were performed.

Surveillance Outcome

Pancreatic ductal adenocarcinoma was detected in 13 (7.3%) CDKN2A mutation carriers. In these patients, the resection rate was 75%, and 5-year survival was 24%. Two CDKN2A mutation carriers (1%) had resection for low-risk precursor lesions.

A pancreatic tumor was found in two individuals (0.9%) in the familial pancreatic cancer group, including one with advanced pancreatic ductal adenocarcinoma and one with early grade 2 neuroendocrine tumor. Resection was performed in 13 individuals in the familial pancreatic cancer group (6.1%) for suspected precursor lesions; 4 (1.9%) had high-risk lesions (ie, high-grade intraductal papillary mucinous neoplasms or grade 3 pancreatic intraepithelial neoplasms).

One BRCA2 mutation carrier was identified with pancreatic ductal adenocarcinoma. Surgery in another BRCA2 mutation carrier and a PALB2 mutation carrier revealed low-risk precursor lesions. There were no serious complications reported in the program.

The investigators concluded: “Surveillance of CDKN2A mutation carriers is relatively successful, detecting most pancreatic ductal adenocarcinomas at a resectable stage. The benefit of surveillance in families with familial pancreatic cancer is less evident.”

The study was supported by ZonMW, Deutsche Krebshilfe, Institute of Health Carlos III, Red Temática de Investigación Cooperativa en Cáncer, and a European Cooperation in Science and Technology grant.

Hans Vasen, MD, of Leiden University Medical Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.