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Expert Point of View: Richard L. Schilsky, MD, FACP, FSCT, FASCO


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Richard L. Schilsky, MD, FACP, FSCT, FASCO, Chief Medical Officer and Executive Vice President of ASCO, called the 74% response rate to cisplatin/gemcitabine “remarkable.” “What’s impressive to me is the high response rate, as well as the progression-free and overall survival data—these data are all far better than what we customarily see in metastatic pancreatic cancer,” he said.

Richard L. Schilsky, MD, FACP, FSCT, FASCO

Richard L. Schilsky, MD, FACP, FSCT, FASCO

Responses to platinum-based therapy are much less common in unselected populations, Dr. Schilsky noted, emphasizing the need to “pull out the 10% or so of patients” with BRCA mutations, “and potentially other mutations in the DNA repair pathway,” for treatment with this regimen. “The real take-home message for most oncologists is that patients with pancreatic cancer should be tested for germline BRCA mutations.”

Because of the robust response seen in this study, he said, cisplatin/gemcitabine should be a preferred option in BRCA-mutated advanced pancreatic cancer. “FOLFIRINOX [leucovorin, fluorouracil, irinotecan, oxaliplatin] has been established as probably the most active regimen in pancreatic cancer, but it does not produce a 70% response rate. If the patient were my family member and had a BRCA mutation, I’d say treat them with gemcitabine/platinum,” he added.

The Bottom Line

Dr. Schilsky was less sure about the use of veliparib, commenting he found its lack of additional benefit difficult to understand. “We’ve seen in POLO that the PARP inhibitor olaparib was clearly beneficial [though this was in the maintenance setting]. Maybe it’s the specific drug, or maybe this study was underpowered to detect the benefit from veliparib, because the response rate was already so high from the chemotherapy,” he suggested.

“The bottom line is we have to test patients for BRCA mutations. With the approval of olaparib and the companion diagnostic test, this should get paid for. I think this study may open the door to more widespread testing,”
Dr. Schilsky concluded.
 

DISCLOSURE: Dr. Schilsky has received institutional research funding from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech/Roche, Lilly, Merck, and Pfizer and has been reimbursed for travel, accommodations, or expenses by Varian.

 


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