Molecularly targeted treatment can prolong pancreatic cancer survival by one year, but only a fraction of eligible people receive it, a new study shows
Results from an observational registry-based study 1,082 pancreatic cancer patients showed that actionable genetic alterations were identified in about a quarter (282) of the patients, but only about 4% of all tested patients received a molecularly matched therapy.
For this group of 46 patients who received targeted treatment the median overall survival was significantly longer than in patients (n=143) who received unmatched treatment: 2·58 years (95% CI 2·39 to not reached) versus 1·51 years (1·33–1·87; hazard ratio [HR] 0·42 [95% CI 0·26–0·68], p=0·0004).
The most common actionable molecular findings included ALK Fusion (treated with crizotinib + IMRT + gemcitabine), MSI-H (treated with pembrolizumab) and BRCA1 mutation (treated with FOLFOX and olaparib) .
Patients did not receive matched therapy because, among other reasons, the treating physician chose not to use such therapy, access to such therapies was insufficient, or patients were unable or unwilling to travel to enrol in a clinical trial that would have enabled access to the matched therapy.
“Although only a small number of patients in this study received a targeted therapy, the results are promising. No other type of therapy has offered a survival benefit of this magnitude to patients with pancreatic cancer,” said study lead investigator Dr Michael Pishvaian of The University of Texas MD Anderson Cancer Centre, USA, in The Lancet Oncology.
“Our findings suggest that adopting a precision medicine approach, where patients are given a therapy targeted to the specific conditions of their tumour, could have a substantial effect on survival prospects for these patients.”
An accompanying commentary said the difference in survival between the groups with actionable alterations but with or without targeted treatment was striking.
It noted that most of the patients received molecularly matched treatment as a second or further line of therapy, with a median PFS of 10·93 months vs 4·53 months (HR 0·50) in patients who received unmatched therapy and 5·37 months (HR 0·53) in patients with no markers.
“These findings are important in that they define an estimation of the current number of potentially actionable targets and in that they provide a – rather disappointing – real-world assessment of the number of patients who actually received molecularly targeted treatment.
The findings are derived data from the Pancreatic Cancer Know Your Tumor (KYT) program of patients with pancreatic cancer from across the USA who had undergone molecular testing of their tumours.
Lynn Matrisian, co-author of the study and Chief Scientific Officer of The Pancreatic Cancer Action Network, USA, said: “Access to high-quality molecular testing is variable. Future efforts should focus on addressing barriers to molecular testing so that more people can benefit from this personalised approach to cancer treatment. We will continue to work to close that gap through our Know Your Tumour programme and through patient and healthcare professional outreach and education.”