Vaibhav Sahai, MBBS, assistant professor of medicine at the University of Michigan, discusses sequencing strategies in metastatic pancreatic cancer.

Approximately half of patients with newly diagnosed metastatic pancreatic cancer receive the combination of gemcitabine plus nab-paclitaxel (Abraxane), and the other half receive FOLFIRINOX. After patients progress on their initial therapy, they are often switched to the alternative regimen. As such, it remains unclear whether sequencing matters if patients are going to be exposed to both regimens regardless, says Sahai.

Presently, there are no known immunotherapies in this space. However, researchers are hopeful that targeted therapy with olaparib (Lynparza) may be a maintenance strategy worth pursuing. Data from the phase III POLO trial presented at the 2019 ASCO Annual Meeting demonstrated that patients with germline 

-mutated metastatic disease experienced a significantly improved progression-free survival with maintenance olaparib versus placebo. Maintenance therapy was given after at least 4 months of FOLFIRINOX or platinum-based chemotherapy, says Sahai.

Videos

Dr. Sahai on Sequencing Strategies in Metastatic Pancreatic Cancer

Vaibhav Sahai, MBBS, assistant professor of medicine at the University of Michigan, discusses the role of genomic profiling in pancreatic cancer.

Genomic profiling can be useful in pancreatic cancer, but it more valuable for research than it is for daily practice, explains Sahai. Data suggest that 27% of patients with metastatic pancreatic cancer may actually have a targetable mutation; however, only 3% of these patients are paired with a therapeutic option. Patients should understand that there is a less than 10% likelihood of finding a targetable mutation that can be identified and paired with a drug, he adds.

It is not an option for all patients, but it is important for clinicians to be able identify the appropriate candidates. Some of the actionable mutations that appear in pancreatic cancer are 

, microsatellite instability—high status, and high tumor mutational burden, says Sahai. Moreover, 

 is another alteration with an available FDA-approved therapy.

Vaibhav Sahai, MBBS

Articles

Dr. Sahai on Sequencing Strategies in Metastatic Pancreatic Cancer

Dr. Sahai on the Role of Genomic Profiling in Pancreatic Cancer