Multimodality therapy in metastatic pancreas cancer with a BRCA mutation and durable long-term outcome: biology, intervention, or both?
Thomas Lee SuttonAaron GrossbergFrederick EyEileen M O'ReillyBrett C SheppardPublished in: Cancer biology & therapy (2021)
Metastatic pancreatic adenocarcinoma (PDAC) is a rapidly lethal disease, with less than half of patients surviving 12 months, and 5-year survival approximately 3%. These outcomes are in large part due to a lack of effective medical and surgical therapies for metastatic PDAC. Herein, we present the case of a patient with oligometastatic liver recurrence of BRCA2-mutated PDAC following a curative-intent resection. Through a combination of systemic chemotherapy, metastasectomy, radiotherapy, and subsequent targeted therapy with olaparib, the patient is asymptomatic four years following metastatic diagnosis with stable low-volume disease. This patient's excellent outcome is attributable to the multi-disciplinary care received, all aspects of which were informed by new evidence surrounding metastasectomy for metastatic PDAC, the unique biology and medical treatment of BRCA-mutated PDAC, and the role of radiotherapy in controlling locoregional recurrence. We provide a review of this evidence, while highlighting the importance of evaluating disease biology through somatic and germline genetic testing as well as monitoring response to systemic chemotherapy.
Keyphrases
- squamous cell carcinoma
- small cell lung cancer
- locally advanced
- healthcare
- case report
- early stage
- randomized controlled trial
- radiation therapy
- end stage renal disease
- free survival
- radiation induced
- palliative care
- papillary thyroid
- quality improvement
- adipose tissue
- oxidative stress
- combination therapy
- skeletal muscle
- drug induced
- peritoneal dialysis
- mesenchymal stem cells
- squamous cell
- young adults
- cell therapy