Pancreatic cancer is a type of tumor that, today, continues to have a poor prognosis – the five-year survival rate is less than 10% – in many cases because the diagnosis comes when the disease is found in an advanced stage and has advanced in such a way that surgical removal is no longer possible.
Likewise, due to the lack of improvement in survival and an increase in its incidence in recent years –possibly, among other factors, due to the aging of the population and the increase in the prevalence of obesity–, forecasts suggest that it will become in the second cause of cancer death in the United States in 2030, while in Europe it is expected that as of last 2018 it will cause more deaths than breast cancer. In Spain, it is the ninth tumor in frequency, but, due to its high lethality, it is the third cause of death from cancer , according to data from the Spanish Society of Medical Oncology (SEOM), which explains that, in our country, it is estimated that 7,765 new cases will be diagnosed per year.
At the moment there are few active treatments to offer these patients, and until today none had a biomarker that would indicate the population that could benefit the most from each of them. Hence, the news that a study for the development of the first therapy directed against pancreatic cancer is especially relevant – in which researchers from the Vall d’Hebron Institute of Oncology (VHIO) have participated, in collaboration with an international team – has obtained very positive results. A targeted therapy is one that uses drugs or other substances that block cancer growth by interfering with specific molecules that take part in such growth – in contrast to regular chemotherapies, which act on all rapidly dividing cells, whether they are cancerous or normal.
The POLO study is a biomarker-guided trial with positive results in pancreatic cancer, which represents “the first personalized treatment alternative for a subgroup of patients with pancreatic tumors (those with metastases and a mutation in the BRCA genes) to be able to rest from chemotherapy treatment ”, the VHIO highlights in a press release. As noted, “it will change the existing treatment standards so far.”
Olaparib, a hopeful drug
The BRCA1 and BRCA2 genes are responsible for encoding two essential proteins for DNA repair, so that, when they undergo a mutation, they suffer genetic instability, it is more difficult for them to fix DNA damage and that increases the risk of suffering certain types of cancer. Olaparib, a drug that has already had positive results in ovarian cancer, is an inhibitor of the PARP protein, which helps repair damaged DNA. Preventing it from performing its function in tumor cells causes the destruction of these cells, but does not affect healthy ones.
The study, recently published in the medical journal New England Journal Of Medicine , has been presented within the framework of a new edition of the congress organized each year by the American Society of Clinical Oncology (ASCO) in Chicago (USA), a of the most important international oncology appointments with regard to the clinical practice of cancer and where scientists from all over the planet present the latest advances in the treatment of this disease.
“We are facing the first option for targeted treatment for pancreatic cancer,” explains Teresa Macarulla, principal investigator of the Gastrointestinal and Endocrine Tumors Group at VHIO, who has led the team at this cancer center and has actively recruited patients for this trial . “Approximately 6-8% of patients with pancreatic cancer are carriers of this mutation and can benefit from this treatment, ” he adds. Likewise, they consider that they should continue working to try to expand the group of patients who can benefit from this drug, beyond BRCA1 and BRCA2 mutations.
The research, which had as first author Henry L. Kindler, from the University of Chicago, and as coordinator with Talia Golan, from the Oncological Institute of the Sheba Medical Center in Tel Hashomer, from Tel Aviv University (Israel), carried out in patients with a BRCA germline mutation and metastatic pancreatic cancer who had received chemotherapy treatment and showed no disease progression after a minimum of 16 weeks of treatment. Olaparib was substituted for chemotherapy to see if it was also able to stop tumor development and allow the patient to rest from chemo toxicity and improve their quality of life.
The result was that this drug “provided a statistically significant improvement in the progression of the disease compared to placebo “, highlights the VHIO. So these results offer a new treatment option for this group of patients with pancreatic cancer who previously had no other alternatives than chemotherapy.
Teresa Macarulla Photo: VHIO
