Herman OI Pfaeffle1*, John B Moore1 and Pramvir S Verma2
1Department of Medicine, Walter Reed National Military Medical Center, USA
2Department of Medicine, Fort Belvoir Community Hospital, USA
The following report depicts the case of a patient with a favorable response to carboplatin chemotherapy followed by olaparib salvage therapy for metastatic pancreatic cancer with a Breast Cancer Susceptibility Gene 2 (BRCA2) gene mutation. Olaparib is an orally delivered poly (ADPribose) Polymerase (PARP) enzyme inhibitor with Food and Drug Administration (FDA) approval in several malignancies associated with BRCA-mutations or Homologous Recombination Deficiency (HRD). Use of olaparib as a salvage therapy may be warranted in cases with poor response to previous chemotherapeutic regimens and can lead to extended survival benefit, substantiating the use of PARP inhibitors for patients with BRCA mutations and limited alternative treatment options. To our knowledge, this case represents the first example of BRCA-mutated pancreatic cancer with Central Nervous System (CNS) involvement responding to an olaparib-containing regimen. While various case reports and a randomized double-blinded trial have shown improvement in Progression Free Survival (PFS), further objective data regarding the benefits and associated risks of this new regimen are necessary to bolster clinical decision-making.
AJCC: American Joint Committee on Cancer; BRCA2: Breast Cancer Susceptibility Gene 2; CA 19-9: Cancer Antigen 19-9; CT: Computed Tomography; CNS: Central Nervous System; ECRP: Endoscopic Retrograde Cholangiopancreatography; EUS; Endoscopic Ultrasound; FNA: Fine Needle Aspiration; FOLFOX: [Folinic Acid, Fluorouracil, Oxaliplatin]; FDA: Food and Drug Administration; HRD: Homologous Recombination Deficiency; KRAS: Kirsten Rat Sarcoma; LM: Leptomeningeal Metastasis; MM: Medullary Metastasis; NGS: Next Generation Sequencing; PDAC: Pancreatic Ductal Adenocarcinoma; PARP: Poly(ADP-Ribose) Polymerase inhibitors; PFS: Progression Free Survival; ST: Salvage Therapy; SCC: Signet Cell Carcinoma; SBRT: Stereotactic Body Radiation Therapy; WBRT: Whole Brain Radiation Therapy
Pfaeffle HOI, Moore JB, Verma PS. Carboplatin & Olaparib Salvage Therapy in BRCA(+) Pancreatic Adenocarcinoma with Medullary & Leptomeningeal Metastasis. Oncol Case Report J. 2021;4(2):1035..