Department of Clinical Pathology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Sklodowskiej-Curie Str. 9, 85-094, Bydgoszcz, Poland.
Department of Pathology, Military Clinical Hospital, Powstańców Warszawy Str. 5, 85-681, Bydgoszcz, Poland.
J Cancer Res Clin Oncol. 2018 Aug;144(8):1503-1507. doi: 10.1007/s00432-018-2666-9. Epub 2018 May 18.
We propose a treatment algorithm for PDAC with particular emphasis on BRCA1 or 2 mutation-positive patients. Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest diseases in the United States and Europe. BRCA1 and BRCA2 are among the most common of the known genetic mutations involved in familial PDAC. The optimal chemotherapy regimen to use for BRCA1 or 2 mutation carriers with PDAC is not yet established. As new treatment options emerge, algorithms must balance the need to give the best drugs first with ensuring that there are still beneficial options available for later.
We conducted a review of the literature for data on possible therapies in BRCA-positive and BRCA-negative pancreatic cancer.
There is accumulating evidence of increased sensitivity to platinum-based therapy and poly-ADP-ribose polymerase inhibitors (PARPi) in BRCA-associated PDAC. There are no studies relating to borderline BRCA-associated PDAC and, therefore, same treatment as for sporadic PDAC seems appropriate. Treatment of unresectable PDAC varies depending on stage of the disease. Patients with BRCA-associated locally advanced PDAC can benefit from targeted therapy with PARPi (olaparib) as a second-line therapy after antimetabolite treatment failure. Patients with unresectable metastatic BRCA-positive PDAC may benefit from platinum-based therapy.
Targeted therapies are shifting the treatment paradigms and increasing survival for patients with PDAC, a group that used to have a grim prognosis.
我们提出了一种治疗 PDAC 的治疗算法，特别强调了 BRCA1 或 2 突变阳性患者。胰腺导管腺癌（PDAC）是美国和欧洲最致命的疾病之一。BRCA1 和 BRCA2 是家族性 PDAC 中最常见的已知基因突变之一。BRCA1 或 2 突变携带者的 PDAC 最佳化疗方案尚未确定。随着新的治疗选择的出现，算法必须平衡首先使用最佳药物的需求，并确保仍然有可供以后使用的有益选择。
我们对 BRCA 阳性和 BRCA 阴性胰腺癌中可能的治疗方法的文献进行了综述。
BRCA 相关 PDAC 对铂类治疗和聚 ADP-核糖聚合酶抑制剂（PARPi）的敏感性增加的证据不断增加。没有关于边界 BRCA 相关 PDAC 的研究，因此，似乎适合对散发性 PDAC 进行相同的治疗。不可切除 PDAC 的治疗因疾病阶段而异。BRCA 相关局部晚期 PDAC 患者可受益于 PARPi（奥拉帕利）的靶向治疗，作为抗代谢物治疗失败后的二线治疗。不可切除转移性 BRCA 阳性 PDAC 患者可能受益于铂类治疗。
靶向治疗正在改变 PDAC 患者的治疗模式并提高生存率，这是一组曾经预后不佳的患者。
