Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy.
Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy.
Curr Oncol. 2022 Jan 27;29(2):544-550. doi: 10.3390/curroncol29020049.
PARP inhibitors are largely recognized as active drugs in BRCA-mutated breast and ovarian malignancies. In pancreatic ductal adenocarcinoma, the PARP inhibitor olaparib has recently been approved as maintenance treatment in patients with germline BRCA mutations reaching disease control after a platinum-based first line chemotherapy, proving significant benefit on progression free survival. On the other hand, little evidence is available regarding olaparib as single agent after progression with standard treatment in BRCA-mutated pancreatic ductal adenocarcinoma. A 61-year-old female patient harboring germline BRCA2 mutation was treated at our institution for a pancreatic ductal adenocarcinoma with lung and liver metastases. The patient received three previous lines of treatment with standard therapies, as follows: after the third line treatment failure, we started a further line of treatment with olaparib in off-label prescription. After the first two cycles, a CT scan documented partial response, with complete regression of lung metastases. The response was maintained after four cycles, with further response and clinical benefit. The radiologic and clinical response was maintained for 6 months. This case highlights the potential of olaparib as single agent after progression with standard treatment in BRCA-mutated pancreatic cancer.
聚腺苷二磷酸核糖聚合酶（PARP）抑制剂在携带 BRCA 突变的乳腺癌和卵巢癌中已被广泛认为是有效的药物。在胰腺导管腺癌中，PARP 抑制剂奥拉帕利最近被批准用于一线含铂化疗后达到疾病控制的种系 BRCA 突变患者的维持治疗，证明了无进展生存期的显著获益。另一方面，对于携带 BRCA 突变的胰腺导管腺癌在标准治疗进展后，奥拉帕利单药治疗的证据有限。我们机构收治了一名 61 岁的女性患者，该患者携带种系 BRCA2 突变，患有肺和肝转移的胰腺导管腺癌。该患者接受了三种标准治疗方案的三线治疗，如下所示：三线治疗失败后，我们开始使用奥拉帕利进行四线治疗（超说明书用药）。在最初的两个周期后，CT 扫描显示部分缓解，肺转移完全消退。在四个周期后，肿瘤继续缩小，患者继续获益。影像学和临床反应持续了 6 个月。这个病例强调了在 BRCA 突变型胰腺癌中，标准治疗进展后，奥拉帕利单药治疗的潜力。
