Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, University Hospital, Ludwig Maximilian University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
Target Oncol. 2023 Mar;18(2):257-267. doi: 10.1007/s11523-023-00950-0. Epub 2023 Feb 28.
In pancreatic cancer, systemic treatment options in addition to chemotherapy remain scarce, and so far only a small proportion of patients benefit from targeted therapies.
The patients with pancreatic cancer discussed in the CCCMunich Molecular Tumor Board were reviewed to gain a better real-world understanding of the challenges and chances of precision oncology in this hard-to-treat cancer.
Patients with pancreatic cancer who received comprehensive genomic profiling and were discussed in the interdisciplinary Molecular Tumor Board between May 2017 and July 2022 were included. These patients' medical charts, comprehensive genomic profiling results, and Molecular Tumor Board recommendations were analyzed in this retrospective cohort study.
Molecular profiles of 165 patients with pancreatic cancer were discussed in the Molecular Tumor Board. In the 149 cases where comprehensive genomic profiling was successful, KRAS mutations were detected in 87.9%, TP53 in 53.0%, and CDKN2A in 14.1%. 33.3% of KRAS wild-type patients harbored targetable mutations, while these were only found in 19.1% of patients with the KRAS mutation; however, this difference was not statistically significant. 63.8% of patients with successful testing received a targeted treatment recommendation by the Molecular Tumor Board; however, only 3.2% of these were put into practice. Compared to a historic cohort of patients with pancreatic cancer with synchronous metastatic disease diagnosed between 2010 and 2017, the patients from the pancreatic cancer cohort with synchronous metastatic disease had a longer survival.
This single-center experience emphasizes the challenges of targeted treatment in pancreatic cancer. Very few patients ultimately received the recommended therapies, highlighting the need for more and better targeted treatment options in pancreatic cancer, early comprehensive genomic profiling to allow sufficient time to put Molecular Tumor Board recommendations into practice, and close cooperation with clinical trial units to give patients access to otherwise not available targeted treatments.
在胰腺癌中，除化疗外的系统治疗选择仍然很少，到目前为止，只有一小部分患者从靶向治疗中获益。
对在慕尼黑 CCC 分子肿瘤委员会讨论的胰腺癌患者进行回顾，以更好地了解在这种难以治疗的癌症中，精准肿瘤学的挑战和机会。
纳入在 2017 年 5 月至 2022 年 7 月间接受综合基因组分析并在多学科分子肿瘤委员会讨论的胰腺癌患者。在这项回顾性队列研究中，分析了这些患者的病历、综合基因组分析结果和分子肿瘤委员会的建议。
在分子肿瘤委员会讨论了 165 例胰腺癌患者的分子谱。在 149 例成功进行全面基因组分析的病例中，KRAS 突变的检出率为 87.9%，TP53 为 53.0%，CDKN2A 为 14.1%。33.3%的 KRAS 野生型患者存在可靶向的突变，而 KRAS 突变患者中仅发现 19.1%存在这些突变；然而，这一差异无统计学意义。63.8%接受测试的患者接受了分子肿瘤委员会的靶向治疗建议；然而，只有 3.2%的患者实际接受了治疗。与 2010 年至 2017 年间诊断为同步转移性疾病的胰腺癌历史队列相比，同步转移性疾病的胰腺癌患者的生存期更长。
这项单中心经验强调了胰腺癌靶向治疗的挑战。很少有患者最终接受了推荐的治疗，这突显了在胰腺癌中需要更多和更好的靶向治疗选择，早期进行全面基因组分析以留出足够的时间将分子肿瘤委员会的建议付诸实践，并与临床试验单位密切合作，使患者能够获得其他无法获得的靶向治疗。
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