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同源重组基因变异与晚期胰腺癌奥沙利铂为基础化疗疗效的相关性:前瞻性多中心观察性研究。

Association between homologous recombination gene variants and efficacy of oxaliplatin-based chemotherapy in advanced pancreatic cancer: prospective multicenter observational study.

机构信息

Department of Clinical Oncology, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.

Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.

出版信息

Med Oncol. 2023 Apr 11;40(5):144. doi: 10.1007/s12032-023-02011-y.

Abstract

Next-generation sequencing (NGS)-based gene profiling can identify patients with pancreatic cancer with homologous recombinant repair gene pathogenic variants (HRRv). Several retrospective studies have reported a positive association between HRRv and the efficacy of platinum-based chemotherapy. However, this association remains to be validated in a prospective study. This multicenter, prospective, observational study included patients with histologically confirmed unresectable or recurrent pancreatic cancer who required systemic chemotherapy. Patients who were oxaliplatin-naïve patients were eligible. The HRRv status was measured using a College of American Pathologists-accredited NGS panel. One-year overall survival rate (1yr-OS%) was calculated after initiation of oxaliplatin-based chemotherapy and was set as the primary endpoint. Forty patients were enrolled between August 2018 and March 2020. The NGS success rate was 95% (38/40). HRRv was detected in 11 patients (27.5%). Oxaliplatin-based chemotherapy was administered to 9 of 11 patients with HRRv (81.8%) and 15 of 29 patients with non-HRRv (51.7%). The 1yr-OS% after initiation of oxaliplatin-based chemotherapy was 44.4% [95% confidence interval (CI) 13.7-71.9] and 57.1% (95% CI 28.4-78.0) in HRRv-positive and -negative cohorts, respectively. These data suggested that HRRv status alone could not be a potential predictive marker of oxaliplatin-based chemotherapy in patients with advanced pancreatic cancer. These results were in line with the results of a recent phase II study reporting the limited efficacy of poly(adenosine diphosphate-ribose) polymerase inhibitor in patients with pancreatic cancer who harbored HRRv other than BRCA. Future studies investigating patients with biallelic HRRv in the first-line setting are warranted.Trial registration UMIN000033655.

摘要

下一代测序(NGS)- 基于基因谱分析可以识别出具有同源重组修复基因致病性变异(HRRv)的胰腺癌患者。几项回顾性研究报告称,HRRv 与铂类化疗的疗效之间存在正相关。然而,这一关联仍有待前瞻性研究验证。这项多中心、前瞻性、观察性研究纳入了组织学证实不可切除或复发性胰腺癌且需要全身化疗的患者。奥沙利铂初治患者符合条件。HRRv 状态使用美国病理学家学会认证的 NGS 面板进行测量。奥沙利铂为基础的化疗开始后计算 1 年总生存率(1yr-OS%),作为主要终点。2018 年 8 月至 2020 年 3 月期间共纳入 40 例患者。NGS 成功率为 95%(38/40)。检测到 HRRv 的患者有 11 例(27.5%)。11 例 HRRv 患者中有 9 例(81.8%)接受了奥沙利铂为基础的化疗,29 例非 HRRv 患者中有 15 例(51.7%)接受了奥沙利铂为基础的化疗。奥沙利铂为基础的化疗开始后 1yr-OS%分别为 HRRv 阳性和阴性队列的 44.4%(95%CI13.7-71.9)和 57.1%(95%CI28.4-78.0)。这些数据表明,在晚期胰腺癌患者中,HRRv 状态本身不能成为奥沙利铂为基础化疗的潜在预测标志物。这些结果与最近一项 II 期研究的结果一致,该研究报告称,在除 BRCA 以外的具有 HRRv 的胰腺癌患者中,聚(腺苷二磷酸核糖)聚合酶抑制剂的疗效有限。有必要在一线治疗中研究具有双等位 HRRv 的患者。试验注册号 UMIN000033655。

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