Biomarkers, targeted and immunotherapies for pancreatic cancer
This section covers the following topics:
- Genetic testing for inherited mutations for treatment selection
- Tumor testing for treatment selectior
- PARP inhibitors
Any person diagnosed with pancreatic cancer meets national guidelines for genetic testing for an . Genetic testing may be used to guide treatment selection.
- People who test positive for an inherited or mutation may respond better to a treatment regimen that includes a type of chemotherapy known as platinum. They may also benefit from with a type of known as a .
- People who test positive for other inherited gene mutations may qualify for clinical trials looking at targeted therapies.
- People who test positive for a gene mutation may benefit from treatment with an agent.
tests look at samples of blood, tumor or other tissue for changes or abnormalities caused by cancer. These tests can give doctors clues about the cancer, including:
- how fast the cancer is growing
- which treatments are most likely to work
- whether or not the cancer is responding to treatment or growing
- whether or not the cancer has come back after remission
tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. tests used to select a specific treatment are sometimes called "companion diagnostic tests." These tests may be done on tumor tissue or (in many cases) on blood. See our Testing section for more information.
Examples of tests used in pancreatic cancer include:
- Some pancreatic cancers will have an abnormality known as MSI-H (“ high") also known as "" ( or ). MSI-H cancers are common in people with a gene mutation. These cancers may respond well to a type of treatment known as an immune checkpoint inhibitor. One example of an agent used for cancers is Keytruda (pembrolizumab).
- Some cancers have a specific genetic change called an NTRK fusion, which can be found on tumor testing. People whose tumor test reveals an NTRK fusion may benefit from the Vitrakvi (larotrectinib).
- Additional tests may help identify people who are elegible for certain clinical trials.
PARP inhibitors work by blocking a protein used by cells to repair damaged . They were initially developed to treat cancers in people with an inherited gene mutation or mutation. For people with pancreatic cancer, the Lynparza () has been approved as in patients with advanced pancreatic cancer whose cancer has stabilized after at least four months of chemotherapy. Approximately 5-8% of patients with pancreatic cancers will have a mutation in or related genes.
Research is ongoing to learn if PARP inhibitors are also affective for treating cancer in other situations, including:
- people with an in a different gene that repairs damage (for example: ).
- people who do not have an inherited gene mutation, but their tumor tested positive for an acquired mutation in a gene that repairs damage.
- in combination with or other agents.
Immunotherapies are cancer treatments that hlep the body’s immune system detect and attack cancer cells. There are several different categories of immunotherapies.
- Keytruda (pembrolizumab) is known as an immune checkpoint inhibitor. Keytruda is approved for treatment of patients with cancer with a known as microsatellite instability-high (MSI-H) or mismatch repair deficient (). Although this is not common in pancreatic cancer, it is often seen in people with a gene mutation who develop cancer.
- Tarceva (erlotinib) is approved in combination with the chemotherapy gemcitabine as therapy for locally advanced, unresectable or pancreatic cancer.
- Vitrakvi (larotrectinib) is approved for treatment of pancreatic cancer that is or cannot be removed with surgery and has worsened with other treatments. It targets a specific genetic change called an NTRK fusion. This type of genetic change is found in a range of cancers, including pancreatic cancer.
- Afinitor (everolimus) is a type of known as an mTOR inhibitor that is approved for treating people with advanced pancreatic neuroendocrine tumors.
- Sutent is a that is approved to treat patients with pancreatic neuroendocrine tumors that cannot be removed by surgery or that have metastasized.
Table of targeted and immunotherapies for pancreatic cancer
|Name of drug||Cancer||Indication||Type of agent|
|pancreatic cancer||maintenance therapy for patients whose disease has not progressed on at least 16 weeks of platinum-based chemotherapy||in or|
|Tarceva (erlotinib)||Locally advanced, unresectable or pancreatic cancer||therapy used in combination with gemcitabine||No required||EGFR inhibitor|
|Progressive pancreatic neuro-endocrine tumors (PNET)||Treatment of neuroendocrine tumors of pancreatic origin (PNET) that have progressed||No required||MTOR inhibitor (type of kinase inhibitor)|
|Unresectable, locally advanced or pancreatic neuro-endocrine tumors (PNET)||For treatment of progressive, well-differentiated pancreatic neuroendocrine tumors (pNET)||No required||Multi-target kinase inhibitor|
|Keytruda (pembrolizumab)||or unresectable||For treatment of that have progressed after treatment and for which there are no other treatment options||MSI-H ( High) or ()||Immune checkpoint inhibitor|
|Keytruda (pembrolizumab)||or unresectable||
For the treatment of that have progressed following prior treatment and for which there are no satisfactory alternative treatment options
|High (TMB-H)||Immune checkpoint inhibitor|
|Vitrakvi (larotrectinib)||solid tumors||For treatment in solid tumors where surgical resection is likely to result in severe , and for which there are no satisfactory alternative treatments or the cancer progressed following treatment||NTRK fusion||Kinase inhibitor|
The following organizations offer peer support services for people with or at high risk for pancreatic cancer:
- FORCE peer support
- Our Message Boards allow people to connect with others who share their situation. Once registered, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Private Facebook Group
- Virtual and in-person support meetings
- Join a Zoom community group meeting.
- American Sign Language
- People of Color
- Let's Win PC
- The Healing NET Foundation is a nonprofit organization for people with neuroendocrine cancers.
- The Neuroendocrine Cancer Awareness Network (NCAN) is a non-profit organization dedicated to raising awareness of neuroendocrine cancer and providing support for caregivers and people with NETs.
The following are treatment studies enrolling people diagnosed with pancreatic cancer:
- NCT04548752: Adding Pembrolizumab to to Treat Pancreatic Cancer in People with an Inherited Mutation. This study is researching whether adding the drug pembrolizumab to the olaparib works better than alone for treating pancreatic cancer in people with an inherited or mutation.
- NCT05252390: NUV-868 Alone and in Combination With PARP Inhibitors in Patients With Advanced . This study will test how safe and effective the experimental drug NUV-868 is by itself and in combination with a in people with different types of advanced cancers.
- NCT04493060: Treating Pancreatic Cancer with an Inherited or Tumor BRCA1/2 or Mutation with and Dostarlimab. This study looks at how well the and the drug dostarlimab work together in treating patients with pancreatic cancer, who have an inherited or tumor mutation in , , , , or .
- NCT04150042: SHARON: A Clinical Trial for Cancer With an Inherited or Mutation Using Chemotherapy and Patients’ Own Stem Cells. This study looks at whether melphalan, BCNU, vitamin B12b, and vitamin C, followed by autologous (self) bone marrow stem cell infusion is safe and effective for treating patients with advanced pancreatic cancer or 4, breast cancer for people with a , or .
- NCT04666740: Pembrolizumab and for Pancreatic Cancer with or Exceptional Response to Platinum Chemotherapy. This is a study for people with pancreatic cancer with a tumor test result called HRD-positive, or whose disease has responded well to or second-line platinum therapy. The study will compare the combination of the pembrolizumab and the olaparib to alone.
- NCT04858334: or in Patients with Surgically Removed Pancreatic Cancer who have a , or Mutation (APOLLO). The purpose of EA2192 / APOLLO is to compare the usual approach (observation) to treatment for one year with , in patients with a , or mutation.
- NCT04550494: Treating Solid Tumors with an Inherited or Acquired Gene Mutation Using the Talazoparib. This study is looking whether the drug is safe and effective for treating people with advanced breast, gastric, ovarian, pancreatic, or other cancers with an or an acquired mutation in certain repair genes, such as , , , , and others.
The following are vaccine studies enrolling people with pancreatic cancer:
- NCT05111353: Neoantigen Vaccines in Pancreatic Cancer in the Window Prior to Surgery. This study will look at the safety of an neoantigen vaccines in pancreatic cancer patients following chemotherapy. Participants will be placed in one of two groups. Group 1 will receive the vaccine following chemotherapy and surgery. Group 2 will receive the vaccine after chemotherapy and before surgery.
Other clinical trials for people with pancreatic cancer can be found here.