Risk Management & Treatment

Biomarkers, targeted and immunotherapies for pancreatic cancer

This section covers the following topics:


Genetic tests for inherited mutations for treatment selection

Any person diagnosed with pancreatic cancer meets national guidelines for genetic testing for an inherited mutation. 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


testing for treatment selection

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 

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 (olaparib) 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 inherited mutation 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 

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. 


Other targeted therapies

  • Tarceva (erlotinib) is approved in combination with the chemotherapy gemcitabine as first-line 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
Lynparza
(olaparib)
pancreatic cancer First-line for patients whose disease has not progressed on at least 16 weeks of platinum-based chemotherapy  Inherited mutation in or
Tarceva (erlotinib) Locally advanced, unresectable or pancreatic cancer First-line therapy used in combination with gemcitabine No required EGFR inhibitor
Afinitor
(everolimus) 
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)
Sutent
(sunitinib malate)
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

find-support find-support

The following organizations offer peer support services for people with, or at high risk for pancreatic cancer:

updated: 01/22/2022

paying-for-service paying-for-service

Paying for testing

Insurance companies are required to cover the costs for cancer treatment. However, health plans may vary on the amount of out-of-pocket costs and coverage for specific doctors, facilities or treatments. Your doctor's office and treating hospital should disclose how much your treatment may cost you and work with your insurance company to help you plan for the cost of your care. Visit our Health Insurance Appeals page for additional information on insurance appeals. 

Medicare will cover the cost for genetic testing and testing for people who meet certain criteria. Medicare coverage varies based on the policies of Medicare in your region. Visit this site to find and contact your regional Medicare provider for more information about coverage. The Medicaid website has a link to state Medicaid programs, which list specific eligibility for each state.

Some laboratories have assistance programs that help cover the cost for tumor testing: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.

updated: 01/22/2022

paying-for-service paying-for-service

Paying for cancer treatment

The majority of public and private health insurance plans are required to cover cancer diagnosis and treatment; copays, coinsurance and deductibles often apply. Patient costs and coverage for specific doctors, facilities or treatments may vary based on your health plan. Visit our section on Insurance and Paying for Care: Treatment  for more information, links to sample appeal letters and other resources. 

Some pharmaceutical companies have assistance programs that help cover the cost for their medications: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Needy Meds: Assistance programs to help patients with cost of medications and other healthcare.
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.

updated: 01/22/2022

clinical-trials clinical-trials

The following are studies enrolling people diagnosed with pancreatic cancer:

A number of other clinical trials for people with pancreatic cancer can be found here.

updated: 12/15/2021

Last updated January 23, 2022