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 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.
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 (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 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 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|
|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|
|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 studies enrolling people diagnosed with pancreatic cancer:
- NCT04548752: Adding Pembrolizumab to Olaparib to Treat Pancreatic Cancer in People with an Inherited Mutation. This study is researching whether adding the drug Pembrolizumab (Keytruda) to the Olaparib (Lynparza) works better than olaparib 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 advanced .
- NCT04229004: Precision Promise Platform Trial for Pancreatic Cancer. This study tests different treatments for pancreatic cancer.
- NCT04267939: ATR Inhibitor BAY 1895344 Plus Phase 1b Study in Advanced and Ovarian Cancer. This study will look at how well advanced respond to treatment with the BAY1895344 combined with the niraparib.
- 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 .
- NCT03337087: Treating Pancreatic, Colorectal, Gastroesophageal, or Biliary Cancer with Chemotherapy and This study will look at how the works with chemotherapy to treat people with pancreatic, colorectal, gastroesophageal or biliary cancer. The study will measure the best dose and look at the side effects of this combination of drugs.
- NCT04150042: A Study of Melphalan, BCNU, Vitamin B12b, Vitamin C and Stem Cell Infusion in People with Advanced Pancreatic Cancer and Mutations. This study will look at whether combining melphalan, BCNU, vitamin B12b and vitamin C, followed by autologous (self) bone marrow stem cell infusion, is safe and effective for treating people with advanced pancreatic cancer who have a or gene mutation.
- NCT04666740: Pembrolizumab and Olaparib for Pancreatic Cancer with or Exceptional Response to Platinum Chemotherapy. This is a study for people diagnosed with pancreatic cancer with a tumor test result called HRD-positive, or whose disease has responded well to first-line or second-line platinum therapy. The study will look at whether combining the drug pembrolizumab and the olaparib is a more effective treatment for this cancer than olaparib alone.
- NCT04858334: Olaparib 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 olaparib, in patients with a , or mutation.
- NCT04657068: Treatment with ATR Inhibitor for Advanced or Solid Tumors. This study will look at how well a new oral known as an ATR inhibitor works on advanced or solid tumors with mutations in genes linked to damage repair. The study will look at the response to treatment with the drug ART0380 in combination with the chemotherapy agent, gemcitabine.
Other clinical trials for people with pancreatic cancer can be found here.