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Sequencing to Target Pancreatic Cancer Tx ‘Challenging’ in Real World

By Lori Solomon, Editor, Diagnostic Testing & Emerging Technologies Real-world application of sequencing for targeting pancreatic cancer treatment remains challenging, according to a study published in Clinical Cancer Research and presented at the American Association for Cancer Research annual meeting (Philadelphia, April 18-22). Insufficient or nonexistent biopsy samples and slow turnaround times were among the […]

By Lori Solomon, Editor, Diagnostic Testing & Emerging Technologies

Real-world application of sequencing for targeting pancreatic cancer treatment remains challenging, according to a study published in Clinical Cancer Research and presented at the American Association for Cancer Research annual meeting (Philadelphia, April 18-22). Insufficient or nonexistent biopsy samples and slow turnaround times were among the most common reasons molecular analysis could not be used to inform treatment decisions.

As part of the Individualized Molecular Pancreatic Cancer Therapy (IMPaCT) trial the ability to return high-quality actionable genomic data within a clinically acceptable timeframe was assessed. The single-arm trial screened patients for three molecular targets: HER2 amplification (to inform treatment with trastuzumab/gemcitabine); KRAS wild-type, (for treatment with erlotinib/gemcitabine); and DNA damage repair pathway defects (expanded to BRCA1, BRCA2, PALB2, ATM assessment for treatment with platinum-based chemotherapy).

“We know that, unfortunately, only about 15 percent of the population had molecular targets eligible for this type of treatment and that it has been very difficult to do the molecular analysis quickly enough before patients get too sick to be treated,” said lead author Lorraine Chantrill, M.B.B.S., from the Garvan Institute of Medical Research in Australia, in a statement.

To date, the researchers have screened 93 tumors over 18 months and identified 22 patients with relevant molecular targets (14 KRAS wild-type, 5 cases of HER2 amplification, 2 mutations in BRCA2, and 1 ATM mutation). The average time from biopsy to delivery of the molecular results was 21 days. An inability to obtain a biopsy sample or insufficient tumor content in the available specimen commonly precluded patients from molecular analysis. Additionally, deteriorating performance status prohibited many patients from proceeding in the study.

“[This study] highlights how current health care systems are not well aligned for a more personalized approach to therapy,” concludes senior study author Andrew Biankin, Ph.D., from University of Glasgow (United Kingdom), in a statement. “Lessons learnt here could inform appropriate changes in health care systems to enable precision medicine in practice.”

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