Family history as a marker of platinum sensitivity in pancreatic adenocarcinoma

David Fogelman, Elizabeth A. Sugar, George Oliver, Neeraj Shah, Alison Klein, Christine Alewine, Huamin Wang, Milind Javle, Rachna Shroff, Robert A. Wolff, James L. Abbruzzese, Daniel Laheru, Luis A. Diaz

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose: Metastatic pancreatic adenocarcinoma is considered a uniformly fatal disease with a median survival of 1 year with modern chemotherapy. While a subset of patients achieve prolonged survival, few of the factors that define this group of patients are known. Methods: For the determination of overall survival (OS), 549 patients with histologically confirmed metastatic pancreatic adenocarcinoma were evaluated. Emphasis was placed on treatment history and family history of breast, ovarian, and pancreatic cancers. To ensure a uniform metastatic population, patients treated with prior locoregional therapies (i.e., surgery or radiotherapy) were excluded as were patients with a prior history of stage I-III disease. Results: Patients with family history or pedigree history of cancer had superior OS. This was especially true in patients with three or more relatives with either breast, ovarian, or pancreatic cancers [hazard ratio (HR) 0.49, 95 % confidence interval (CI) 0.30-0.80, p = 0.003]. First-line platinum chemotherapy was associated with a poor survival (hazard ratio for death 1.74, 95 % CI 1.12-2.71, p = 0.01) for patients without a family history of these cancers but not for those without such a history (p = 0.31). In fact, as the number of relatives with these cancers increased, the OS survival improved for individuals receiving first-line platinum therapy (HR 0.76, 95 % CI 0.65-0.89, p = 0.0004), which was not the case for those receiving other therapies (p = 0.98). Conclusions: Treatment with platinum chemotherapy in patients with a family history of breast, ovarian, or pancreatic cancers was associated with a longer survival, whereas platinum use in patients without such a family history of cancer was associated with poor survival. These findings suggest that family history may serve as a predictive marker for platinum use in patients with metastatic pancreatic adenocarcinoma.

Original languageEnglish (US)
Pages (from-to)489-498
Number of pages10
JournalCancer Chemotherapy and Pharmacology
Volume76
Issue number3
DOIs
StatePublished - Sep 21 2015

Keywords

  • BRCA
  • Chemotherapy
  • Family history
  • Pancreatic adenocarcinoma
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Toxicology
  • Pharmacology
  • Cancer Research
  • Pharmacology (medical)

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