In a retrospective study reported in The Lancet Oncology, Michael J. Pishvaian, MD, and colleagues found that overall survival was better in patients with pancreatic cancer with actionable molecular alterations who received matched therapies compared with those who received only unmatched therapies and those with no actionable molecular alterations.
Michael J. Pishvaian, MD
Study Details
The study included data from adults with pancreatic cancer of any stage enrolled in the Know Your Tumor (KYT) program who had undergone testing for molecular alterations. The program—which includes patients based in the United States—enables patients to undergo commercially available multiomic profiling to provide molecularly tailored therapy options and clinical trial recommendations. The primary outcome measure—median overall survival—was calculated from the initial diagnosis of advanced disease until death.
Key Findings
Of 1,856 patients referred to the KYT program between June 2014 and March 2019, 1,082 (58%) received personalized reports based on molecular testing results. Actionable molecular alterations were identified in 282 (26%).
Among 677 patients with available outcomes, 189 (28%) had actionable molecular alterations. With a median follow-up of 383 days, median overall survival was 2.58 years (95% confidence interval [CI] = 2.39 years–not reached) among 46 patients with actionable alterations who received a matched therapy vs 1.51 years (95% CI = 1.33–1.87 years) among 143 with actionable alterations who received only unmatched therapies (hazard ratio [HR] = 0.42, P = .0004).
“These real-world outcomes suggest that the adoption of precision medicine can have a substantial effect on survival in patients with pancreatic cancer, and that molecularly guided treatments targeting oncogenic drivers and the DNA damage response and repair pathway warrant further prospective evaluation.”— Michael J. Pishvaian, MD, and colleagues
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The 46 patients who received a matched therapy had significantly longer median overall survival vs the 488 patients who did not have an actionable molecular alteration (1.32 years, 95% CI = 1.25–1.47 years; HR = 0.34, P < .0001).
No significant difference in median overall survival was observed between patients with actionable alterations who received unmatched therapy vs those without an actionable alteration (HR = 0.82, P = .10).
The investigators concluded, “These real-world outcomes suggest that the adoption of precision medicine can have a substantial effect on survival in patients with pancreatic cancer, and that molecularly guided treatments targeting oncogenic drivers and the DNA damage response and repair pathway warrant further prospective evaluation.”
Dr. Pishvaian, of the Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the Pancreatic Cancer Action Network and Perthera. For full disclosures of the study authors, visit thelancet.com.
