The impact of HRD in patients with pancreatic adenocarcinoma undergoing surgical resection: An updated analysis.

Authors

Gudbjorg Jonsdottir

Gudbjorg Jonsdottir

University of Iowa Hospitals and Clinics, Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, Iowa City, IA

Gudbjorg Jonsdottir , Asgeir Thor Masson , Laura S. Jacobus , Michelle L. Churchman , Stephen B. Edge , Anne M. Noonan , Michael J. Cavnar , Susanna Varkey Ulahannan , Ibrahim Halil Sahin , Carlos Hou Fai Chan

Organizations

University of Iowa Hospitals and Clinics, Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, Iowa City, IA, University of Iowa Hospitals and Clinics, Department of Surgery, Iowa City, IA, University of Iowa, Iowa City, IA, M2Gen, Tampa, FL, Roswell Park Comprehensive Cancer Center, Buffalo, NY, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH, University of Kentucky, Lexington, KY, Stephenson Cancer Center, Oklahoma City, OK, H. Lee Moffitt Cancer Center & Research Institute, and Alliance, Tampa, FL, University of Iowa Hospitals and Clinics, Iowa City, IA

Research Funding

No funding received

Background: Limited data is available regarding which mutations in the homologous recombination repair (HRR) pathway beyond BRCA can be targeted with platinum-based chemotherapy in the perioperative setting in patients with pancreatic ductal adenocarcinoma (PDAC). In this updated analysis, we assess the outcome of patients with homologous recombination deficiency (HRD) in response to platinum vs. non-platinum based perioperative chemotherapy in resected PDAC and have included additional variants linked to HRD. Methods: Patients with resectable PDAC, diagnosed between 1999-2020 from the participating members of the Oncology Research Information Exchange Network (ORIEN) were included in the study. Patient’s germline and somatic whole exome sequencing (WES) data were analyzed for known pathogenic and likely pathogenic variants according to ClinVar for the following HRR pathway genes: BRCA1, BRCA2, PALB2, BRIP1, BRAD1, BLM, BAP1, ATM, RAD51C, RAD51, RAD50, RAD54B, CHECK2, NBN, FANCA/B/C/D2/E/F/G, ARID1A, MRE11 and XRCC2. The Kaplan Meier method was used to compare median overall survival (mOS) between patients with and without HRR pathway mutations in response to perioperative platinum vs non-platinum-based chemotherapy. Multivariate cox proportional hazard model was used to calculate HR and 95% CIs adjusting for age, sex and pathologic stage. Results: The ORIEN cohort included 311 patients with resectable PDAC and available WES data. A total of 22 patients (7%) had an HRR pathway mutation. Of these, 8 (36%) received perioperative platinum-based chemotherapy and 9 (41%) a non-platinum based regimen, 4 patients (23%) received no perioperative systemic treatment. Frequency of HRR variants detected: BRCA2 n=8 (2.6%), BRCA1 n=3 (1%), ATM n=2 (0.6%), ARID1A n=1 (0.3%), BRIP1 n=1 (0.3%), CHECK2 n=1 (0.3%), FANCG n=1 (0.3%), PALPB2 n=1 (0.3%), RAD50 n=4 (1.3%), RAD51C n=1 (0.3%). The mOS for patients with HRR mutations exposed to perioperative platinum-based chemotherapy was 3.5 years (95% CI 3.4-NA), patients with HRR mutation but no platinum exposure had a mOS of 1.2 years (CI 0.9-NA). In patients with no HRR mutation exposed to platinum-based chemotherapy mOS was 2.7 years (CI 2.3-3.9) and in those without exposure mOS was 2.9 years, p=0.43. Comparison of risk of death between the 4 groups is demonstrated in the table. Conclusions: There was a trend towards improved survival in patients with PDAC who harbored a HRR pathway mutation and were treated with perioperative platinum-based chemotherapy compared to those with no platinum exposure. Our results highlight the importance of identifying patients with HRD beyond BRCA and the need for large prospective studies in the perioperative setting to further assess their predictive role.


HR
95% CI
P-value
HRD-, non-platinum
Reference
-
-
HRD+, non-platinum
2.53
0.99-6.5
0.05
HRD-, platinum
1.06
0.69-1.6
0.81
HRD+, platinum
0.78
0.26-2.3
0.65

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Pancreatic Cancer

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 4132)

DOI

10.1200/JCO.2022.40.16_suppl.4132

Abstract #

4132

Poster Bd #

118

Abstract Disclosures

Similar Abstracts

Abstract

2023 ASCO Annual Meeting

Comprehensive genomic analysis for homologous recombination deficiency in pancreatic cancer.

First Author: Kwangrok Jung

First Author: Muhammad Danyal Ahsan