Editor's note
From September 16 to 21, 2021, the 2021 European Society for Medical Oncology (ESMO) annual meeting will be held in the form of an online conference. As one of the most influential tumor academic platforms in the world, the ESMO annual meeting brings together global oncology professionals to share cutting-edge R&D trends and progress in the field of oncology.
Pancreatic cancer is one of the common malignant tumors of the digestive tract, and is known as the "King of Cancer" in the field of tumors. According to The Lancet, the five-year survival rate of after the diagnosis of pancreatic cancer is about 10%, which is one of the worst-prognostic malignant tumors. This issue of [Medical Yuehui] sorts out some hot researches on pancreatic cancer for readers!
Pancreatic cancer
1 Hereditary breast cancer, Ovarian cancer and pancreatic cancer: beyond BRCA1/2 gene
Background
Hereditary breast cancer (BC), ovarian cancer (OC ) And pancreatic cancer (PC) are the main BRCA-related tumors. However, some BRCA1/2 non-informative patients with a strong personal and/or family history of cancer require further genetic testing through a multi-gene panel including other high-risk and medium-risk susceptibility genes. In recent years, next-generation sequencing has allowed the simultaneous study of multiple genes, reducing analysis costs, increasing genetic data, and providing patients with more information.
method
Our study aims to assess whether certain BC, OC, and PC patients should be provided based on clear criteria regarding the personal and/or family history of cancer (such as early onset of cancer, occurrence of multiple tumors) Multi-gene panel testing, and there are two or more affected first-degree relatives. Therefore, among the 915 patients with BC, OC and PC, 205 BRCA1/2 have no information and have significant personal and/or family history of cancer, which are resistant to germline pathogenic or possibly pathogenic variants in the gene ( PV/LPV) has undergone genetic testing which is different from BRCA1/2.
Results
Our study showed that 31 of 205 patients (15.1%) had germline PV/LPV in non-BRCA genes, including PALB2, CHEK2, ATM, MUTYH, MSH2, RAD51C. In particular, we found that 11 out of 24 (45.8%) BC patients who carried PV/LPV without BRCA gene showed bilateral breast cancer. Interestingly, in the absence of multi-gene panel analysis, a considerable portion (15.1%) of PVs/LPVs will be lost in this patient environment.
Conclusion
provides multi-gene panel detection for BRCA1/2 non-informative BC, OC and PC patients with a strong personal and/or family history of cancer, which can significantly increase the risk of other cancers other than BRCA1/2 The detection rate of germline PV/LPV in susceptible genes. The use of multi-gene panel testing can improve the risk assessment and clinical management of hereditary cancers for patients and unaffected family members.
2 A multicenter randomized phase II open-label study comparing the safety and effectiveness of direct oral anticoagulant and subcutaneous injection of dalteparin in the treatment of advanced upper gastrointestinal cancer, hepatobiliary cancer and pancreatic cancer patients with cancer-related venous thromboembolism
Background
Anticoagulant therapy for cancer-related venous thromboembolism (CA-VTE) is challenging, especially in terms of balancing the risk of CA-VTE recurrence and the risk of bleeding during anticoagulation, because the cancer itself is The risks of both. Recently, direct oral anticoagulant (DOAC) has been recommended as an equivalent treatment option with subcutaneous injection of dalteparin. However, questions about the risk of bleeding in DOAC treatment are constantly being raised. This study evaluated the safety and effectiveness of DOAC and subcutaneous injection of dalteparin on CA-VTE in patients with advanced upper gastrointestinal (GI) tract cancer, hepatobiliary cancer, or pancreatic cancer.
method
This is a multicenter, randomized, open-label phase II trial conducted in five centers.Patients were randomly assigned to receive rivaroxaban (15 mg twice a day for 3 weeks, then 20 mg once a day)/apixaban (10 mg twice a day for the first 7 days, then 5 mg twice a day) or dalteparin (200IU/kg once a day for the first month, then 150IU/kg once a day). Randomization was stratified according to the performance status of the Eastern Cooperative Oncology Group, the type of primary cancer, active chemotherapy, and participating centers. The primary endpoint is the incidence of clinically relevant bleeding (CRB) in the full analysis set (FAS).
Results
In FAS, a total of 90 patients were randomly assigned to the DOAC (n=44) and dalteparin groups (n=46). The incidence of CRB and major bleeding (MB) in the DOAC and dalteparin groups were 34.1% and 13.0% (P=0.018), and 18.2% and 4.3% (P=0.047), respectively. The cumulative incidence of CRB and MB in the DOAC group was higher than that in the dalteparin group (hazard ratio [HR] 2.83; P=0.03, HR4.32; P=0.064). In univariate analysis, cancer of the gastrointestinal mucosa is also an important risk factor for CRB. CA-VTE recurred in 2.3% of the DOAC group and 2.2% of the dalteparin group (P=1.000).
Conclusion
In patients with active advanced upper gastrointestinal cancer, hepatobiliary cancer, or pancreatic cancer, DOAC treatment further increases the risk of bleeding compared with dalteparin, so when choosing an anticoagulant for CA-VT Need to be extra careful.
3 plus famitinib for previously treated advanced pancreatic cancer or biliary tract cancer phase II study
background
pancreatic cancer (PC) and biliary tract cancer (BTC) Is a highly aggressive cancer,Treatment options are limited. The objective response rate (ORR) of second-line chemotherapy in both PC and BTC was <10%.> tyrosine kinase inhibitor targeting multiple targets, including vascular endothelial growth factor receptor 2/3, platelet-derived growth factor receptor β and stem cell factor receptor. Here, we report the safety and efficacy of SHR-1701 combined with famitinib in previously treated advanced PC and BTC patients (pts).
Method
This is an ongoing Phase II study of SHR-1701 plus famitinib for the treatment of patients with C or BTC who have failed ≥1 previous treatment. Patients received SHR-1701 (30mg/kg q3w) combined with famitinib (20mg qd) until disease progression or unacceptable toxicity. According to RECISTv1.1, the primary endpoint is ORR. Secondary endpoints include disease control rate (DCR), progression-free survival, overall survival, and safety.
Results
As of April 27, 2021, 10 and 4 patients were enrolled in the PC and BTC cohorts, respectively. Of the 7 evaluable patients in the PC cohort, 2 patients were in stable condition (SD) (one patient remained stable for 4.6 months), and one patient had not confirmed complete remission. The DCR is 43%. Of the 3 evaluable patients in the BTC cohort, 1 had SD and 1 had a partial response, lasting more than 3.3 months (tumor shrinkage>45%). ORR and DCR were 33% and 67%, respectively. 11pts is included in the security group. The most common treatment-related adverse events (TRAE) of any grade were proteinuria (82%), hypertension (64%), hematuria (64%), elevated alanine aminotransferase (64%), Elevated aspartate aminotransferase (55%) and hypoalbuminemia (55%).The most common grade 3 TRAE is an increase in conjugated bilirubin (2 points); no grade 4/5 adverse events have been reported.
Conclusion
The combination of SHR-1701 and Famitinib showed promising activity and well-tolerated toxicity in patients with advanced PC or BTC. The updated result will be displayed.
We will continue to update more hot tumor research studies at ESMO 2021, so stay tuned!
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