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Alexander Drilon, MD

Gregory J. Riely, MD, PhD


Targetable Biomarkers May Be Worth Identifying in Pancreatic and Liver Cancers: Expert Consensus From Spain

By: Kayci Reyer
Posted: Tuesday, November 29, 2022

According to research presented in Clinical & Translational Oncology, biomarkers such as NTRK fusions may contribute to carcinogenesis in patients with pancreatic and biliary tract cancers. The Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP) produced an expert consensus outlining suggested molecular-oriented approaches to regulate the diagnosis and treatment of these gastrointestinal tumors.

“Pancreatic cancer and [biliary tract cancer] represent two tumors of low incidence but high mortality, with very poor oncological treatment outcomes,” commented Beatriz Madrigal-Rubiales, MD, of Río Hortega University Hospital, Valladolid, Spain, and colleagues. “The most important advances have come from personalized medicine. For this reason, it is important to agree on the biomarkers recommended for use for these neoplasms.”

The consensus team recommended that the presence of certain key biomarkers in pancreatic and biliary tract cancers be established, and that information be used to determine subsequent treatment types. NTRK and NRG1 fusions were identified as consequential in both cancer types; if present, the TRK inhibitors larotrectinib or entrectinib may be an appropriate therapy.  Determining the presence of high microsatellite instability is also recommended for patients with either cancer, since it may predict response to immunotherapy.

In pancreatic cancer, germline BRCA1 and BRCA2 mutations are associated with superior response to platinum and PARP inhibition. KRAS mutations, present in 93% to 95% of patients with pancreatic cancer, may indicate the presence of other alterations that may be therapeutic targets. The authors noted that 40% of patients with intrahepatic cholangiocarcinoma carry molecular alterations that may be therapeutic targets. If mutations in IDH1 as well as FGFR2 fusion or rearrangement are present, targeted treatments such as ivosidenib or pemigatinib, respectively, may be selected.

Disclosure: The study authors reported no conflicts of interest.

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