TARGETED THERAPY SAVED A PATIENT’S LIFE

Pancreatic cancer has always been considered a dangerous and poorly treatable type of cancer pathology. Last year, mortality from this disease ranked 5th among malignant neoplasms both in the world and in our country. In 2022, more than 16.7 thousand new cases were recorded in the Russian Federation.

The insidiousness of this type of cancer is that more than half of patients at the time of diagnosis already have metastases, and in this case, only 3% of patients live to five years. Recently, specialists from the P. Hertsen Moscow Oncology Research Institute – branch of the FSBI “National Medical Research Radiological Centre” of the Ministry of Health of the Russian Federation presented a clinical case of effective treatment of a 62-year-old patient suffering from cancer of the head of the pancreas with molecular genetic features of the tumor.

In February 2018, the woman was diagnosed with ductal adenocarcinoma based on the results of abdominal CT scan and then histologic examination. Given the limited extent of the tumor process, the treating physicians decided on surgical treatment. They removed a part of the pancreas with the tumor, gallbladder and the nearest lymph node, but the cancer cells had already managed to get into the blood, and a month later on PET-CT the doctors found multiple metastatic foci in both liver lobes of the size. It was at this stage that the patient came to our Center.

The woman was treated with FOLFIRINOX, a chemotherapy regimen recognized as the most effective in comparison with other regimens. However, after completion of 10 courses, negative dynamics was observed in the form of new metabolically active foci in the liver capsule and peritoneal carcinomatosis. In addition, the body responded to the drug by disruption of the functions of peripheral nerve fibers and a decrease in the content of leukocytes, platelets and erythrocytes in the blood.

Then the specialists of the chemotherapy department sent a sample of the tumor and the patient’s blood for molecular genetic testing with the help of new generation sequencing, which is performed in our Center. The results of the analysis revealed the presence of a germline mutation in the woman, which allowed the doctors to offer the patient targeted therapy.

The clinical guidelines for patients with such genetic disorders stipulate the prescription of the targeting drug olaparib. At the time of the patient’s treatment in the chemotherapy department of the P. Hertsen Moscow Oncology Research Institute, there was a program of extended access to another drug of the same group, talazoparib, so the doctors had an opportunity to prescribe it.

The main feature of the mechanism of action of these drugs is their ability to create a complex with a break in the DNA of the tumor cell in which the mutation is present, and to prevent other proteins capable of eliminating this defect from joining this zone. As a result, the tumor cell dies.

Starting from March 2019, according to regular check-ups, doctors noted positive dynamics on the background of therapy, and in January 2021 (after 21 months of treatment) a complete response was recorded – complete disappearance of liver metastases.

To date, the patient continues to take the drug for 60 months (5 years!) and the resumption of tumor growth is not observed.

“On the example of this clinical case we can say with certainty that the appointment of such therapy in the presence of targets (mutations) gives a very good result, explains the head of the Department of Chemotherapy Dr. L.V. Bolotina. Target agents allow us to help patients who have limited or completely exhausted the options of standard treatment, and achieve impressive survival rates exceeding the 5-year mark”.