Abstract 1474P
Background
Emerging evidence suggests BRCA1/2 or ATM gene mutation status in metastatic pancreatic cancer (mPC) could predict clinical benefit from platinum-based chemotherapy and targeted therapies. We examined treatment patterns by BRCA 1/2/ATM mutation status in patients with mPC receiving routine care in the United States.
Methods
We identified patients, ≥18 years, with mPC (≥2 PC diagnoses within 90 days and ≥1 diagnosis or ≥2 note mentions of metastatic disease) in Optum’s de-identified electronic health record database (1/1/2011 – 6/30/2020; N=42.5M). Index date was first diagnosis/note mention of metastatic disease. Patients were observed for 12 months pre-index for baseline characteristics and followed for up to 36 months or until death.
Results
Among 546 mPC patients tested for BRCA/ATM, 182 (33.3%) had BRCA/ATM mutation (POS), 94 (17.2%) had BRCA/ATM (NEG), and 270 (49.5%) unknown status. Patients were 66% and 60% female with mean (SD) age 65.1 (11.0) and 63.3 (10.5) years for POS and NEG, respectively. 43% of POS patients had 2+ metastases, 56% had liver metastases and 73% had visceral metastases. Only 30% of NEG patients had 2+ metastases, 53% had liver metastases and 70% had visceral metastases. At 36-months post-index, use of platinum-based therapies and PARP inhibitors was 64% vs 74% and 14% vs 0% in POS and NEG patients, respectively (Table). Table: 1474P
Most common first-line regimens & targeted therapies
6 Month | 12 Month | 24 Month | 36 Month | |||||
BRCA POS | BRCA NEG | BRCA POS | BRCA NEG | BRCA POS | BRCA NEG | BRCA POS | BRCA NEG | |
Treated Patients | 76 | 38 | 80 | 39 | 82 | 39 | 82 | 39 |
Gemcitabine + Paclitaxel in 1st line | 31.6% | 26.3% | 30.0% | 25.6% | 30.5% | 25.6% | 30.5% | 25.6% |
Fluorouracil + Irinotecan + Leucovorin + Oxaliplatin in 1st line | 23.7% | 50.0% | 22.5% | 48.7% | 22.0% | 48.7% | 22.0% | 48.7% |
Platinum-based Chemotherapy in any line/setting | 52.6.% | 63.2% | 60.0% | 74.4% | 63.4% | 74.4% | 64.6% | 74.4% |
PARP Inhibitor in any line/setting | 6.6% | 0.0% | 10.0% | 0.0% | 12.2% | 0.0% | 14.6% | 0.0% |
Conclusions
While there are few differences in patient and treatment characteristics between patients by BRCA/ATM status, BRCA/ATM POS patients had a greater number of metastases and PARP inhibitor use. There is need for further research to understand the role of BRCA/ATM status on treatment choice and outcomes.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Merck & Co., Inc.
Funding
Merck & Co., Inc.
Disclosure
M.I. Sierra: Financial Interests, Personal, Full or part-time Employment: Optum; Financial Interests, Institutional, Other, Optum was contracted by Merck to conduct this research.: Merck & Co., Inc. G. Adeboyeje: Financial Interests, Personal, Full or part-time Employment: Merck & Co., Inc; Financial Interests, Personal, Stocks/Shares: Merck & Co., Inc. S. Joo: Financial Interests, Personal, Full or part-time Employment: Merck & Co., Inc; Financial Interests, Personal, Stocks/Shares: Merck & Co., Inc. A. Bartels: Financial Interests, Personal, Full or part-time Employment: Optum; Financial Interests, Institutional, Other, Optum was contracted by Merck to conduct this research.: Merck & Co., Inc. M. Field: Financial Interests, Personal, Full or part-time Employment: Optum; Financial Interests, Institutional, Other, Optum was contracted by Merck to conduct this research.: Merck & Co., Inc; Financial Interests, Personal, Stocks/Shares: Optum. A. Buikema: Financial Interests, Personal, Full or part-time Employment: Optum; Financial Interests, Institutional, Other, Optum was contracted by Merck to conduct this research.: Merck & Co., Inc; Financial Interests, Personal, Stocks/Shares: Optum. S. Jhamb: Financial Interests, Personal, Full or part-time Employment: Optum; Financial Interests, Institutional, Other, Optum was contracted by Merck to conduct this research.: Merck & Co., Inc.