title: Molecular profiling of a case of advanced pancreatic cancer identifies an active and tolerable combination of targeted therapy with backbone chemotherapy.
abstract: Typical survival with common 1(st)-line regimens for pancreatic cancer range from 6-11 months. We report a case of a patient with stage IVB pancreatic adenocarcinoma treated with gemcitabine and erlotinib who stopped therapy after 3 months without achieving a response due to intolerance. To decide upon additional treatment options, molecular analysis was performed on liver metastasis which revealed KRAS, FBXW7, APC, and ATM mutations, with thymidylate synthase (TS) negativity and PD-1 positivity. Based on this profile of TS negativity and ATM mutation, a combination strategy was devised consisting of capecitabine, oxaliplatin, bevacizumab and vorinostat. The patient had a near complete response to therapy with this regimen. In refractory metastatic pancreatic cancer, responses of this magnitude are rarely seen. To our knowledge, this represents the first demonstrated activity of this combination in the metastatic setting which could prompt further investigation of its use in large scale clinical trials.
authors.affiliation: 1 The University of Tennessee Health Science Center and West Cancer Center, Memphis, TN 38120, USA ; 2 Hope Health Center, Reseda, CA, USA ; 3 Caris Life Sciences, Irving, TX, USA.
authors.forename: Benny
authors.initials: B
authors.lastname: Johnson
authors.affiliation: 1 The University of Tennessee Health Science Center and West Cancer Center, Memphis, TN 38120, USA ; 2 Hope Health Center, Reseda, CA, USA ; 3 Caris Life Sciences, Irving, TX, USA.
authors.forename: Ari
authors.initials: A
authors.lastname: Vanderwalde
authors.affiliation: 1 The University of Tennessee Health Science Center and West Cancer Center, Memphis, TN 38120, USA ; 2 Hope Health Center, Reseda, CA, USA ; 3 Caris Life Sciences, Irving, TX, USA.
authors.forename: Nader
authors.initials: N
authors.lastname: Javadi
authors.affiliation: 1 The University of Tennessee Health Science Center and West Cancer Center, Memphis, TN 38120, USA ; 2 Hope Health Center, Reseda, CA, USA ; 3 Caris Life Sciences, Irving, TX, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Feldman
authors.affiliation: 1 The University of Tennessee Health Science Center and West Cancer Center, Memphis, TN 38120, USA ; 2 Hope Health Center, Reseda, CA, USA ; 3 Caris Life Sciences, Irving, TX, USA.
authors.forename: Sandeep Bobby
authors.initials: SB
authors.lastname: Reddy
keywords: Metastatic pancreatic cancer; molecular profiling; targeted therapy