This protocol applies to patients with metastatic pancreatic cancer who carry a germline BRCA mutation. Identifying this mutation changes the treatment approach and determines eligibility for a specific maintenance strategy.
The recommended approach involves platinum-based chemotherapy as the initial treatment. For patients whose disease responds to or remains stable on platinum-based therapy, a specific maintenance treatment is available — the full regimen and sequencing criteria are in the complete protocol.
Patients with BRCA mutations should receive platinum-based ChT [III, A].
BRCA genetic testing should be offered to all patients with metastatic PC to determine eligibility for selection of platinum-based ChT, followed by maintenance with olaparib [I, B; olaparib ESMO-MCBS v1.1 score: 2].
Olaparib maintenance treatment is an option for patients with a gBRCA1/2 variant whose disease is stable or responsive to platinum-based ChT [I, B; ESMO-MCBS v1.1 score: 2; ESMO Scale for Clinical Actionability of molecular Targets (ESCAT) score: I-A].