Jun 07, 2016
A study carried out across three cancer centers in Europe assessed whether surveillance and screening for people with a genetic risk of pancreatic cancer (PDAC) improved detection rates of early-stage PDAC, or precursor lesions (PRLs), and improved overall survival (OS), compared to the general population of patients with PDAC. Published online ahead of print, April 25, in the Journal of Clinical Oncology (JCO), the study focused on families with patterns of familial pancreatic cancer (FPC) and families with genetic defects that increase the risk of developing PDAC; the relevant genes include CDKN2A/p16-Leiden, BRCA1/2, and PALB2. The study followed 411 people with a genetic risk for PDAC over 4 to 15 years. Participants underwent annual imaging at cancer centers in Marburg, Germany; Leiden, the Netherlands; and Madrid, Spain.
The study “The Benefit of Surveillance for Pancreatic Cancer in High-Risk Individuals: Outcome of Long-Term Prospective Follow-Up Studies From Three European Expert Centers,” found that among people with a CDKN2A/p16-Leiden gene defect, surveillance detected pancreatic cancer in 7% of individuals and among those individuals, 75% were able to undergo resection; 75% is much higher than the resection rate of 15-20% reported for sporadic pancreatic cancer in the general population. Patients with PDAC with a CDKN2A/p16-Leiden defect also had higher OS; at five years, 24% were alive, compared to 5% reported among patients with symptomatic pancreatic cancer overall.
Among the group with FPC, pancreatic cancer was detected in less than 1% of participants. Thirteen individuals with FPC (6.1%) underwent surgical resection for a suspected PRL, but only four (1.9%) were found to have high-risk lesions.
Commenting on the study’s findings, the study’s first author, Hans Vasen, MD, PhD, said, “The outcome in the group of patients with a CDKN2A/p16-Leiden mutation encourages us to continue the screening program. With the application of tumor markers and a more sensitive MRI, we hope to improve the results further.”
An aggressive tumor benefits from early detection
Dr. Vasen explained the importance of early detection of PDAC.
“It is well-known that pancreatic cancer is a very aggressive tumor, with a mean survival after diagnosis of only 6 months and a 5-year survival rate of only 5%. Despite progress in our understanding of PDAC development and improvements in surgical techniques, the survival rate has not substantially changed since the introduction of pancreaticoduodenectomy 80 years ago. Currently, surgical resection is the only potentially curative treatment for PDAC, but in approximately 80% of symptomatic patients, the tumor is already unresectable at the time of diagnosis,” Dr. Vasen said.
Dr. Vasen said that 3-5% of all cases of pancreatic cancers are caused by hereditary factors; people in families with FPC or with genetic risk factors for PDAC present an opportunity for early detection.
“Because screening for pancreatic cancer is relatively effective in individuals genetically predisposed to develop pancreatic cancer, it is important to identify these patients and offer screening. Such patients should be referred to expert centers with ongoing screening programs for the early detection of pancreatic cancer and a high volume of pancreatic surgery.”
Dr. Vasen cautioned that before starting the program, those at high risk for PDAC should be told about the advantages and disadvantages of screening programs.
Hans Vasen, MD, PhD, is an Internist in the department of Gastroenterology and Hepatology at the Leiden University Medical Centre in Leiden, the Netherlands. He is also the Medical Director of the Dutch Hereditary Cancer Registry. In addition, Dr. Vasen is Editor in Chief of Familial Cancer.
Abstract of the original JOP article.
PDF of the original JOP article.
Vasen H, Ibrahim I, Guillen Ponce CG, et al. The benefit of surveillance for pancreatic cancer in high-risk individuals: outcome of long-term prospective follow-up studies from three European expert centers. J Clin Oncol. Epub 2016 April 25.
The Exclusive Coverage series on ASCO.org highlights selected research from JCO, JOP, and JGO, with additional perspective provided by the lead or corresponding author.
@ 2016 American Society of Clinical Oncology