Cancer Chemotherapy and Pharmacology

, Volume 76, Issue 3, pp 489–498 | Cite as

Family history as a marker of platinum sensitivity in pancreatic adenocarcinoma

  • David Fogelman
  • Elizabeth A. Sugar
  • George Oliver
  • Neeraj Shah
  • Alison Klein
  • Christine Alewine
  • Huamin Wang
  • Milind Javle
  • Rachna Shroff
  • Robert A. Wolff
  • James L. Abbruzzese
  • Daniel Laheru
  • Luis A. DiazJr.
Original Article

Abstract

Purpose

Metastatic pancreatic adenocarcinoma is considered a uniformly fatal disease with a median survival of 1 year with modern chemotherapy. While a subset of patients achieve prolonged survival, few of the factors that define this group of patients are known.

Methods

For the determination of overall survival (OS), 549 patients with histologically confirmed metastatic pancreatic adenocarcinoma were evaluated. Emphasis was placed on treatment history and family history of breast, ovarian, and pancreatic cancers. To ensure a uniform metastatic population, patients treated with prior locoregional therapies (i.e., surgery or radiotherapy) were excluded as were patients with a prior history of stage I–III disease.

Results

Patients with family history or pedigree history of cancer had superior OS. This was especially true in patients with three or more relatives with either breast, ovarian, or pancreatic cancers [hazard ratio (HR) 0.49, 95 % confidence interval (CI) 0.30–0.80, p = 0.003]. First-line platinum chemotherapy was associated with a poor survival (hazard ratio for death 1.74, 95 % CI 1.12–2.71, p = 0.01) for patients without a family history of these cancers but not for those without such a history (p = 0.31). In fact, as the number of relatives with these cancers increased, the OS survival improved for individuals receiving first-line platinum therapy (HR 0.76, 95 % CI 0.65–0.89, p = 0.0004), which was not the case for those receiving other therapies (p = 0.98).

Conclusions

Treatment with platinum chemotherapy in patients with a family history of breast, ovarian, or pancreatic cancers was associated with a longer survival, whereas platinum use in patients without such a family history of cancer was associated with poor survival. These findings suggest that family history may serve as a predictive marker for platinum use in patients with metastatic pancreatic adenocarcinoma.

Keywords

Pancreatic adenocarcinoma Family history BRCA Chemotherapy Survival 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • David Fogelman
    • 5
    • 6
  • Elizabeth A. Sugar
    • 2
    • 4
    • 7
  • George Oliver
    • 2
    • 8
  • Neeraj Shah
    • 5
    • 9
  • Alison Klein
    • 3
    • 10
    • 11
    • 12
  • Christine Alewine
    • 3
    • 13
  • Huamin Wang
    • 14
  • Milind Javle
    • 5
    • 6
  • Rachna Shroff
    • 5
  • Robert A. Wolff
    • 5
    • 6
  • James L. Abbruzzese
    • 5
    • 15
  • Daniel Laheru
    • 2
    • 10
  • Luis A. DiazJr.
    • 1
    • 2
  1. 1.Swim Across America LaboratoryLudwig Center for Cancer Genetics and Therapeutics at Johns HopkinsBaltimoreUSA
  2. 2.Sidney Kimmel Cancer CenterThe Johns Hopkins Medical InstitutionsBaltimoreUSA
  3. 3.Departments of Pathology and MedicineJohns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Departments of Biostatistics and Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  5. 5.Department of G.I. Medical OncologyM.D. Anderson Cancer CenterHoustonUSA
  6. 6.University of Texas/M.D. Anderson Cancer CenterHoustonUSA
  7. 7.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  8. 8.DallasUSA
  9. 9.Staten Island University HospitalStaten IslandUSA
  10. 10.Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins School of MedicineBaltimoreUSA
  11. 11.Sol Goldman Pancreatic Cancer Research CenterJohns Hopkins School of MedicineBaltimoreUSA
  12. 12.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  13. 13.Department of Medical OncologyNCI-National Cancer InstituteBethesdaUSA
  14. 14.HoustonUSA
  15. 15.Division of Medical OncologyDuke UniversityDurhamUSA

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