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Singh H, Nipp RD. Bridging the Divide: From Universal Germline Testing Guidance to Real-World Implementation in Pancreatic Cancer Care. JCO Oncol Pract 2024; 20:1012-1015. [PMID: 38718312 DOI: 10.1200/op.24.00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 08/15/2024] Open
Abstract
In this editorial accompanying manuscript the by Klatte and colleagues, Drs Singh, and Nipp review the data behind universal germline testing in pancreatic adenocarcinoma, and review possible reasons for and solutions continued inadequate rates of germline testing in our community. Making germline testing for all patients with pancreatic adenocarcinoma is critical and will require cross-disciplinary collaboration and innovation.
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Affiliation(s)
- Harshabad Singh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ryan D Nipp
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK
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2
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Cremin C, Bedard AC, Hong Q, Mung SW, Nuk J, Wong A, Akbar H, Cheung E, Renouf D, Schaeffer D, Sun S, Schrader KA. Improving Access to Hereditary Testing in Pancreatic Ductal Carcinoma. JCO Precis Oncol 2024; 8:e2400167. [PMID: 39102633 PMCID: PMC11371118 DOI: 10.1200/po.24.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/23/2024] [Accepted: 06/25/2024] [Indexed: 08/07/2024] Open
Abstract
PURPOSE Approximately 5%-10% of patients with pancreatic ductal adenocarcinoma (PDAC) have an inherited basis, yet uptake of genetic testing remains low and subject to disparities. This study compared two genetic testing pathways available to patients referred to a provincial cancer center, BC Cancer: a traditional hereditary cancer clinic-initiated testing (HCT) pathway and a new oncology clinic-initiated testing (OCT) pathway. METHODS Study subjects were patients with confirmed PDAC referred for genetic testing through the HCT or OCT pathway between June 1, 2020, and February 1, 2022. Charts were retrospectively reviewed for patient characteristics and testing outcomes. RESULTS The study population was 397 patients (HCT, n = 279 and OCT, n = 118). OCT patients were more likely to have non-European ethnicity compared with HCT patients (41.9% v 25.6%, P = .004), to have earlier-stage disease (P = .012), and to have better Eastern Cooperative Oncology Group performance status than the HCT group (P = .001). A total of 306 patients completed testing (77%). OCT patients had higher test completion rates than HCT patients (odds ratio, 3.74 [95% CI, 1.66 to 9.62]). Median time for results was shorter in OCT than in HCT (53 days [IQR, 44-76] v 107 days [IQR, 63.8-158.3]). Pancreatic cancer susceptibility pathogenic gene variants were identified in 8.5% (26/306). CONCLUSION The real-world observations in our study show that oncology clinic-initiated hereditary testing is more effective and faster than testing through hereditary cancer clinic referrals and reaches a more ethnically diverse population. This has important implications for publicly funded environments with limited resources for genetic counseling.
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Affiliation(s)
- Carol Cremin
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
- Pancreas Centre BC, Vancouver, BC, Canada
- Department of Medical Genetics, The University of British Columbia, Vancouver, BC, Canada
| | | | - Quan Hong
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Sze Wing Mung
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
- Department of Medical Genetics, The University of British Columbia, Vancouver, BC, Canada
| | - Andrew Wong
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Husain Akbar
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Eugene Cheung
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Daniel Renouf
- Pancreas Centre BC, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - David Schaeffer
- Pancreas Centre BC, Vancouver, BC, Canada
- Division of Anatomical Pathology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Sophie Sun
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Kasmintan A. Schrader
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
- Pancreas Centre BC, Vancouver, BC, Canada
- Department of Medical Genetics, The University of British Columbia, Vancouver, BC, Canada
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
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3
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Rodriguez NJ, Syngal S. Expanding access to genetic testing for pancreatic cancer. Fam Cancer 2024; 23:247-254. [PMID: 38733419 DOI: 10.1007/s10689-024-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/04/2024] [Indexed: 05/13/2024]
Abstract
Among individuals with pancreatic ductal adenocarcinoma (PDAC) 5-10% have a pathogenic germline variant (PGV) in a PDAC susceptibility gene. Guidelines recommend genetic testing among all individuals with PDAC. Additionally, at-risk relatives of PDAC patients benefit from their own genetic education, risk assessment, and testing. Multigene panel testing (MGPT) can identify individuals with inherited cancer risk who can benefit from early cancer surveillance and risk reduction strategies. This manuscript discusses various healthcare delivery models for MGPT including traditional in-person genetic counseling, novel integrated in-person infrastructures, telemedicine genetics care via telephone- or video-visits and direct-to-consumer testing. Barriers and facilitators to care on the individual, provider, and system level are also outlined including specific considerations for historically marginalized communities.
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Affiliation(s)
- Nicolette Juliana Rodriguez
- Division of Gastroenterology, Hepatology and Endoscopy | Brigham and Women's Hospital, Division of Cancer Genetics and Prevention | Dana-Farber Cancer Institute Instructor of Medicine, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Sapna Syngal
- Center for Cancer Genetics and Prevention Dana-Farber Cancer Institute, Gastrointestinal Cancer Genetics and Prevention Program, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
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Pathak P, Hacker-Prietz A, Herman JM, Zheng L, He J, Narang AK. Variation in outcomes and practice patterns among patients with localized pancreatic cancer: the impact of the pancreatic cancer multidisciplinary clinic. Front Oncol 2024; 14:1427775. [PMID: 39055559 PMCID: PMC11269111 DOI: 10.3389/fonc.2024.1427775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Patients with localized pancreatic adenocarcinoma (PDAC) benefit from multi-modality therapy. Whether care patterns and oncologic outcomes vary if a patient was seen through a pancreatic multi-disciplinary clinic (PMDC) versus only individual specialty clinics is unclear. Methods Using institutional Pancreatic Cancer Registry, we identified patients with localized PDAC from 2019- 2022 who eventually underwent resection. It was our standard practice for borderline resectable (BRPC) patients to undergo ≤4 months of neoadjuvant chemotherapy, ± radiation, followed by exploration, while locally advanced (LAPC) patients were treated with 4-6 months of chemotherapy, followed by radiation and potential exploration. Descriptive and multivariable analyses (MVA) were performed to examine the association between clinic type (PMDC vs individual specialty clinics i.e. surgical oncology, medical oncology, or radiation oncology) and study outcomes. Results A total of 416 patients met inclusion criteria. Of these, 267 (64.2%) had PMDC visits. PMDC group received radiation therapy more commonly (53.9% versus 27.5%, p=0.001), as compared to individual specialty clinic group. Completion of neoadjuvant treatment (NAT) was far more frequent in patients seen through PMDC compared to patients seen through individual specialty clinics (69.3% vs 48.9%). On MVA, PMDC group was significantly associated with receipt of NAT per institutional standards (adjusted OR 2.23, 95% CI 1.46-7.07, p=0.006). Moreover, the average treatment effect of PMDC on progression-free survival (PFS) was 4.45 (95CI: 0.87-8.03) months. No significant association between overall survival (OS) and clinic type was observed. Discussion Provision of care through PMDC was associated with significantly higher odds of completing NAT per institutional standards as compared to individual specialty clinics, which possibly translated into improved PFS. The development of multidisciplinary clinics for management of pancreatic cancer should be incentivized, and any barriers to such development should be addressed.
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Affiliation(s)
- Priya Pathak
- Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Amy Hacker-Prietz
- Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Joseph M. Herman
- Department of Radiation Oncology, Northwell Health, New Hyde Park, NY, United States
| | - Lei Zheng
- Department of Medical Oncology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Jin He
- Department of Surgical Oncology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Amol K. Narang
- Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Rodriguez NJ, Furniss CS, Yurgelun MB, Ukaegbu C, Constantinou PE, Fortes I, Caruso A, Schwartz AN, Stopfer JE, Underhill-Blazey M, Kenner B, Nelson SH, Okumura S, Zhou AY, Coffin TB, Uno H, Horiguchi M, Ocean AJ, McAllister F, Lowy AM, Klein AP, Madlensky L, Petersen GM, Garber JE, Lippman SM, Goggins MG, Maitra A, Syngal S. A Randomized Trial of Two Remote Health Care Delivery Models on the Uptake of Genetic Testing and Impact on Patient-Reported Psychological Outcomes in Families With Pancreatic Cancer: The Genetic Education, Risk Assessment, and Testing (GENERATE) Study. Gastroenterology 2024; 166:872-885.e2. [PMID: 38320723 PMCID: PMC11034726 DOI: 10.1053/j.gastro.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND & AIMS Genetic testing uptake for cancer susceptibility in family members of patients with cancer is suboptimal. Among relatives of patients with pancreatic ductal adenocarcinoma (PDAC), The GENetic Education, Risk Assessment, and TEsting (GENERATE) study evaluated 2 online genetic education/testing delivery models and their impact on patient-reported psychological outcomes. METHODS Eligible participants had ≥1 first-degree relative with PDAC, or ≥1 first-/second-degree relative with PDAC with a known pathogenic germline variant in 1 of 13 PDAC predisposition genes. Participants were randomized by family, between May 8, 2019, and June 1, 2021. Arm 1 participants underwent a remote interactive telemedicine session and online genetic education. Arm 2 participants were offered online genetic education only. All participants were offered germline testing. The primary outcome was genetic testing uptake, compared by permutation tests and mixed-effects logistic regression models. We hypothesized that Arm 1 participants would have a higher genetic testing uptake than Arm 2. Validated surveys were administered to assess patient-reported anxiety, depression, and cancer worry at baseline and 3 months postintervention. RESULTS A total of 424 families were randomized, including 601 participants (n = 296 Arm 1; n = 305 Arm 2), 90% of whom completed genetic testing (Arm 1 [87%]; Arm 2 [93%], P = .014). Arm 1 participants were significantly less likely to complete genetic testing compared with Arm 2 participants (adjusted ratio [Arm1/Arm2] 0.90, 95% confidence interval 0.78-0.98). Among participants who completed patient-reported psychological outcomes questionnaires (Arm 1 [n = 194]; Arm 2 [n = 206]), the intervention did not affect mean anxiety, depression, or cancer worry scores. CONCLUSIONS Remote genetic education and testing can be a successful and complementary option for delivering genetics care. (Clinicaltrials.gov, number NCT03762590).
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Affiliation(s)
- Nicolette J Rodriguez
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - C Sloane Furniss
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Matthew B Yurgelun
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Chinedu Ukaegbu
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Pamela E Constantinou
- Sheikh Ahmed Center for Pancreatic Cancer Research, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | | | | | - Scott H Nelson
- Pancreatic Cancer Action Network Volunteer, Patient Advocate, and Pancreatic Cancer Survivor
| | | | | | - Tara B Coffin
- WIRB-Copernicus Group Institutional Review Board, Puyallup, Washington
| | - Hajime Uno
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Miki Horiguchi
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Florencia McAllister
- Sheikh Ahmed Center for Pancreatic Cancer Research, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Andrew M Lowy
- Moores Cancer Center, UC San Diego, San Diego, California
| | - Alison P Klein
- Johns Hopkins University, Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland
| | - Lisa Madlensky
- Moores Cancer Center, UC San Diego, San Diego, California
| | | | - Judy E Garber
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michael G Goggins
- Johns Hopkins University, Sol Goldman Pancreatic Cancer Research Center, Baltimore, Maryland
| | - Anirban Maitra
- Sheikh Ahmed Center for Pancreatic Cancer Research, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Sapna Syngal
- Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts.
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Horn IP, Zakas AL, Smith-Simmer KJ, Birkeland LE, Sundstrom R, Burkard ME, Weiss JM. Genetic Testing Utilization: Discrepancies Between Somatic and Germline Results in Patients With Cancer Reviewed at the UW Health Precision Medicine Molecular Tumor Board. JCO Precis Oncol 2024; 8:e2300466. [PMID: 38810171 DOI: 10.1200/po.23.00466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/26/2024] [Accepted: 03/15/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Somatic and germline testing are increasingly used to estimate risks for patients with cancer. Although both germline testing and somatic testing can identify genetic variants that could change a patient's care and eligible treatments, the aims of these tests and their technologies are fundamentally different and cannot be used interchangeably. This study examines the timing and results of somatic and germline genetic testing for patients with cancer at UW Health. METHODS Eight hundred and seventy-seven participants underwent somatic genetic testing, which was reviewed by the Precision Medicine Molecular Tumor Board (PMMTB). Patients were diagnosed with cancers, including breast, colorectal, endometrial, pancreatic, or ovarian cancer, and met National Comprehensive Cancer Network criteria for germline genetic testing. Germline testing details were collected by medical record review. RESULTS The results of this study found that only 310 patients (35%) had germline evaluation before PMMTB review. The percent of germline pathogenic/likely pathogenic variants identified in actionable genes was 28%. Most germline variants were identified in the BRCA1 (26%) and BRCA2 (28%) genes. In total, 65% (54/83) of germline variants were detected with both germline testing and somatic testing; however, 35% (29/83) of germline variants were not identified on somatic results. These results demonstrate the importance of combination germline and somatic testing. CONCLUSION This study highlights the differences in genetic testing types and demonstrates that conducting germline testing at earlier stages of diagnoses is necessary to identify potentially actionable and treatment-specific variants in patients with cancer.
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Affiliation(s)
- Isaac P Horn
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Anna L Zakas
- Oncology Genetics, University of Wisconsin Carbone Cancer Center, UW Health, Madison, WI
- Master of Genetic Counselor Studies, Academic Affairs, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kelcy J Smith-Simmer
- Oncology Genetics, University of Wisconsin Carbone Cancer Center, UW Health, Madison, WI
- Master of Genetic Counselor Studies, Academic Affairs, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Laura E Birkeland
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Rachel Sundstrom
- Oncology Genetics, University of Wisconsin Carbone Cancer Center, UW Health, Madison, WI
| | - Mark E Burkard
- Oncology Genetics, University of Wisconsin Carbone Cancer Center, UW Health, Madison, WI
- Department of Medicine, Division of Hematology and Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jennifer M Weiss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Ceyhan-Birsoy O, Stadler ZK. Tumor-Only Sequencing: A Story Only Half Told. JCO Precis Oncol 2024; 8:e2400226. [PMID: 38810205 DOI: 10.1200/po.24.00226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024] Open
Abstract
Germline testing and tumor sequencing are often both necessary for optimal cancer treatment and management.
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Affiliation(s)
- Ozge Ceyhan-Birsoy
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Pantaleo A, Forte G, Fasano C, Lepore Signorile M, Sanese P, De Marco K, Di Nicola E, Latrofa M, Grossi V, Disciglio V, Simone C. Understanding the Genetic Landscape of Pancreatic Ductal Adenocarcinoma to Support Personalized Medicine: A Systematic Review. Cancers (Basel) 2023; 16:56. [PMID: 38201484 PMCID: PMC10778202 DOI: 10.3390/cancers16010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most fatal malignancies worldwide. While population-wide screening recommendations for PDAC in asymptomatic individuals are not achievable due to its relatively low incidence, pancreatic cancer surveillance programs are recommended for patients with germline causative variants in PDAC susceptibility genes or a strong family history. In this study, we sought to determine the prevalence and significance of germline alterations in major genes (ATM, BRCA1, BRCA2, CDKN2A, EPCAM, MLH1, MSH2, MSH6, PALB2, PMS2, STK11, TP53) involved in PDAC susceptibility. We performed a systematic review of PubMed publications reporting germline variants identified in these genes in PDAC patients. Overall, the retrieved articles included 1493 PDAC patients. A high proportion of these patients (n = 1225/1493, 82%) were found to harbor alterations in genes (ATM, BRCA1, BRCA2, PALB2) involved in the homologous recombination repair (HRR) pathway. Specifically, the remaining PDAC patients were reported to carry alterations in genes playing a role in other cancer pathways (CDKN2A, STK11, TP53; n = 181/1493, 12.1%) or in the mismatch repair (MMR) pathway (MLH1, MSH2, MSH6, PMS2; n = 87/1493, 5.8%). Our findings highlight the importance of germline genetic characterization in PDAC patients for better personalized targeted therapies, clinical management, and surveillance.
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Affiliation(s)
- Antonino Pantaleo
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Giovanna Forte
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Candida Fasano
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Martina Lepore Signorile
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Paola Sanese
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Katia De Marco
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Elisabetta Di Nicola
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Marialaura Latrofa
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Valentina Grossi
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Vittoria Disciglio
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
| | - Cristiano Simone
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Bari, Italy; (A.P.); (G.F.); (C.F.); (M.L.S.); (P.S.); (K.D.M.); (E.D.N.); (M.L.); (V.G.)
- Medical Genetics, Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
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Golan T, Casolino R, Biankin AV, Hammel P, Whitaker KD, Hall MJ, Riegert-Johnson DL. Germline BRCA testing in pancreatic cancer: improving awareness, timing, turnaround, and uptake. Ther Adv Med Oncol 2023; 15:17588359231189127. [PMID: 37720496 PMCID: PMC10504836 DOI: 10.1177/17588359231189127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/04/2023] [Indexed: 09/19/2023] Open
Abstract
Prognosis is generally poor for patients with pancreatic ductal adenocarcinoma. However, patients with germline BRCA1 or BRCA2 mutations (gBRCAm) may benefit from first-line platinum-based chemotherapy and maintenance therapy with the poly(adenosine diphosphate-ribose) polymerase inhibitor olaparib following at least 16 weeks of first-line platinum-based chemotherapy without disease progression. Germline breast cancer gene (BRCA) testing is therefore important to ensure that patients receive the most effective treatment. In addition, testing for other DNA damage response gene mutations beyond gBRCAm may also guide treatment decisions. However, clinical pathways for genetic testing are often suboptimal, leading to delays in treatment initiation or missed opportunities for personalized therapy. Barriers to testing include low rates of referral and uptake, delays to referral and slow result turnaround times, cost, and biopsy and assay limitations if somatic testing is performed, leading to the requirement for subsequent dedicated germline testing. Low rates of referral may result from lack of awareness among physicians of the clinical value of testing, coupled with low confidence in interpreting test results and poor availability of genetic counseling services. Among patients, barriers to uptake may include similar lack of awareness of the clinical value of testing, anxiety regarding the implications of test results, lack of insurance coverage, fear of negative insurance implications, and socioeconomic factors. Potential solutions include innovative approaches to testing pathways, including 'mainstreaming' of testing in which BRCA tests are routinely arranged by the treating oncologist, with the involvement of genetic counselors if a patient is found to have a gBRCAm. More recently, the utility of multigene panel analyses has also been explored. Access to genetic counseling may also be improved through initiatives such as having a genetic counseling appointment for all new patient visits and telemedicine approaches, including the use of telephone consultations or DVD-assisted counseling. Educational programs will also be beneficial, and cost effectiveness is likely to improve as the number of targeted treatments increases and when the earlier detection of tumors in family members following cascade testing is considered.
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Affiliation(s)
- Talia Golan
- Institute of Oncology, Sheba Medical Center, Tel Hashomer 52621, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Raffaella Casolino
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Andrew V. Biankin
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, Australia
| | - Pascal Hammel
- Department of Digestive and Medical Oncology, University Paris-Saclay, Paul Brousse Hospital (AP-HP), Villejuif, France
| | - Kristen D. Whitaker
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Michael J. Hall
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
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10
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Brugel M, Marulier T, Evrard C, Carlier C, Tougeron D, Piessen G, Truant S, Turpin A, Williet N, Botsen D, Brasseur M, Perrier M, Bouché O. Genetic counselling referral practices for patients with pancreatic adenocarcinoma: A French retrospective multicentre observational cohort study (CAPANCOGEN). Pancreatology 2023; 23:622-629. [PMID: 37394294 DOI: 10.1016/j.pan.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND/OBJECTIVES Genetic counselling (GC) is a key step in the identification of inherited germline mutations. However, the oncogenetic practices are poorly described for pancreatic adenocarcinoma (PA) in Europe. The CAPANCOGEN study aimed to describe the GC referral practices in France and assess the implementation of international guidelines in patients with PA. METHODS Information about GC referrals with PA was collected in 13 French centres from September 2019 to October 2021. In the 5 largest centres, personal and familial histories of cancers and diseases associated with a higher risk of germline mutations were collected in 460 patients, according to international, American, European and French GC referral guidelines. Univariate and multivariate logistic regression analysis were performed to identify the factors influencing GC referral. RESULTS Among 833 patients, a total of 100 patients (12%) had an indication of GC according to local multidisciplinary tumour board meetings (MTBM). Among these patients, 41% did not undergo GC. The median time between MTBM and GC was 55 days (IQR: 14.5-112). Among 460 patients with collected personal and familial history, 31.5% were not referred to a GC despite an existing indication. In multivariate logistic regression analysis, suspected CDKN2A (p = 0.032) or BRCA mutation (p < 0.001), familial pancreatic cancer history (p < 0.001) and controlled disease with first-line platinum-based chemotherapy (p < 0.001) increased the referral rate. Conversely, older age (p = 0.002) and a locally advanced PA (p = 0.045) decreased the risk of GC referral. CONCLUSIONS GC referral is inadequate despite valuable information in patients' medical files.
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Affiliation(s)
- Mathias Brugel
- Université de Reims Champagne-Ardenne, Department of Digestive Oncology, CHU Reims, Reims, France.
| | - Thibault Marulier
- Université de Reims Champagne-Ardenne, Department of Digestive Oncology, CHU Reims, Reims, France
| | - Camille Evrard
- Department of Medical Oncology, Poitiers University Hospital, Poitiers, France
| | - Claire Carlier
- Université de Reims Champagne-Ardenne, Department of Digestive Oncology, CHU Reims, Reims, France; Department of Medical Oncology, Godinot Cancer Institute, Reims, France
| | - David Tougeron
- Department of Hepato-Gastro-enterology, Poitiers University Hospital, Poitiers, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Stéphanie Truant
- Department of Digestive Surgery and Liver Transplantation Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Anthony Turpin
- Department of Medical Oncology, CHU Lille, University of Lille, CNRS, Inserm, Institut Pasteur de Lille, UMR9020 - UMR-S 1277, Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Nicolas Williet
- Department of Hepatogastroenterology, CHU Saint Etienne, Saint-Priest-en-Jarez, France
| | - Damien Botsen
- Université de Reims Champagne-Ardenne, Department of Digestive Oncology, CHU Reims, Reims, France; Department of Medical Oncology, Godinot Cancer Institute, Reims, France
| | - Mathilde Brasseur
- Université de Reims Champagne-Ardenne, Department of Digestive Oncology, CHU Reims, Reims, France
| | - Marine Perrier
- Université de Reims Champagne-Ardenne, Department of Digestive Oncology, CHU Reims, Reims, France
| | - Olivier Bouché
- Université de Reims Champagne-Ardenne, Department of Digestive Oncology, CHU Reims, Reims, France
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11
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Hanson EN, Delacroix E, Austin S, Carr G, Kidwell KM, Bacon E, Gerido LH, Griggs JJ, Stoffel EM, Resnicow K. Psychosocial factors impacting barriers and motivators to cancer genetic testing. Cancer Med 2023; 12:9945-9955. [PMID: 36808717 PMCID: PMC10166953 DOI: 10.1002/cam4.5709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Only a small proportion of patients who qualify for clinical genetic testing for cancer susceptibility get testing. Many patient-level barriers contribute to low uptake. In this study, we examined self-reported patient barriers and motivators for cancer genetic testing. METHODS A survey comprised of both new and existing measures related to barriers and motivators to genetic testing was emailed to patients with a diagnosis of cancer at a large academic medical center. Patients who self-reported receiving a genetic test were included in these analyses (n = 376). Responses about emotions following testing as well as barriers and motivators prior to getting testing were examined. Group differences in barriers and motivators by patient demographic characteristics were examined. RESULTS Being assigned female at birth was associated with increased emotional, insurance, and family concerns as well as increased health benefits compared to patients assigned male at birth. Younger respondents had significantly higher emotional and family concerns compared to older respondents. Recently diagnosed respondents expressed fewer concerns about insurance implications and emotional concerns. Those with a BRCA-related cancer had higher scores on social and interpersonal concerns scale than those with other cancers. Participants with higher depression scores indicated increased emotional, social and interpersonal, and family concerns. CONCLUSIONS Self-reported depression emerged as the most consistent factor influencing report of barriers to genetic testing. By incorporating mental health resources into clinical practice, oncologists may better identify those patients who might need more assistance following through with a referral for genetic testing and the response afterwards.
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Affiliation(s)
- Erika N. Hanson
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Emerson Delacroix
- School of Public Health, Department of Health Behavior and EducationUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah Austin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Grant Carr
- School of Public Health, Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Kelley M. Kidwell
- School of Public Health, Department of BiostatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Elizabeth Bacon
- Center for Health Communications Research, Rogel Cancer Center, Michigan MedicineAnn ArborMichiganUSA
| | - Lynette Hammond Gerido
- School of Public Health, Department of Health Behavior and EducationUniversity of MichiganAnn ArborMichiganUSA
| | - Jennifer J. Griggs
- Department of Medicine, Division of Hematology/OncologyUniversity of MichiganAnn ArborMichiganUSA
- School of Public Health, Department of Health Management and PolicyUniversity of MichiganAnn ArborMichiganUSA
- University of Michigan, Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
| | - Elena M. Stoffel
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- University of Michigan, Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
| | - Ken Resnicow
- School of Public Health, Department of Health Behavior and EducationUniversity of MichiganAnn ArborMichiganUSA
- University of Michigan, Institute for Healthcare Policy and InnovationAnn ArborMichiganUSA
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12
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Petersen JM, Jhala DN. Compliance with the Current NCCN Guidelines and Its Critical Role in Pancreatic Adenocarcinoma. Lab Med 2023; 54:e1-e9. [PMID: 35706071 DOI: 10.1093/labmed/lmac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Since 2019, the National Comprehensive Cancer Network (NCCN) has recommended genetic testing for patients diagnosed with pancreatic adenocarcinoma that includes universal germline testing and tumor gene profiling for metastatic, locally advanced, or recurrent disease. However, testing compliance with this guideline has not yet been published in the English literature. METHODS A quality assurance/quality improvement retrospective review was done to identify patients diagnosed with pancreatic adenocarcinoma from January 2019 to February 2021 to include the patient's clinical status and genetic test results. RESULTS There were 20 patient cases identified with pancreatic adenocarcinoma. A total of 11 cases had molecular tumor gene profiling and microsatellite instability/mismatch repair (MSI/MMR) testing performed and 1 case had only MSI/MMR testing by immunohistochemistry performed. Only 3 patients of the 20 in total received germline testing. CONCLUSION There was a significant number of patients for whom tumor gene profiling or germline testing had never been attempted as per recommended NCCN guidelines.
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Affiliation(s)
- Jeffrey M Petersen
- Corporal Michael J Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Darshana N Jhala
- Corporal Michael J Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Philadelphia, Pennsylvania, USA
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13
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Ramsey ML, Tomlinson J, Pearlman R, Abushahin L, Aeilts A, Chen HZ, Chen Y, Compton A, Elkhatib R, Geiger L, Hays J, Jeter J, Jin N, Malalur P, Roychowdhury S, Ruple J, Prebish J, Stanich PP, Hampel H. Mainstreaming germline genetic testing for patients with pancreatic cancer increases uptake. Fam Cancer 2023; 22:91-97. [PMID: 35713757 PMCID: PMC9204376 DOI: 10.1007/s10689-022-00300-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/29/2022] [Indexed: 01/17/2023]
Abstract
Germline genetic testing is recommended for all patients with pancreatic cancer (PC) but uptake rates are low. We implemented a mainstreaming program in oncology clinics to increase testing for PC patients. Genetic counselors trained oncology providers to offer a standardized multigene panel and obtain informed consent using an educational video. Pre-test genetic counseling was available upon request. Otherwise, patients with identified pathogenic variants, strong family history, or questions regarding their results were referred for post-test genetic counseling. We measured rates of testing and genetic counseling visits. From September 2019 to April 2021, 245 patients with PC underwent genetic testing. This represents a 6.5-fold increase in germline testing volume (95% confidence interval 5.2-8.1) compared to previous years. At least one pathogenic or likely pathogenic variant (PV/LPV) was found in 34 (13.9%) patients, including 17 (6.9%) PV/LPVs in high or moderate risk genes and 18 (7.3%) in low risk or recessive genes. Five (2.0%) PVs had implications on treatment selection. 22 of the positive patients (64.7%) and an additional 8 PC patients (1 negative, 3 VUS, and 4 pre-test) underwent genetic counseling during the study period. Genetic counselors saw 2.0 PC patients/month prior to this project, 1.6 PC patients/month during this project, and would have seen 2.2 PC patients/month if all patients with pathogenic variants attended post-test counseling. Conclusions Mainstreaming genetic testing expands access for PC patients without overwhelming genetic counseling resources.
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Affiliation(s)
- Mitchell L Ramsey
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jewel Tomlinson
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rachel Pearlman
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laith Abushahin
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amber Aeilts
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hui-Zi Chen
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yan Chen
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ashley Compton
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rifat Elkhatib
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Levi Geiger
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John Hays
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joanne Jeter
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ning Jin
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pannaga Malalur
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sameek Roychowdhury
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jessica Ruple
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Prebish
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter P Stanich
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Heather Hampel
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- The Ohio State University Comprehensive Cancer Center, 2012 Kenny Road, Room 257, Columbus, OH, 43221, USA.
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14
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Turpin A, Neuzillet C, Colle E, Dusetti N, Nicolle R, Cros J, de Mestier L, Bachet JB, Hammel P. Therapeutic advances in metastatic pancreatic cancer: a focus on targeted therapies. Ther Adv Med Oncol 2022; 14:17588359221118019. [PMID: 36090800 PMCID: PMC9459481 DOI: 10.1177/17588359221118019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
Mortality from pancreatic ductal adenocarcinoma (PDAC) is increasing worldwide and effective new treatments are urgently needed. The current treatment of metastatic PDAC in fit patients is based on two chemotherapy combinations (FOLFIRINOX and gemcitabine plus nab-paclitaxel) which were validated more than 8 years ago. Although almost all treatments targeting specific molecular alterations have failed so far when administered to unselected patients, encouraging results were observed in the small subpopulations of patients with germline BRCA 1/2 mutations, and somatic gene fusions (neurotrophic tyrosine receptor kinase, Neuregulin 1, which are enriched in KRAS wild-type PDAC), KRAS G12C mutations, or microsatellite instability. While targeted tumor metabolism therapies and immunotherapy have been disappointing, they are still under investigation in combination with other drugs. Optimizing pharmacokinetics and adapting available chemotherapies based on molecular signatures are other promising avenues of research. This review evaluates the current expectations and limits of available treatments and analyses the existing trials. A permanent search for actionable vulnerabilities in PDAC tumor cells and microenvironments will probably result in a more personalized therapeutic approach, keeping in mind that supportive care must also play a major role if real clinical efficacy is to be achieved in these patients.
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Affiliation(s)
- Anthony Turpin
- Department of Medical Oncology, CNRS UMR9020,
Inserm UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to
Therapies, University Lille, CHU Lille, Lille, France
| | - Cindy Neuzillet
- Department of Medical Oncology, Curie
Institute, Versailles Saint-Quentin University, Paris-Saclay University,
Saint-Cloud, France
| | - Elise Colle
- Department of Digestive and Medical Oncology,
Hospital Paul Brousse (AP-HP), Villejuif, University of Paris Saclay,
France
| | - Nelson Dusetti
- Cancer Research Center of Marseille, CRCM,
Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille,
France
| | - Rémy Nicolle
- Centre de Recherche sur l’Inflammation, INSERM,
U1149, CNRS, ERL 8252, Université de Paris Cité, Paris, France
| | - Jérôme Cros
- Department of Pathology, University of Paris
Cité, Hospital Beaujon (AP-HP), Clichy, France
| | - Louis de Mestier
- Department of Gastroenterology and
Pancreatology, University of Paris Cité, Hospital Beaujon (AP-HP), Clichy,
France
| | - Jean-Baptiste Bachet
- Department of Gastroenterology and Digestive
Oncology, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University,
Paris, France
| | - Pascal Hammel
- Department of Digestive and Medical Oncology,
Hôpital Paul Brousse (AP-HP), 12 Avenue Paul Vaillant-Couturier, Villejuif
94800, University of Paris Saclay, France
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15
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Everett JN, Dettwyler SA, Jing X, Stender C, Schmitter M, Baptiste A, Chun J, Kawaler EA, Khanna LG, Gross SA, Gonda TA, Beri N, Oberstein PE, Simeone DM. Impact of comprehensive family history and genetic analysis in the multidisciplinary pancreatic tumor clinic setting. Cancer Med 2022; 12:2345-2355. [PMID: 35906821 PMCID: PMC9939217 DOI: 10.1002/cam4.5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/25/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Genetic testing is recommended for all pancreatic ductal adenocarcinoma (PDAC) patients. Prior research demonstrates that multidisciplinary pancreatic cancer clinics (MDPCs) improve treatment- and survival-related outcomes for PDAC patients. However, limited information exists regarding the utility of integrated genetics in the MDPC setting. We hypothesized that incorporating genetics in an MDPC serving both PDAC patients and high-risk individuals (HRI) could: (1) improve compliance with guideline-based genetic testing for PDAC patients, and (2) optimize HRI identification and PDAC surveillance participation to improve early detection and survival. METHODS Demographics, genetic testing results, and pedigrees were reviewed for PDAC patients and HRI at one institution over 45 months. Genetic testing analyzed 16 PDAC-associated genes at minimum. RESULTS Overall, 969 MDPC subjects were evaluated during the study period; another 56 PDAC patients were seen outside the MDPC. Among 425 MDPC PDAC patients, 333 (78.4%) completed genetic testing; 29 (8.7%) carried a PDAC-related pathogenic germline variant (PGV). Additionally, 32 (9.6%) met familial pancreatic cancer (FPC) criteria. These PDAC patients had 191 relatives eligible for surveillance or genetic testing. Only 2/56 (3.6%) non-MDPC PDAC patients completed genetic testing (p < 0.01). Among 544 HRI, 253 (46.5%) had a known PGV or a designation of FPC, and were eligible for surveillance at baseline; of the remainder, 15/291 (5.2%) were eligible following genetic testing and PGV identification. CONCLUSION Integrating genetics into the multidisciplinary setting significantly improved genetic testing compliance by reducing logistical barriers for PDAC patients, and clarified cancer risks for their relatives while conserving clinical resources. Overall, we identified 206 individuals newly eligible for surveillance or genetic testing (191 relatives of MDPC PDAC patients, and 15 HRI from this cohort), enabling continuity of care for PDAC patients and at-risk relatives in one clinic.
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Affiliation(s)
- Jessica N. Everett
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA,Department of SurgeryNew York University Langone HealthNew York CityNew YorkUSA,Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Shenin A. Dettwyler
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Xiaohong Jing
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Cody Stender
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Madeleine Schmitter
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Ariele Baptiste
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Jennifer Chun
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Emily A. Kawaler
- Applied Bioinformatics LaboratoriesNew York University Langone HealthNew York CityNew YorkUSA
| | - Lauren G. Khanna
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA
| | - Seth A. Gross
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA
| | - Tamas A. Gonda
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA
| | - Nina Beri
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA,Department of SurgeryNew York University Langone HealthNew York CityNew YorkUSA
| | - Paul E. Oberstein
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA,Department of SurgeryNew York University Langone HealthNew York CityNew YorkUSA
| | - Diane M. Simeone
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA,Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA,Department of PathologyNew York University Langone HealthNew York CityNew YorkUSA
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16
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Bednar EM, Nitecki R, Krause KJ, Rauh-Hain JA. Interventions to improve delivery of cancer genetics services in the United States: A scoping review. Genet Med 2022; 24:1176-1186. [PMID: 35389342 DOI: 10.1016/j.gim.2022.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Interventions that decrease barriers and improve clinical processes can increase patient access to guideline-recommended cancer genetics services. We sought to identify and describe interventions to improve patient receipt of guideline-recommended cancer genetics services in the United States. METHODS We performed a comprehensive search in Ovid MEDLINE and Embase, Scopus, and Web of Science from January 1, 2000 to February 12, 2020. Eligible articles reported interventions to improve the identification, referral, genetic counseling (GC), and genetic testing (GT) of patients in the United States. We independently screened titles and abstracts and reviewed full-text articles. Data were synthesized by grouping articles by clinical process. RESULTS Of 44 included articles, 17 targeted identification of eligible patients, 14 targeted referral, 15 targeted GC, and 16 targeted GT. Patient identification interventions included universal tumor testing and screening of medical/family history. Referral interventions included medical record system adaptations, standardizing processes, and provider notifications. GC interventions included supplemental patient education, integrated GC within oncology clinics, appointment coordination, and alternative service delivery models. One article directly targeted the GT process by implementing provider-coordinated testing. CONCLUSION This scoping review identified and described interventions to improve US patients' access to and receipt of guideline-recommended cancer genetics services.
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Affiliation(s)
- Erica M Bednar
- Cancer Prevention and Control Platform, Moon Shots Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Roni Nitecki
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Saba LF, Sullivan CM, Solomon T, Huguenard S, Nassef SA. Prenatal genetic counseling practices regarding recommendations for cancer genetic counseling: A retrospective chart review from two academic institutions. J Genet Couns 2022; 31:1062-1070. [DOI: 10.1002/jgc4.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Lisa F. Saba
- School of Health Professions Baylor College of Medicine Houston Texas USA
| | - Cathy M. Sullivan
- Department of Internal Medicine Baylor College of Medicine Houston Texas USA
| | - Tamara Solomon
- Department of Molecular and Human Genetics Baylor College of Medicine Houston Texas USA
| | - Sarah Huguenard
- Department of Molecular and Human Genetics Baylor College of Medicine Houston Texas USA
| | - Salma A. Nassef
- School of Health Professions Baylor College of Medicine Houston Texas USA
- Department of Molecular and Human Genetics Baylor College of Medicine Houston Texas USA
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18
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Walker EJ, Goldberg D, Gordon KM, Pedley C, Carnevale J, Cinar P, Collisson EA, Tempero MA, Ko AH, Blanco AM, Dhawan M. Implementation of an Embedded In-Clinic Genetic Testing Station to Optimize Germline Testing for Patients with Pancreatic Adenocarcinoma. Oncologist 2021; 26:e1982-e1991. [PMID: 34506673 PMCID: PMC8571767 DOI: 10.1002/onco.13968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Germline genetic testing is universally recommended for patients with pancreatic cancer, but testing remains infrequent. In May 2018, we implemented a systematic patient intake workflow featuring an in-clinic genetic testing station (GTS) at the University of California San Francisco (UCSF) to expedite genetic counseling and facilitate sample collection. We sought to determine the impact of this innovation on rates of genetic counseling and testing. METHODS Medical records, patient intake records, and genetic test reports were retrospectively reviewed for new patients with pancreatic cancer eligible for germline testing at UCSF from May 2018 to May 2019. Primary outcomes included the rate of offered genetic counseling and confirmed germline testing. Data were compared for periods before and after GTS implementation. Associations between demographic characteristics and testing rates were assessed. RESULTS Genetic counseling/testing was offered to 209 (94%) of 223 eligible patients, and 158 (71%) completed testing (135 at UCSF, 23 elsewhere). Compared with a traditional referral-based genetic counseling model, confirmed testing increased from 19% to 71%, patient attrition between referral and genetics appointment decreased from 36% to 3%, and rate of pathogenic variant detection increased from 20% to 33%. Patients who were younger, identified as non-Hispanic White, and spoke English as a primary language were more likely to complete testing. CONCLUSIONS Implementation of a systematic patient intake workflow and in-clinic GTS resulted in the highest reported real-world rate of germline testing for patients with pancreatic cancer. Health care disparities were identified and will guide future innovation. This report provides a model for other centers to create a similar testing infrastructure. IMPLICATIONS FOR PRACTICE This study demonstrates that a systematic patient intake workflow and associated in-clinic genetic testing station improve delivery of genetic counseling and completion of germline testing for patients with pancreatic cancer. This study achieved, to the authors' knowledge, the highest real-world rate of confirmed genetic testing in this patient population. This article describes this innovation in detail to guide replication at other medical centers and facilitate guideline-concordant care for patients with pancreatic cancer. This infrastructure can also be applied to other cancers for which germline testing is recommended.
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Affiliation(s)
- Evan J. Walker
- Division of Hematology and Oncology, University of California San FranciscoSan FranciscoCaliforniaUSA
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Dena Goldberg
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
- Cancer Genetics and Prevention Program, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Kelly M. Gordon
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
- Cancer Genetics and Prevention Program, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Christina Pedley
- Division of Hematology and Oncology, University of California San FranciscoSan FranciscoCaliforniaUSA
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Julia Carnevale
- Division of Hematology and Oncology, University of California San FranciscoSan FranciscoCaliforniaUSA
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Pelin Cinar
- Division of Hematology and Oncology, University of California San FranciscoSan FranciscoCaliforniaUSA
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Eric A. Collisson
- Division of Hematology and Oncology, University of California San FranciscoSan FranciscoCaliforniaUSA
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Margaret A. Tempero
- Division of Hematology and Oncology, University of California San FranciscoSan FranciscoCaliforniaUSA
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Andrew H. Ko
- Division of Hematology and Oncology, University of California San FranciscoSan FranciscoCaliforniaUSA
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Amie M. Blanco
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
- Cancer Genetics and Prevention Program, University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Mallika Dhawan
- Division of Hematology and Oncology, University of California San FranciscoSan FranciscoCaliforniaUSA
- Helen Diller Family Comprehensive Cancer Center, University of California San FranciscoSan FranciscoCaliforniaUSA
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Murali K, Dwarte TM, Nikfarjam M, Tucker KM, Vaughan RB, Efthymiou M, Collins A, Spigelman AD, Salmon L, Johns AL, Williams DB, Delatycki MB, John T, Stoita A. Significant detection of new germline pathogenic variants in Australian Pancreatic Cancer Screening Program participants. Hered Cancer Clin Pract 2021; 19:33. [PMID: 34399810 PMCID: PMC8365963 DOI: 10.1186/s13053-021-00190-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Australian Pancreatic Cancer Screening Program (APCSP) offers endoscopic ultrasound surveillance for individuals at increased risk of pancreatic ductal adenocarcinoma (PDAC) with all participants requiring assessment by a Familial Cancer Service before or after study enrolment. METHODS Individuals aged 40-80 years (or 10 years younger than the earliest PDAC diagnosis) were eligible for APCSP study entry if they had 1) ≥ two blood relatives with PDAC (at least one of first-degree association); 2) a clinical or genetic diagnosis of Hereditary Pancreatitis or Peutz-Jeghers syndrome irrespective of PDAC family history; or 3) a known PDAC predisposition germline pathogenic variant (BRCA2, PALB2, CDKN2A, or Lynch syndrome) with ≥one PDAC-affected first- or second-degree relative. Retrospective medical record review was conducted for APCSP participants enrolled at the participating Australian hospitals from January 2011 to December 2019. We audited the genetic investigations offered by multiple Familial Cancer Services who assessed APCSP participants according to national guidelines, local clinical protocol and/or the availability of external research-funded testing, and the subsequent findings. Descriptive statistical analysis was performed using Microsoft Excel. RESULTS Of 189 kindreds (285 participants), 50 kindreds (71 participants) had a known germline pathogenic variant at enrolment (BRCA2 n = 35, PALB2 n = 6, CDKN2A n = 3, STK11 n = 3, PRSS1 n = 2, MLH1 n = 1). Forty-eight of 136 (35%) kindreds with no known germline pathogenic variant were offered mutation analysis; 89% was clinic-funded, with increasing self-funded testing since 2016. The relatively low rates of genetic testing performed reflects initial strict criteria for clinic-funded genetic testing. New germline pathogenic variants were detected in five kindreds (10.4%) after study enrolment (BRCA2 n = 3 kindreds, PALB2 n = 1, CDKN2A n = 1). Of note, only eight kindreds were reassessed by a Familial Cancer Service since enrolment, with a further 21 kindreds identified as being suitable for reassessment. CONCLUSION Germline pathogenic variants associated with PDAC were seen in 29.1% of our high-risk cohort (55/189 kindreds; 82/285 participants). Importantly, 10.4% of kindreds offered genetic testing were newly identified as having germline pathogenic variants, with majority being BRCA2. As genetic testing standards evolve rapidly in PDAC, 5-yearly reassessment of high-risk individuals by Familial Cancer Services is warranted.
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Affiliation(s)
- Krithika Murali
- Department of Clinical Genetics, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Tanya M Dwarte
- Australian Pancreatic Cancer Genome Initiative, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
- Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Mehrdad Nikfarjam
- Division of Surgery, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
- University of New South Wales, St Vincent's Clinical School and Prince of Wales Clinical School, Randwick, NSW, 2031, Australia
| | - Rhys B Vaughan
- Department of Gastroenterology, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Marios Efthymiou
- Department of Gastroenterology, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Allison Collins
- Clinical Trials Unit, Olivia Newton John Cancer and Wellness Centre, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Allan D Spigelman
- University of New South Wales, St Vincent's Clinical School and Prince of Wales Clinical School, Randwick, NSW, 2031, Australia
- Cancer Genetics Unit, The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Lucinda Salmon
- Department of Clinical Genetics, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Amber L Johns
- Australian Pancreatic Cancer Genome Initiative, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
| | - David B Williams
- Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Martin B Delatycki
- Department of Clinical Genetics, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Thomas John
- Peter MacCallum Cancer Centre, Parkville, VIC, 3000, Australia
| | - Alina Stoita
- Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia.
- University of New South Wales, St Vincent's Clinical School and Prince of Wales Clinical School, Randwick, NSW, 2031, Australia.
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Abstract
Pancreatic cancer is a tumor with a high degree of malignancy, morbidity, and mortality. Immunotherapy is another important treatment for pancreatic cancer in addition to surgery and chemotherapy, but its application in pancreatic cancer is very limited, which is related to the unique biological behavior of pancreatic cancer and the tumor microenvironment. The immunosuppressive microenvironment of pancreatic cancer is highly heterogeneous and presents challenges for immunotherapy. The transformation of tumor immunosuppressive microenvironment contributes to the response to tumor immunotherapy, such that the tumor undergoes functional reprogramming to change from immunologically "cold" to immunologically "hot." In this review, we summarized the research and progress in immunotherapy for pancreatic cancer, including immune checkpoint inhibitors, vaccines, adoptive T cell therapy, oncolytic viruses, and immunomodulators, and suggest that individualized, combination, and precise therapy should be the main direction of future immunotherapy in pancreatic cancer.
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Affiliation(s)
- Jia Wu
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang Province, China
| | - Jianting Cai
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang Province, China.
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21
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Anderson JL, Pilarski R, Kirschner L, Brock P. Genetic evaluation of patients and families with concern for hereditary endocrine tumor syndromes. Fam Cancer 2021; 21:93-100. [PMID: 33409929 DOI: 10.1007/s10689-020-00222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022]
Abstract
Hereditary endocrine tumor syndromes are rare conditions with overlapping features. It is imperative that healthcare providers differentiate between these syndromes for proper patient care. Advances in genetic testing technologies have increased utilization of genetic counseling and testing in this field; however, few endocrine cancer genetics clinics exist. Two years ago, a genetic counselor (GC) specializing in endocrine cancer genetics was added to the multidisciplinary team of the James Neuroendocrine/Thyroid Clinic at The Ohio State University. Here, we report on this experience. In total, 358 patients were seen. The majority were referred by medical oncology (n = 204; 57%) for a personal history of disease (n = 249; 81%). The most common referral indications were pancreatic neuroendocrine tumors (n = 44; 17%), multiple primary tumors (n = 37; 14%), and pheochromocytoma/paraganglioma (n = 35; 14%). Most patients completed genetic testing after genetic counseling (n = 200; 65%). Targeted gene panel testing was the most common testing ordered (n = 98; 32%). Thirty-one patients (15.5%) had ≥ one likely pathogenic variant (LPV) or pathogenic variant (PV) identified. Approximately 37% (n = 11) did not meet genetic testing guidelines for the gene they tested positive for. The most common genes with LPV/PVs were the SDH genes (n = 8) and MEN1 (n = 7). Referral indications with the highest likelihood of LPV/PVs were paraganglioma, medullary thyroid carcinoma, and multiple primary tumors. We believe this data can provide valuable guidance to healthcare providers who see patients with endocrine neoplasia or who are seeking to establish hereditary endocrine cancer clinics.
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Affiliation(s)
- Jennifer L Anderson
- Center for Individualized Medicine, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Robert Pilarski
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, 2012 Kenny Road, Columbus, OH, 43202, USA
| | - Lawrence Kirschner
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center, 5Th Floor McCampbell Hall, 1581 Dodd Street, Columbus, OH, 43210, USA
| | - Pamela Brock
- Division of Human Genetics, Department of Internal Medicine and James Comprehensive Cancer Center, The Ohio State University, 2012 Kenny Road, Columbus, OH, 43202, USA.
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22
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Cremin C, Lee MK, Hong Q, Hoeschen C, Mackenzie A, Dixon K, McCullum M, Nuk J, Kalloger S, Karasinska J, Scudamore C, Kim PTW, Donnellan F, Lam ECS, Lim HJ, Neben CL, Stedden W, Zhou AY, Schaeffer DF, Sun S, Renouf DJ, Schrader KA. Burden of hereditary cancer susceptibility in unselected patients with pancreatic ductal adenocarcinoma referred for germline screening. Cancer Med 2020; 9:4004-4013. [PMID: 32255556 PMCID: PMC7286471 DOI: 10.1002/cam4.2973] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent guidelines recommend consideration of germline testing for all newly diagnosed pancreatic ductal adenocarcinoma (PDAC). The primary aim of this study was to determine the burden of hereditary cancer susceptibility in PDAC. A secondary aim was to compare genetic testing uptake rates across different modes of genetic counselling. PATIENTS AND METHODS All patients diagnosed with PDAC in the province of British Columbia, Canada referred to a population-based hereditary cancer program were eligible for multi-gene panel testing, irrespective of cancer family history. Any healthcare provider or patients themselves could refer. RESULTS A total of 305 patients with PDAC were referred between July 2016 and January 2019. Two hundred thirty-five patients attended a consultation and 177 completed index germline genetic testing. 25/177 (14.1%) of unrelated patients had a pathogenic variant (PV); 19/25 PV were in known PDAC susceptibility genes with cancer screening or risk-reduction implications. PDAC was significantly associated with PV in ATM (OR, 7.73; 95% CI, 3.10 to 19.33, P = 6.14E-05) when comparing age and gender and ethnicity-matched controls tested on the same platform. The overall uptake rate for index testing was 59.2% and was significantly higher with 1-on-1 consultations and group consultations compared to telehealth consultations (88.9% vs 82.9% vs 61.8%, P < .001). CONCLUSION In a prospective clinic-based cohort of patients with PDAC referred for testing irrespective of family history, germline PV were detected in 14.1%. PV in ATM accounted for half of all PVs and were significantly associated with PDAC. These findings support recent guidelines and will guide future service planning in this population.
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Affiliation(s)
- Carol Cremin
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
- Pancreas Centre BCVancouverBCCanada
| | - Michael Kuan‐Ching Lee
- Pancreas Centre BCVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Quan Hong
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Carolyn Hoeschen
- Pancreas Centre BCVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Anna Mackenzie
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Katherine Dixon
- Department of Medical GeneticsUniversity of British ColumbiaVancouverBCCanada
| | - Mary McCullum
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Jennifer Nuk
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Steve Kalloger
- Pancreas Centre BCVancouverBCCanada
- Department of Pathology & Laboratory MedicineVancouver General HospitalVancouverBCCanada
| | | | - Charles Scudamore
- Pancreas Centre BCVancouverBCCanada
- Department of SurgeryVancouver General HospitalVancouverBCCanada
| | - Peter T. W. Kim
- Pancreas Centre BCVancouverBCCanada
- Department of SurgeryVancouver General HospitalVancouverBCCanada
| | - Fergal Donnellan
- Pancreas Centre BCVancouverBCCanada
- Department of GastroenterologyVancouver General HospitalVancouverBCCanada
| | - Eric C. S. Lam
- Pancreas Centre BCVancouverBCCanada
- Department of GastroenterologySt. Paul's HospitalVancouverBCCanada
| | - Howard J. Lim
- Pancreas Centre BCVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | | | | | | | - David F. Schaeffer
- Pancreas Centre BCVancouverBCCanada
- Department of Pathology & Laboratory MedicineVancouver General HospitalVancouverBCCanada
| | - Sophie Sun
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Daniel J. Renouf
- Pancreas Centre BCVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Kasmintan A. Schrader
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
- Pancreas Centre BCVancouverBCCanada
- Department of Medical GeneticsUniversity of British ColumbiaVancouverBCCanada
- Department of Molecular Oncology, BC Cancerpart of Provincial Health Services AuthorityVancouverBCCanada
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23
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Gambale A, Russo R, Andolfo I, Quaglietta L, De Rosa G, Contestabile V, De Martino L, Genesio R, Pignataro P, Giglio S, Capasso M, Parasole R, Pasini B, Iolascon A. Germline mutations and new copy number variants among 40 pediatric cancer patients suspected for genetic predisposition. Clin Genet 2019; 96:359-365. [DOI: 10.1111/cge.13600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Antonella Gambale
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Lucia Quaglietta
- Azienda Ospedaliera di Rilievo Nazionale Santobono PausiliponS.C. Pediatria Oncologia, Dip. di Oncoematologia Pediatrica Napoli Italy
| | - Gianluca De Rosa
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Valentina Contestabile
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Lucia De Martino
- Azienda Ospedaliera di Rilievo Nazionale Santobono PausiliponS.C. Pediatria Oncologia, Dip. di Oncoematologia Pediatrica Napoli Italy
| | - Rita Genesio
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
| | - Piero Pignataro
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
| | - Sabrina Giglio
- Biomedical Experimental and Clinical Sciences "Mario Serio"University of Florence Florence Italy
- SOD Genetica MedicaAzienda Ospedaliero‐Universitaria Meyer Florence Italy
| | - Mario Capasso
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
- IRCCS SDN Naples Italy
| | - Rosanna Parasole
- Azienda Ospedaliera di Rilievo Nazionale Santobono PausiliponS.C. Pediatria Oncologia, Dip. di Oncoematologia Pediatrica Napoli Italy
| | - Barbara Pasini
- Dipartimento di Scienze MedicheUniversità degli Studi di Torino Torino Italy
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
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