After I completed standard of care chemotherapy which was Folfirinox, the concern was what could be used after to ensure I not only stayed NED, but prevent a new primary cancer from developing. Maintenance monotherapy is a single drug regimen to keep things in check. Targeted maintenance monotherapy is when you have a genetic mutation, in my case BRCA2 and using a drug that specifically rages that genetic defect. The targeted drug is a PARP-1 inhibitor (poly (ADP) ribose polymerase) which prevents the PARP enzyme from repairing DNA strand breaks in cells. Because individuals with a germline (inherited) BRCA mutation have a lifetime risk of developing new primary cancers (pancreatic, prostate, colon, ovarian, breast, the objective on targeted maintenance monotherapy is to prevent new cancers from developing.

In patients doing SoC Folfirinox or Gemzar plus Abraxane, the concern is minimal residual disease exists. If one was experiencing side effects that were hard to tolerate, the incentive to do additional chemotherapy is diminished. Maintenance monotherapy using an oral medication may work differently than traditional IV chemo making it more tolerable and beneficial for long-term survival with a good quality of life.

Monotherapy means treating with a single agent and immunotherapy using a single component could be considered monotherapy. In my case, it was a single drug used after first line chemo drugs were used as post-chemo treatment. Immunotherapy can be used in a first line or second line treatment. For pancreatic cancer, the immunotherapy drug Keytruda (pembrolizumab) is the only FDA approved immunotherapy. The others are being used in clinical trial settings.