1. < Pancreatic Cancer

PARP inhibitors and Maintenance Drugs

Posted by Peter S (Aussie) @spicerpa, Dec 1, 2023

I have stage 4 pancreatic cancer and have just completed my 11th round of chemo. I have a BRCA2 gene mutation. So far, the chemo is doing a pretty good job. Liver mets have shrunk considerably and I feel generally pretty well... I have even put on weight!

My onc has proposed taking a break from chemo for a few months starting in the new year. It has also been suggested to me to try and get onto Olaparib as a maintenance drug to keep things under control while not doing chemo.

In Australia, Olaparib is covered by our government medicare program for ovarian and some of cancers but NOT pancreatic. This means that if I wanted to try it, it costs about $12,000 per month! My oncologist has reached out to Astrazenica (its manufacturer)... to try and get it under compassionate grounds... turns out they aren't remotely compassionate!

My oncologist has also tried getting me onto a clinical trial which az is running for a next generation PARP inhibitor but I am being told there aren't any slots available for me.

My onc has not been overly enthusiastic about the efficacy of the drug and has told me that it hasn't actually improved overall survival but has shown some improvement in progression free survival (PFS).

Does anyone have any experience with these drugs with pancreatic cancer maintenance post chemo?

thanks

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ncteacher | @ncteacher | Dec 2, 2023

I'm not an MD, and I'm repeating second-hand info from my MD, and I've never taken Lynparza, so take this post with many grains of salt. 🙂 I'm in the US, but my oncologist said many of the same things about Lynparza (olaparib) as you've found. He said it's approved for BRCA mutations in breast cancer, but not the ATM mutation in pancan, which I have. He said it was difficult to get insurance approval for pancan patients, although he added that he's been successful in several cases. Mostly, though, he didn't think it would be really effective in my case, that the results in pancan aren't very promising. He added that it can cause low blood counts, fatigue and diarrhea, which could actually make things worse.

In my case, my oncologist said he prefers to keep me on IV maintenance therapy, which in my case is Folfiri (Folfirinox minus the oxaliplatin), every other week, just like usual. We actually dropped the oxali after round 8, and I just completed round 14 on Tuesday (well, the 5FU pump was removed Thursday). He said research shows no survival difference, but the longer maintenance therapy continues, the longer it takes for the cancer to worsen. (That sounds like extended survival to me, but whatever.) So in his words, "practice in the real world" is to keep the patient on therapy for as long as possible as long as the patient is doing well. We decided to continue with Folfiri because I'm currently having good results with it. FYI, I don't qualify for surgery or any form of radiation due to being stage 4 and the location of my main tumor. He said that if/when Folfiri becomes less effective, we can switch regimens and/or look for a clinical trial.

This is all so confusing to me because, according to him, there is no real standard of care once 12 cycles are completed. You have to choose among options. That seems to jibe with what I see in posts here on the board. Many people talk about having chemo stopped after 12 rounds, or going from 8 rounds of chemo to radiation to surgery, etc., but those ideas weren't even on the table for me or my doctor. We are soldiering on with Folfiri! My husband and I are looking at it as taking my medicine for a chronic condition, as I would any other medication, and hopefully that works for as long as possible. I hope you find the info and approval you need to get Lynparza or whatever therapy will work best for you!

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1 reply
Peter S (Aussie) | @spicerpa | Dec 2, 2023
In reply to @ncteacher "I'm not an MD, and I'm repeating second-hand info from my MD, and I've never taken..." + (show)
@ncteacher

I'm not an MD, and I'm repeating second-hand info from my MD, and I've never taken Lynparza, so take this post with many grains of salt. 🙂 I'm in the US, but my oncologist said many of the same things about Lynparza (olaparib) as you've found. He said it's approved for BRCA mutations in breast cancer, but not the ATM mutation in pancan, which I have. He said it was difficult to get insurance approval for pancan patients, although he added that he's been successful in several cases. Mostly, though, he didn't think it would be really effective in my case, that the results in pancan aren't very promising. He added that it can cause low blood counts, fatigue and diarrhea, which could actually make things worse.

In my case, my oncologist said he prefers to keep me on IV maintenance therapy, which in my case is Folfiri (Folfirinox minus the oxaliplatin), every other week, just like usual. We actually dropped the oxali after round 8, and I just completed round 14 on Tuesday (well, the 5FU pump was removed Thursday). He said research shows no survival difference, but the longer maintenance therapy continues, the longer it takes for the cancer to worsen. (That sounds like extended survival to me, but whatever.) So in his words, "practice in the real world" is to keep the patient on therapy for as long as possible as long as the patient is doing well. We decided to continue with Folfiri because I'm currently having good results with it. FYI, I don't qualify for surgery or any form of radiation due to being stage 4 and the location of my main tumor. He said that if/when Folfiri becomes less effective, we can switch regimens and/or look for a clinical trial.

This is all so confusing to me because, according to him, there is no real standard of care once 12 cycles are completed. You have to choose among options. That seems to jibe with what I see in posts here on the board. Many people talk about having chemo stopped after 12 rounds, or going from 8 rounds of chemo to radiation to surgery, etc., but those ideas weren't even on the table for me or my doctor. We are soldiering on with Folfiri! My husband and I are looking at it as taking my medicine for a chronic condition, as I would any other medication, and hopefully that works for as long as possible. I hope you find the info and approval you need to get Lynparza or whatever therapy will work best for you!

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Thanks ncteacher.

Yours sounds like a very similar pathway as I am on.

I have had 8 rounds of fulfirinox, then when neuropathy started to get a bit worse the onc swapped me to gem + cisplatin for a couple of rounds and now on gem + carboplatin. Round 12 coming up in a couple of weeks after a short holiday.

I expect the game plan going forward will be similar to you.

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pdacbrca2 | @pdacbrca2 | Jun 2 1:11am

How has everyone been since the end of 2023?

I have a BRCA2 mutation driven PDAC, extensive metastasis to liver when first spotted, that seems to be responding well to 5 or 6 rounds of Gem+Cisplatin. We’re supposed to switch to a PARP inhibitor soon and I guess I hadn’t been planning that far ahead because I had assumed it improved outcomes over continuing with chemo. Is it actually preferred because it is more tolerable, or maybe develops resistance separately, or…?

Thanks for any insights. I’ll share what I learn from my oncologists when I see them this week.

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