Surveillance of CDNK2A mutation carriers is relatively successful, detecting most pancreatic ductal adenocarcinoma (PDAC) at a resectable stage, according to a study published in the Journal of Clinical Oncology.1
Hereditary factors play a role in the development of PDAC in 3% to 5% of patients. It typically has a poor prognosis. Surveillance of high-risk groups may aid in the detection of PDAC at an early stage. Therefore investigators sought to assess whether surveillance helps detect early stage PDAC or precursor lesions, thus improving the prognosis.
Investigators collected screening outcomes from 3 European centers that conducted prospective screening in high-risk groups including families with clustering of PDAC or families with a gene defect that predisposes to PDAC. Surveillance included annual magnetic resonance imaging, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound.
A total of 411 asymptomatic participants were included in the study: 178 participants were CDKN2A mutation carriers, 214 participants had familial pancreatic cancer, and 19 participants were BRCA1/2 or PALB2 mutation carriers.
Results showed that the resection rate was 75% and 5-year survival rate was 24%. A total of 2 CDKN2A mutation carriers (1%) had surgical resection for low-risk precursor lesions.
Two participants (.9%) in the familial pancreatic cancer cohort had a pancreatic tumor: one was advanced PDAC and another was early grade 2 neuroendocrine tumor. Out of the participants with familial pancreatic cancer, 13 (6.1%) underwent surgical resection for a suspected precursor lesion, but only 4 (1.9%) had high-risk lesions.
One participant who was a BRCA2 carrier had a PDAC, and another BRCA2 mutation carrier and a PALB2 mutation carrier underwent surgery and were found to have low-risk precursor lesions.
No serious complications occurred.
The authors concluded that while surveillance of CDNK2A mutations was successful, conducting surveillance in families with familial pancreatic cancer was less beneficial.
- Vasen H, Ibrahim I, Ponce CG, et al. Benefit of surveillance for pancreatic cancer in high-risk individuals: outcome of long-term prospective follow-up studies from three European expert centers [published online ahead of print April 25, 2016]. J Clin Oncol. doi: 10.1200/JCO.2015.64.0730.