Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2021; 27(17): 1943-1958
Published online May 7, 2021. doi: 10.3748/wjg.v27.i17.1943
BRCA mutated pancreatic cancer: A change is coming
Michael N Rosen, Rachel A Goodwin, Michael M Vickers
Michael N Rosen, Rachel A Goodwin, Faculty of Medicine, The University of Ottawa, Ottawa K1H 8L6, Ontario, Canada
Michael M Vickers, The Ottawa Hospital Cancer Center, The University of Ottawa, Ottawa K1H 8L6, Ontario, Canada
Author contributions: Rosen MN, Goodwin RA and Vickers MM made contributions to the conception and design of the study; Rosen MN was involved in drafting and revising the manuscript; all authors reviewed the review and approved the final version of the manuscript.
Conflict-of-interest statement: Michael N Rosen and Michael M Vickers declare no conflict of interest for this topic. Rachel A Goodwin has received compensation for an advisory role with AstraZeneca.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Michael M Vickers, FRCPC, MD, Assistant Professor, Doctor, The Ottawa Hospital Cancer Center, The University of Ottawa, 501 Smyth Road, Ottawa K1H 8L6, Ontario, Canada.
Received: January 25, 2021
Peer-review started: January 25, 2021
First decision: February 27, 2021
Revised: March 4, 2021
Accepted: April 13, 2021
Article in press: April 13, 2021
Published online: May 7, 2021

Pancreatic cancer remains a leading cause of cancer-related death with few available therapies for advanced disease. Recently, patients with germline BRCA mutations have received increased attention due to advances in the management of BRCA mutated ovarian and breast tumors. Germline BRCA mutations significantly increase risk of developing pancreatic cancer and can be found in up to 8% of patients with sporadic pancreatic cancer. In patients with germline BRCA mutations, platinum-based chemotherapies and poly (ADP-ribose) polymerase inhibitors are effective treatment options which may offer survival benefits. This review will focus on the molecular biology, epidemiology, and management of BRCA-mutated pancreatic cancer. Furthermore, we will discuss future directions for this area of research and promising active areas of research.

Keywords: Pancreatic cancer, Systemic therapy, Platinum chemotherapy, BRCA, Deoxyribonucleic acid repair, Poly (ADP-ribose) polymerase inhibitors

Core Tip: Recent advances in the field of BRCA-mutated pancreatic cancer suggest that these patients benefit from platinum-based chemotherapy regimens. In light of new findings from the Pancreas Cancer Olaparib Ongoing trial, patients with germline BRCA mutations may benefit from maintenance treatment with olaparib, a Poly (ADP-ribose) polymerase inhibitors following response to platinum-based chemotherapy. Based on these important findings, all pancreatic cancer patients should be offered early access to genetic screening in order to identify patients who will benefit from these therapies.