{"doi":"10.1016/j.esmoop.2024.102244","title":"Controversies in upper GI oncology: maintenance treatment in pancreatic cancer","abstract":"Click here to listen to the Podcast Click here to listen to the Podcast In 2019, results of the POLO trial were published evaluating the efficacy of olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, as maintenance treatment following platinum-based first-line chemotherapy for patients with metastatic pancreatic cancer with a germline BRCA1 or BRCA2 mutation. Maintenance olaparib resulted in a significantly longer progression-free survival compared to placebo (7.4 months versus 3.8 months, hazard ratio 0.53, 95% confidence interval 0.35-0.82). However, some questions for clinical practice regarding the use of olaparib are remaining. In this podcast, Dr Jeroen Dekervel, Dr Eileen O’Reilly and Dr Daniel Laheru discuss the role of maintenance treatment in pancreatic cancer based on a case. A fit 65-year-old male patient was recently diagnosed with metastatic pancreatic cancer in the context of a familial history of breast cancer. Dr O’Reilly emphasizes the role of germline and somatic genomic testing for all patients with pancreatic cancer. Germline testing should be carried out with a panel that includes genes associated with homologous recombination (HR) repair deficiency as alterations in these genes might have implications for the patient as well as their relatives. Both Dr O’Reilly and Dr Laheru recommend first-line platinum-based chemotherapy while waiting for the results of the genomic testing, certainly when there is a familial history of breast cancer. As, in this specific case, a germline BRCA2 mutation is detected and a partial response to platinum-based chemotherapy is observed, the question arises whether the recommendation should be to (i) continue chemotherapy, (ii) switch to olaparib maintenance or (iii) opt for a treatment-free interval. Dr O’Reilly outlines the rationale to use olaparib in this setting, which has the highest chance of being active when the disease is still platinum sensitive. The results from the POLO trial reflect this activity showing higher response rates and progression-free survival compared to placebo. Moreover, the different toxicity profile with this oral agent compared to chemotherapy as well as the flexibility it provides in terms of hospital visits should be taken into account. Dr Laheru highlights the lack of an overall survival benefit in clinical trials investigating this strategy. Both experts agree that this is not a black-or-white discussion and all arguments should be discussed which ultimately will lead to a shared decision with patients and their families. Finally, the podcast covers some future avenues that are being explored using PARP inhibition in pancreatic cancer, including combination treatments as well as extending the use to HR defects beyond germline BRCA. None declared.","journal":"ESMO Open","year":2024,"id":494219,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9457,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":88024,"name":"Daniel A. Laheru","orcid":"0000-0001-6646-0200","position":1,"is_corresponding":false},{"id":242198,"name":"Eileen M. O’Reilly","orcid":"0000-0002-8076-9199","position":2,"is_corresponding":false},{"id":1208296,"name":"Jeroen Dekervel","orcid":"0000-0001-7208-3480","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:09:07.920649Z","pmid":"38350337","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}