Editor’s note: The National Comprehensive Cancer Network (NCCN), which sets guidelines for the treatment and management of pancreatic adenocarcinoma (the most common type of pancreatic cancer), now recommends all patients undergo germline testing, and they expanded their recommendations about somatic testing. This is a substantial change from earlier versions, which only listed the tests as considerations. Please note that the NCCN guidelines are written for healthcare professionals and require a password-protected account to access. To learn more about the guidelines and for recommendations on how to discuss them with your healthcare team, contact PanCAN Patient Services.
Germline genetic testing is now recommended for all patients with pancreatic adenocarcinoma (the most common form of pancreatic cancer), according to updated guidelines released this week by the National Comprehensive Cancer Network (NCCN). The guidelines have also strengthened recommendations around somatic (tumor tissue) testing.
Germline testing checks a person’s DNA for genetic mutations, including those that may increase their lifetime risk of developing pancreatic cancer or other cancers. People are born with germline genetic mutations, which are present in every cell in their body. These are different from somatic mutations, which happen after someone is born and can occur in any cell in someone’s body except eggs or sperm.
The new recommendation for all pancreatic cancer patients to have germline testing is in response to recent research showing germline mutations can occur at a similar rate in pancreatic cancer patients with or without a family history of any type of cancer. Therefore, the recommendation has been expanded to include all patients, rather than just those with a family or personal history of cancer.
Undergoing this testing can provide patients and their doctors with information to inform the use of treatments with specific therapies to treat a patient’s pancreatic cancer. Germline testing can also provide patients information about their own likelihood of a future cancer diagnosis and can inform whether their family members may be at risk.
Somatic testing looks at a sample of a patient’s tumor to find specific genetic and protein changes that are unique to the cancer cells. This information can help determine their best treatment options.
The new recommendation for patients to undergo somatic testing as clinically indicated, as opposed to simply mentioned as a consideration, builds on the guidelines’ 2018 update recommending healthcare professionals get a large enough tissue sample during diagnosis for somatic testing. The new recommendation is for patients with pancreatic cancer that has spread to other organs (metastatic) or is locally advanced.
Studies and programs, like the Pancreatic Cancer Action Network’s (PanCAN) Know Your Tumor® precision medicine service, show that treatments based on the makeup of a patient’s tumor may increase their success.
For example, Know Your Tumor recently produced data showing that pancreatic cancer patients who had highly actionable alterations found in their tumor – alterations that have been found to make a type of tumor particularly weak to certain treatment approaches – and went on a matched therapy had better outcomes.
“Results from germline and somatic testing can have an important impact on managing and treating pancreatic cancer,” said Cassadie Moravek, associate director of clinical initiatives at PanCAN and a member of the NCCN expert panel that regularly reviews and revises the guidelines. “These recommended tests will help healthcare professionals, patients and their families get important answers to guide next steps.”