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Living with cancer· Appointment prep

Appointment sheet: BRCA or PALB2-mutant pancreatic ductal adenocarcinoma

One page to bring and write on: your details, the questions for BRCA or PALB2-mutant pancreatic ductal adenocarcinoma plus your own, the words you may hear, what to bring, the treatments the standard of care names, and room for the answers and agreed next steps. What you type stays in this browser. Print it or save it as a PDF. New to all this? Start with the first 60 days. Orientation, not medical advice.

Tick the questions to print

All of this cancer's questions start ticked. Untick what does not apply; ticks are kept in this browser. .

Your own questions

Shared with the prep pack, so questions you add there appear here too.

Print or save as PDF

Use (or Ctrl+P, Cmd+P on a Mac). To keep a copy, choose Save as PDF as the destination in the print dialog. Only the sheet prints; the controls stay on screen. Your typed notes print where you typed them; empty fields print as ruled lines to write on.

Appointment sheet

BRCA or PALB2-mutant pancreatic ductal adenocarcinoma

Prepared with OnCo (onco.cc/prep/brca-palb2-pdac/). Orientation, not medical advice; your team knows your case.

My details

Name
Date of appointment
Hospital and clinician
Who is coming with me

What I know, what is unclear, changes to discuss

Saved in this browser
What I know so far
What is unclear to me
Changes since last time

My questions

20 on the sheet
Newly diagnosed
  1. 1.What is my exact diagnosis, stage, and grade, and which tests established them?
  2. 2.Which biomarkers have been tested on my tumour (for example Germline BRCA1, BRCA2 and PALB2 testing in every patient at diagnosis, Somatic homologous recombination gene alterations on tumour sequencing, Homologous recombination deficiency signatures, Response to at least sixteen weeks of platinum without progression, BRCA reversion mutations in plasma at progression on a PARP inhibitor), and what were the results?
  3. 3.Which subtype is my cancer, and does that change the recommended treatment?
  4. 4.Is germline (inherited) genetic testing recommended for me or my family?
Testing
  1. 5.For my situation (testing), which of the standard options do you recommend and why?
Metastatic, first line
  1. 6.For my situation (metastatic, first line), which of the standard options do you recommend and why?
  2. 7.Am I a candidate for FOLFIRINOX / mFOLFIRINOX, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), Gemcitabine + cisplatin or related drugs, and what side effects should I expect?
Maintenance
  1. 8.For my situation (maintenance), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Olaparib, Rucaparib, and what side effects should I expect?
  3. 10.How do the results of POLO apply to someone like me?
Resectable or borderline
  1. 11.For my situation (resectable or borderline), which of the standard options do you recommend and why?
  2. 12.Am I a candidate for FOLFIRINOX / mFOLFIRINOX, and what side effects should I expect?
  3. 13.How do the results of PRODIGE 24 / CCTG PA6 and PREOPANC-1 / PREOPANC-2 apply to someone like me?
After progression on a PARP inhibitor
  1. 14.For my situation (after progression on a parp inhibitor), which of the standard options do you recommend and why?
  2. 15.Am I a candidate for Gemcitabine + nab-paclitaxel, Daraxonrasib, and what side effects should I expect?
Any stage
  1. 16.Are there clinical trials I could join, for example of Rucaparib, Niraparib, Talazoparib, Ipilimumab?
  2. 17.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 18.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 19.I read that “Olaparib delays progression but has not lengthened overall survival, and the best duration of maintenance is unknown”. How does that affect my plan?
  5. 20.I read that “Somatic and non-BRCA repair gene alterations respond unpredictably, and there is no validated homologous recombination deficiency test for the pancreas”. How does that affect my plan?

The words I may hear

  • Homologous recombination deficiency (HRD): A tumour that cannot properly repair double-strand DNA breaks, usually because of BRCA or related gene loss.
  • BRCA reversion mutations: A cancer with a broken BRCA gene can repair the break itself under the pressure of PARP inhibitors or platinum: a second mutation restores the reading frame, the DNA-repair machinery switches back on, and both drugs stop working.
  • Platinum-sensitive / platinum-resistant: Whether a cancer that responded to platinum chemotherapy came back more than six months later (sensitive, so platinum can be used again) or sooner (resistant, so something else is needed).
  • Germline vs somatic mutations: Germline mutations are inherited and in every cell; somatic mutations arise in the tumour only.
  • Germline BRCA mutation (gBRCA): An inherited fault in the BRCA1 or BRCA2 gene, present in every cell from birth, that greatly raises the risk of breast, ovarian, prostate and pancreatic cancer and makes those cancers sensitive to PARP inhibitors and platinum.
  • Drug resistance (primary and acquired): Why cancer drugs stop working: the tumour either never depended on the target or evolves around the block.
  • Neoadjuvant / adjuvant / perioperative: Neoadjuvant therapy is treatment given before surgery, adjuvant therapy is treatment given after it, and perioperative therapy is both.

Tests and results to bring

Biomarker results to ask for: Germline BRCA1, BRCA2 and PALB2 testing in every patient at diagnosis, Somatic homologous recombination gene alterations on tumour sequencing, Homologous recombination deficiency signatures (investigational in the pancreas), Response to at least sixteen weeks of platinum without progression (POLO eligibility), BRCA reversion mutations in plasma at progression on a PARP inhibitor, Family history and Ashkenazi Jewish ancestry (prior probability of a variant).

Scans and tests linked to this cancer: Germline (hereditary) testing, Liquid biopsy (ctDNA), High-risk pancreatic surveillance (CAPS / PRECEDE).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

The treatments I may be offered

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.

Answers and next steps

Saved in this browser
What I was told
Agreed next steps, dates and who to call