Preview

Medical alphabet

Advanced search
Open Access Open Access  Restricted Access Subscription or Fee Access

Clinical significance of germline mutations in BRCA1/2 gene in pancreatic ductal adenocarcinoma (literature review)

https://doi.org/10.33667/2078-5631-2023-36-7-12

Abstract

Pancreatic ductal adenocarcinoma occupies a leading position in mortality among other malignant neoplasms. The five-year survival of patients is less than 9 %. Risk of a tumor development increases with a mutation in the BRCA gene, however, the effect of this mutation on the clinical course of the disease has been poorly studied and is of certain scientific and practical interest. A review of the world literature on the clinical significance of germline mutations – the risks of malignancy, the choice of treatment tactics – is presented.

About the Authors

V. E. Moiseenko
Russian Scientific Centre of Radiology and Surgical Technologies n. a. academician A.M. Granov
Russian Federation

Moiseenko Vladislav E. - PhD Med, surgeon, oncologist of Dept of Surgery No. 2.

Saint Petersburg



A. V. Pavlovskii
Russian Scientific Centre of Radiology and Surgical Technologies n. a. academician A.M. Granov
Russian Federation

Pavlovsky Alexander V. - DM Sci (habil.), chief researcher.

Saint Petersburg



S. A. Popov
Russian Scientific Centre of Radiology and Surgical Technologies n. a. academician A.M. Granov
Russian Federation

Popov Sergey A. - PhD Med, surgeon, oncologist of Dept of Surgery No. 2.

Saint Petersburg



D. A. Granov
Russian Scientific Centre of Radiology and Surgical Technologies n. a. academician A.M. Granov
Russian Federation

Granov Dmitry A. - DM Sci (habil.), professor, academician of RAS, scientific director.

Saint Petersburg



A. S. Turlak
Russian Scientific Centre of Radiology and Surgical Technologies n. a. academician A.M. Granov
Russian Federation

Turlak Anastasia S. - clinical resident of Dept of Radiology, Surgery and Oncology.

Saint Petersburg



G. R. Avanesyan
Saint Petersburg State Pediatric Medical University
Russian Federation

Avanesyan Garry R. - 6th year student of Faculty of Pediatrics.

Saint Petersburg



References

1. Siegel R. L., Miller K. D., Wagle N. S., Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023; 73 (1): 17–48. https://doi.org/10.3322/caac.21763

2. Moiseenko V. E., Pavlovsky A. V., Granov D. A., Kardanova I. G., Kochorova L. V., Dodonova I. V. Incidence rates of pancreatic malignancies in the Russian Federation: A retrospective cohort study. Kuban Scientific Medical Bulletin. 2021; 28 (3): 97–111. https://doi.org/10.25207/1608–6228–2021–28–3–97–111

3. Kaprin A. D., Starinsky V. V., Shakhzodova A. O. Malignant neoplasms in Russia in 2020 (morbidity and mortality). M.: Moscow Research Institute of Oncology n. a. P. A. Herzen – a Branch of the National Medical Research Centre of Radiology. 2021; 252.

4. Moiseenko V. E., Pavlovsky A. V., Granov D. A., Kochorova L. V., Dodonov, I.V., Khizha V. V., Yazenok A. V., Yakovenko T. V. Analysis of statistical indicators of the population of St. Petersburg suffering from malignant neoplasms of the pancreas. Bulletin of the Russian Military Medical Academy. 2021; 23 (2): 155–164. https://doi.org/10.17816/brmma60343

5. Moiseenko V. E., Ponomarev P. A., Pavlovsky A. V., Granov D. A., Kochorova L. V., Vishnyakov N. I. Analysis of the clinical characteristics of patients with malignant neoplasms of the pancreas who received medical care in hospitals in St. Petersburg in the period from 2015 to 2020. Scientific notes of the First St. Petersburg State Medical University n. a. academician I. P. Pavlova. 2022; 29 (2): 16–23. https://doi.org/10.24884/1607–4181–2022–29–2–16–23

6. Trikudanathan G., Lou E., Maitra A., Majumder S. Early detection of pancreatic cancer: Current state and future opportunities. Curr Opin Gastroenterol. 2021; 37 (5): 532–538. https://doi.org/10.1097/mog.0000000000000770

7. Neoptolemos J. P., Palmer D. H., Ghaneh P., Psarelli E. E., Valle J. W., Hallora C. M., Faluyi O., O’Reilly D.A., Cunningham D., Wadsley J., Darby S., Meyer T., Gillmore R., Anthoney A., Lind P., Glimelius B., Falk S., Izbicki J. R., Middleton G. W., Büchler M. W. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): A multicentre, open-label, randomised, phase 3 trial. The Lancet. 2017; 389 (10073): 1011–1024. https://doi.org/10.1016/s0140–6736(16)32409–6

8. Conroy T., Desseigne F., Ychou M., et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 364 (19): 1817–1825. https://doi.org/10.1056/nejmoa1011923

9. Murphy K. M., Brune K. A., Griffin C. et al. Evaluation of candidate genes MAP2K4, MADH4, ACVR 1B, and BRCA2 in familial pancreatic cancer: Deleterious BRCA2 mutations in 17 %. Cancer Res. 2002; 62 (13): 3789–3793.

10. Roberts N. J., Norris A. L., Petersen G. M. et al. Whole Genome Sequencing Defines the Genetic Heterogeneity of Familial Pancreatic Cancer. Cancer Discov. 2016; 6 (2): 166–175. https://doi.org/10.1158/2159–8290.cd-15–0402

11. Salo-Mullen E.E., O’Reilly E.M., Kelsen D. P., Ashraf A. M., Lowery M. A., Yu K. H., Reidy D. L., Epstein A. S., Lincoln A., Saldia A., Jacobs L. M., Rau-Murthy R., Zhang L. et al. Identification of germline genetic mutations in patients with pancreatic cancer. Cancer. 2015; 121: 4382–4388. https://doi.org/10.1002/cncr.29664

12. Greer J. B., Lynch H. T., Brand R. E. Hereditary pancreatic cancer: A clinical perspective. Best Pract Res Clin Gastroenterol. 2009; 23: 159–70. https://doi.org/10.1016/j.bpg.2009.02.001

13. Greer J. B., Whitcomb D. C., Brand R. E. Genetic predisposition to pancreatic cancer: A brief review. Am J Gastroenterol. 2007; 102: 2564–2569. https://doi.org/10.1111/j.1572–0241.2007.01475.x

14. Zhen D. B., Rabe K. G., Gallinger S., Syngal S., Schwartz A. G., Goggins M. G., Hruban R. H., Cote M. L., McWilliams R.R., Roberts N. J., Cannon-Albright L.A., Li D., Moyes K., Wenstrup R. J., Hartman A. R., Seminara D., Klein A. P., Petersen G. M. BRCA1, BRCA2, PALB 2, and CDKN 2A mutations in familial pancreatic cancer: A PACGENE study. Genetics in Medicine. 2015; 17 (7): 569–577. https://doi.org/10.1038/gim.2014.153

15. Møller P., Hagen A. I., Apold J., Maehle L., Clark N., Fiane B., Løvslett K., Hovig E., Vabø A. Genetic epidemiology of BRCA mutations – family history detects less than 50 % of the mutation carriers. Eur J Cancer. 2007; 43: 1713–1717. https://doi.org/10.1016/j.ejca.2007.04.023

16. Holter S., Borgida A., Dodd A., Grant R., Semotiuk K., Hedley D., Dhani N., Narod S., Akbari M., Moore M., Gallinger S. Germline BRCA mutations in a large clinic-based cohort of patients with pancreatic adenocarcinoma. J Clin Oncol. 2015; 33: 3124–3129. https://doi.org/10.1200/jco.2014.59.7401

17. Shindo K., Yu J., Suenaga M., Fesharakizadeh S., Cho C., Macgregor-Das A., Siddiqui A., Witmer P. D., Tamura K., Song T. J., Navarro Almario J. A., Brant A., Borges M., Ford M., Barkley T., He J., Weiss M. J., Wolfgang C. L., Roberts N. J., Hruban R. H., Klein A. P., Goggins M. Deleterious germline mutations in patients with apparently sporadic pancreatic adenocarcinoma. J Clin Oncol. 2017; 35: 3382–3390. https://doi.org/10.1200/jco.2017.72.3502

18. Kondo T., Kanai M., Kou T., Sakuma T., Mochizuki H., Kamada M., Nakatsui M., Uza N., Kodama Y., Masui T., Takaori K., Matsumoto S., Miyake H., Okuno Y., Muto M. Association between homologous recombination repair gene mutations and response to oxaliplatin in pancreatic cancer. Oncotarget. 2018; 9: 19817–19825. https://doi.org/10.18632/oncotarget.24865

19. Gabai-Kapara E., Lahad A., Kaufman B., Friedman E., Segev S., Renbaum P., Beeri R., Gal M., Grinshpun-Cohen J., Djemal K., Mandell J. B., Lee M. K., Beller U., Catane R., King M. C., Levy-Lahad E. Population-based screening for breast and ovarian cancer risk due to BRCA1 and BRCA2. Proc Natl Acad Sci USA. 2014; 111: 14205–14210. https://doi.org/10.1073/pnas.1415979111

20. Manchanda R., Loggenberg K., Sanderson S., Burnell M., Wardle J., Gessler S., Side L., Balogun N., Desai R., Kumar A., Dorkins H., Wallis Y., Chapman C., Taylor R., Jacobs C., Tomlinson I., McGuire A., Beller U., Menon U., Jacobs I. Population testing for cancer predisposing BRCA1/BRCA2 mutations in the Ashkenazi-Jewish community: A randomized controlled trial. J Natl Cancer Inst. 2015; 107: 379–390. https://doi.org/10.1093/jnci/dju379

21. Metcalfe K. A., Poll A., Royer R., Llacuachaqui M., Tulman A., Sun P., Narod S. A. Screening for founder mutations in BRCA1 and BRCA2 in unselected Jewish women. J Clin Oncol. 2010; 28: 387–391. https://doi.org/10.1200/jco.2009.25.0712

22. Tennen R. I., Laskey S. B., Koelsch B. L., McIntyre M.H., Tung J. Y. Identifying Ashkenazi jewish BRCA1/2 founder variants in individuals who do not self-report Jewish ancestry. Sci Rep. 2020; 10: 7669. https://doi.org/10.1038/s41598–020–63466-x

23. Mandelker D., Zhang L., Kemel Y., Stadler Z. K., Joseph V., Zehir A., Pradhan N., Arnold A., Walsh M. F., Li Y., Balakrishnan A. R., Syed A., Prasad M., Nafa K., Carlo M. I., Cadoo K. A., Sheehan M., Fleischut M. H., Salo-Mullen E., Trottier M., Lipkin S. M., Lincoln A., Mukherjee S., Ravichandran V., Cambria R., Galle J., Abida W., Arcila M. E., Benayed R., Shah R., Yu K., Bajorin D. F., Coleman J. A., Leach S. D., Lowery M. A., Garcia-Aguilar J., Kantoff P. W., Sawyers C. L., Dickler M. N., Saltz L., Motzer R. J., O’Reilly E.M., Scher H. I., Baselga J., Klimstra D. S., Solit D. B., Hyman D. M., Berger M. F., Ladanyi M., Robson M. E., Offit K. Mutation detection in patients with advanced cancer by universal sequencing of cancer-related genes in tumor and normal DNA vs guideline-based germline testing. JAMA. 2017; 318: 825–835. https://doi.org/10.1001/jama.2017.11137

24. Daly M. B., Pilarski R., Yurgelun M. B., Berry M. P., Buys S. S., Dickson P., Domchek S. M., Elkhanany A., Friedman S., Garber J. E., Goggins M., Hutton M. L., Khan S., Klein C., Kohlmann W., Kurian A. W., Laronga C., Litton J. K., Mak J. S., Menendez C. S., Merajver S. D., Norquist B. S., Offit K., Pal T., Pederson H. J., Reiser G., Shannon K. M., Visvanathan K., Weitzel J. N., Wick M. J., Wisinski K. B., Dwyer M. A., Darlow S. D. NCCN Guidelines. Genetic/familial highrisk assessment: Breast, ovarian, and pancreatic version 1.2020. J Natl Compr Cancer Netw. 2020; 18: 380–391. https://doi.org/10.6004/jnccn.2020.0017

25. Zhen D. B., Rabe K. G., Gallinger S., Syngal S., Schwartz A. G., Goggins M. G., Hruban R. H., Cote M. L., McWilliams R.R., Roberts N. J., Cannon-Albright L.A., Li D., Moyes K., Wenstrup R. J., Hartman A. R., Seminara D., Klein A. P., Petersen G. M. BRCA1, BRCA2, PALB 2 and CDKN 2A mutations in familial pancreatic cancer: A PACGENE study. Genet Med. 2015; 17: 569–577. https://doi.org/10.1038/gim.2014.153

26. Smith A. L., Wong C., Cuggia A., Borgida A., Holter S., Hall A., Connor A. A., Bascuñana C., Asselah J., Bouganim N., Poulin V., Jolivet J., Vafiadis P., Le P., Martel G., Lemay F., Beaudoin A., Rafatzand K., Chaudhury P., Barkun J., Metrakos P., Marcus V., Omeroglu A., Chong G., Akbari M. R., Foulkes W. D., Gallinger S., Zogopoulos G. Reflex testing for germline BRCA1, BRCA2, PALB 2 and ATM mutations in pancreatic cancer: Mutation prevalence and clinical outcomes from two canadian research registries. JCO Precision Oncology. 2018; 2: 1–16. https://doi.org/10.1200/po.17.00098

27. Ferrone C. R., Levine D. A., Tang L. H., Allen P. J., Jarnagin W., Brennan M. F., Offit K., Robson M. E. BRCA germline mutations in Jewish patients with pancreatic adenocarcinoma. J Clin Oncol. 2009; 27: 433–438. https://doi.org/10.1200/jco.2008.18.5546

28. Golan T., Kanji Z. S., Epelbaum R., Devaud N., Dagan E., Holter S., Aderka D., Paluch-Shimon S., Kaufman B., Gershoni-Baruch R., Hedley D., Moore M. J., Friedman E., Gallinger S. Overall survival and clinical characteristics of pancreatic cancer in BRCA mutation carriers. Br J Cancer. 2014; 111: 1132–1138. https://doi.org/10.1038/bjc.2014.418

29. Golan T., Sella T., O’Reilly E.M., Katz M. H., Epelbaum R., Kelsen D. P., Borgida A., Maynard H., Kindler H., Friedmen E., Javle M., Gallinger S. Overall survival and clinical characteristics of BRCA mutation carriers with stage I/II pancreatic cancer. Br J Cancer. 2017; 116: 697–702. https://doi.org/10.1038/bjc.2017.19

30. Pishvaian M. J., Blais E. M., Brody J. R., Lyons E., DeArbeloa P., Hendifar A., Mikhail S., Chung V., Sahai V., Sohal D. P.S., Bellakbira S., Thach D., Rahib L., Madhavan S., Matrisian L. M., Petricoin E. F. 3rd. Overall survival in patients with pancreatic cancer receiving matched therapies following molecular profiling: A retrospective analysis of the Know Your Tumor registry trial. Lancet Oncol 2020; 21: 508–518 https://doi.org/10.1016/s1470–2045(20)30074–7

31. Perri G., Prakash L., Qiao W., Varadhachary G. R., Wolff R., Fogelman D., Overman M., Pant S., Javle M., Koay E. J., Herman J., Kim M., Ikoma N., Tzeng C. W., Lee J. E., Katz M. H.G. Response and survival associated with first-line FOLFIRINOX vs Gemcitabine and nab-Paclitaxel chemotherapy for localized pancreatic ductal adenocarcinoma. JAMA Surg 2020; 155: 832–839 https://doi.org/10.1001/jamasurg.2020.2286

32. Williet N., Saint A., Pointet A. L., Tougeron D., Pernot S., Pozet A., Bechade D., Trouilloud I., Lourenco N., Hautefeuille V., Locher C., Desrame J., Artru P., Thirot Bidault A., Le Roy B., Pezet D., Phelip J. M., Taieb J. Folfirinox versus gemcitabine/nab-paclitaxel as first-line therapy in patients with metastatic pancreatic cancer: A comparative propensity score study. Therapeutic Advances in Gastroenterology. 2019; 12: 1756284819878660 https://doi.org/10.1177/1756284819878660

33. Bhattacharyya A., Ear U. S., Koller B. H., Weichselbaum R. R., Bishop D. K. The breast cancer susceptibility gene BRCA1 is required for subnuclear assembly of Rad51 and survival following treatment with the DNA cross-linking agent cisplatin. Journal of Biological Chemistry. 2000; 275: 23899–23903 https://doi.org/10.1074/jbc.c000276200

34. Mylavarapu S., Das A., Roy M. Role of BRCA mutations in the modulation of response to platinum therapy. Frontiers in Oncology. 2018; 8: 16 https://doi.org/10.3389/fonc.2018.00016

35. Golan T., Kanji Z. S., Epelbaum R., Devaud N., Dagan E., Holter S., Aderka D., Paluch-Shimon S., Kaufman B., Gershoni-Baruch R., Hedley D., Moore M. J., Friedman E., Gallinger S. Overall survival and clinical characteristics of pancreatic cancer in BRCA mutation carriers. Br J Cancer. 2014; 111: 1132–1138 https://doi.org/10.1038/bjc.2014.418

36. Blair A. B., Groot V. P., Gemenetzis G., Wei J., Cameron J. L., Weiss M. J., Goggins M., Wolfgang C. L., Yu J., He J. BRCA1/BRCA2 germline mutation carriers and sporadic pancreatic ductal adenocarcinoma. Journal of the American College of Surgeons. 2018; 226: 630–637. https://doi.org/10.1016/j.jamcollsurg.2017.12.021

37. Reiss K. A., Yu S., Judy R., Symecko H., Nathanson K. L., Domchek S. M. Retrospective survival analysis of patients with advanced pancreatic ductal adenocarcinoma and germline BRCA or PALB 2 mutations. JCO PrecisOncol. 2018; 2: 1–9 https://doi.org/10.1200/po.17.00152

38. Yu S., Agarwal P., Mamtani R., Symecko H., Spielman K., O’Hara M., O’Dwyer P.J., Schneider C., Teitelbaum U., Nathanson K. L., Domchek S. M., Reiss K. A. Retrospective survival analysis of patients with resected pancreatic ductal adenocarcinoma and a germline BRCA or PALB 2 mutation. JCO Precis Oncol 2019; 2: 1–11 https://doi.org/10.1200/po.18.00271

39. Farmer H., McCabe N., Lord C. J., Tutt A. N., Johnson D. A., Richardson T. B., Santarosa M., Dillon K. J., Hickson I., Knights C., Martin N. M., Jackson S. P., Smith G. C., Ashworth A. Targeting the DNA repair defect in BRCA mutant cells as a therapeutic strategy. Nature. 2005; 434: 917–92. https://doi.org/10.1038/nature03445

40. Mirza M. R., Coleman R. L., González-Martín A., Moore K. N., Colombo N., Ray-Coquard I., Pignata S. The forefront of ovarian cancer therapy: Update on PARP inhibitors. Ann Oncol. 2020; 31: 1148–1159 https://doi.org/10.1016/j.annonc.2020.06.004

41. Mirza M. R., Monk B. J., Herrstedt J., Oza A. M., Mahner S., Redondo A., Fabbro M., Ledermann J. A., Lorusso D., Vergote I., Ben-Baruch N.E., Marth C., Mądry R., Christensen R. D., Berek J. S., Dørum A., Tinker A. V., du Bois A., González-Martín A., Follana P., Benigno B., Rosenberg P., Gilbert L., Rimel B. J., Buscema J., Balser J. P., Agarwal S., Matulonis U. A. Niraparib maintenance therapy in platinum-sensitive, recurrent ovarian cancer. New England Journal of Medicine. 2016; 375: 2154–2164 https://doi.org/10.1056/nejmoa1611310

42. Litton J. K., Rugo H. S., Ettl J., Hurvitz S. A., Gonçalves A., Lee K. H., Fehrenbacher L., Yerushalmi R., Mina L. A., Martin M., Roché H., Im Y. H., Quek R. G.W., Markova D., Tudor I. C., Hannah A. L., Eiermann W., Blum J. L. Talazoparib in patients with advanced breast cancer and a germline BRCA mutation. N Engl J Med 2018; 379: 753–763 https://doi.org/10.1056/nejmoa1802905

43. O’Reilly E.M., Lee J. W., Zalupski M., Capanu M., Park J., Golan T., Tahover E., Lowery M. A., Chou J. F., Sahai V., Brenner R., Kindler H. L., Yu K. H., Zervoudakis A., Vemuri S., Stadler Z. K., Do R. K.G., Dhani N., Chen A. P., Kelsen D. P. Randomized, multicenter, phase II trial of gemcitabine and cisplatin with or without veliparib in patients with pancreas adenocarcinoma and a germline BRCA/PALB 2 mutation. J Clin Oncol. 2020; 38: 1378–1388. PMID: 31976786 DOI: 10.1200/JCO.19.02931.

44. Lowery M. A., Kelsen D. P., Capanu M., Smith S. C., Lee J. W., Stadler Z. K., Moore M. J., Kindler H. L., Golan T., Segal A., Maynard H., Hollywood E., Moynahan M., Salo-Mullen E.E., Do R. K.G., Chen A. P., Yu K. H., Tang L. H., O’Reilly E. M. Phase II trial of veliparib in patients with previously treated BRCA-mutated pancreas ductal adenocarcinoma. Eur J Cancer. 2018; 89: 19–26. https://doi.org/10.1016/j.ejca.2017.11.004

45. Kaufman B., Shapira-Frommer R., Schmutzler R. K., Audeh M. W., Friedlander M., Balmaña J., Mitchell G., Fried G., Stemmer S. M., Hubert A., Rosengarten O., Steiner M., Loman N., Bowen K., Fielding A., Domchek S. M. Olaparib monotherapy in patients with advanced cancer and a germline BRCA1/2 mutation. J Clin Oncol 2015; 33: 244–250. https://doi.org/10.1200/jco.2014.56.2728

46. Golan T., Hammel P., Reni M., Van Cutsem E., Macarulla T., Hall M. J., Park J. O., Hochhauser D., Arnold D., Oh D. Y., Reinacher-Schick A., Tortora G., Algül H., O’Reilly E.M., McGuinness D., Cui K. Y., Schlienger K., Locker G. Y., Kindler H. L. Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer. N Engl J Med. 2019; 381: 317–327. https://doi.org/10.1056/nejmoa1903387

47. Waddell N., Pajic M., Patch A. M., Chang D. K., Kassahn K. S., Bailey P., Johns A. L., Miller D., Nones K., Quek K., Quinn M. C., Robertson A. J., Fadlullah M. Z., Bruxner T. J., Christ A. N., Harliwong I., Idrisoglu S., Manning S., Nourse C., Nourbakhsh E., Wani S., Wilson P. J., Markham E., et al. Whole genomes redefine the mutational landscape of pancreatic cancer. Nature 2015; 518: 495–501 https://doi.org/10.1371/journal.pone.0074380

48. Sato H., Niimi A., Yasuhara T., Permata T. B.M., Hagiwara Y., Isono M., Nuryadi E., Sekine R., Oike T., Kakoti S., Yoshimoto Y., Held K. D., Suzuki Y., Kono K, Miyagawa K., Nakano T., Shibata A. DNA double-strand break repair pathway regulates PD-L1 expression in cancer cells. Nat Commun 2017; 8: 175. htps://doi.org/10.1038/s41467–017–01883–9

49. Seeber A., Zimmer K., Kocher F., Puccini A., Xiu J., Nabhan C., Elliott A., Goldberg R. M., Grothey A., Shields A. F., Battaglin F., El-Deiry W.S., Philip P. A., Marshall J. L., Hall M., Korn W. M., Lenz H. J., Wolf D., Feistritzer C., Spizzo G. Molecular characteristics of BRCA1/2 and PALB 2 mutations in pancreatic ductal adenocarcinoma. ESMO Open. 2020; 5: e000942. PMID: 33229504. https://doi.org/10.1136/esmoopen-2020–000942

50. Vikas P., Borcherding N., Chennamadhavuni A., Garje R. Therapeutic potential of combining PARP inhibitor and immunotherapy in solid tumors. Front Oncol. 2020; 10: 570. https://doi.org/10.3389/fonc.2020.00570


Review

For citations:


Moiseenko V.E., Pavlovskii A.V., Popov S.A., Granov D.A., Turlak A.S., Avanesyan G.R. Clinical significance of germline mutations in BRCA1/2 gene in pancreatic ductal adenocarcinoma (literature review). Medical alphabet. 2023;(36):7-12. (In Russ.) https://doi.org/10.33667/2078-5631-2023-36-7-12

Views: 421


ISSN 2078-5631 (Print)
ISSN 2949-2807 (Online)