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| Profile Name | PALB2 inact mut |
| Gene Variant Detail | |
| Relevant Treatment Approaches | PARP Inhibitor (Pan) |
| Molecular Profile | Indication/Tumor Type | Response Type | Relevant Treatment Approaches | Therapy Name | Approval Status | Evidence Type | Efficacy Evidence | References |
|---|---|---|---|---|---|---|---|---|
| PALB2 inact mut | prostate cancer | sensitive | PARP Inhibitor (Pan) | Olaparib | FDA approved - On Companion Diagnostic | Actionable | In a Phase III trial (PROfound) that supported FDA approval, Lynparza (olaparib) treatment significantly improved median imaging-based progression-free survival (5.8 vs 3.5 mo, HR 0.49, p<0.001) compared to control in patients with metastatic castration-resistant prostate cancer who progressed on hormone therapy and harbored deleterious or suspected deleterious mutations in homologous recombination repair genes, including PALB2 (PMID: 32343890; NCT02987543). | detail... detail... 32343890 |
| PALB2 inact mut | prostate cancer | sensitive | PARP Inhibitor (Pan) | Enzalutamide + Talazoparib | FDA approved | Actionable | In a Phase III trial (TALAPRO-2) that supported FDA approval, Talzenna (talazoparib) plus Xtandi (enzalutamide) improved median radiographic progression-free survival compared to enzalutamide plus placebo (27.9 vs 16.4 mo, HR 0.46, p=0.0003) in patients with metastatic castration-resistant prostate cancer harboring deficient homologous recombination repair genes including PALB2, with an HR of 0.66 (p=0.12) in patients with non-BRCA mutations treated with Talzenna (talazoparib) (PMID: 37285865; NCT03395197). | 37285865 detail... |
| PALB2 inact mut | prostate cancer | sensitive | PARP Inhibitor (Pan) | Olaparib | Guideline | Actionable | Lynparza (olaparib) is included in guidelines as second-line therapy post androgen receptor-directed therapy for patients with metastatic castration-resistant prostate cancer harboring pathogenic mutations in PALB2 (NCCN.org). | detail... |
| PALB2 inact mut | estrogen-receptor positive breast cancer | sensitive | PARP Inhibitor (Pan) | Olaparib | Guideline | Actionable | Lynparza (olaparib) is included in guidelines as second-line therapy for patients with ESR1 (ER)-positive, ERBB2 (HER2)-negative metastatic breast cancer with germline or somatic pathogenic/likely pathogenic PALB2 mutations who have progressed on an endocrine therapy plus CDK4/6 inhibitor (PMID: 34678411; ESMO.org). | detail... 34678411 |
| PALB2 inact mut | estrogen-receptor positive breast cancer | sensitive | PARP Inhibitor (Pan) | Talazoparib | Guideline | Actionable | Talzenna (talazoparib) is included in guidelines as second-line therapy for patients with ESR1 (ER)-positive, ERBB2 (HER2)-negative metastatic breast cancer with germline or somatic pathogenic/likely pathogenic PALB2 mutations who have progressed on an endocrine therapy plus CDK4/6 inhibitor (PMID: 34678411; ESMO.org). | 34678411 detail... |
| PALB2 inact mut | prostate cancer | sensitive | PARP Inhibitor (Pan) | Enzalutamide + Talazoparib | Guideline | Actionable | Talzenna (talazoparib) plus Xtandi (enzalutamide) is included in guidelines as systemic therapy for patients with metastatic castration-resistant prostate cancer harboring a pathogenic germline or somatic PALB2 mutation who have not been treated in the setting of castration-resistant prostate cancer (NCCN.org). | detail... |
| PALB2 inact mut | Her2-receptor negative breast cancer | sensitive | PARP Inhibitor (Pan) | Olaparib | Guideline | Actionable | Lynparza (olaparib) is included in the Pan-Asian Guidelines Adaptation (PAGA) as second-line therapy for patients with hormone receptor-positive, ERBB2 (HER2)-negative metastatic breast cancer with germline pathogenic/likely pathogenic PALB2 mutations who have progressed on an endocrine therapy plus CDK4/6 inhibitor (PMID: 37178669; ESMO.org). | 37178669 detail... |
| PALB2 inact mut | biliary tract cancer | sensitive | PARP Inhibitor (Pan) | Rucaparib | Guideline | Actionable | Rubraca (rucaparib) is included in the Pan-Asian Guidelines Adaptation (PAGA) for platinum-sensitive biliary tract cancer patients harboring PALB2 mutations (PMID: 39232586; ESMO.org). | detail... 39232586 |
| PALB2 inact mut | breast cancer | sensitive | PARP Inhibitor (Pan) | Olaparib | Guideline | Actionable | Lynparza (olaparib) is included in guidelines for patients with stage IV (M1) disease harboring germline PALB2 mutations (category 2A) (NCCN.org). | detail... |
| PALB2 inact mut | biliary tract cancer | sensitive | PARP Inhibitor (Pan) | Rucaparib | Guideline | Actionable | Rubraca (rucaparib) is included in guidelines as second or later-line therapy for patients with biliary tract cancer harboring PALB2 mutations (PMID: 39864891; ESMO.org). | 39864891 detail... |
| PALB2 inact mut | prostate cancer | predicted - sensitive | PARP Inhibitor (Pan) | Abiraterone + Niraparib + Prednisone | Phase III | Actionable | In a Phase III trial (MAGNITUDE), Zejula (niraparib) in combination with Zytiga (abiraterone) and Adasone (prednisone) (AAP) improved radiographic progression-free survival (HR 0.59) compared to placebo and AAP in patients with metastatic castration-resistant prostate cancer harboring inactivating mutations in the homologous recombination repair (HRR)-Fanconi pathway (BRIP1, FANCA, PALB2), with a HR of 0.59 in patients with PALB2 mutations (J Clin Oncol 40, no. 16_suppl (June 01, 2022) 5020; NCT03748641). | detail... |
| PALB2 inact mut | pancreatic ductal adenocarcinoma | no benefit | PARP Inhibitor (Pan) | Cisplatin + Gemcitabine + Veliparib | Phase II | Actionable | In a Phase II trial, the addition of Veliparib (ABT-888) to Gemzar (gemcitabine) and Platinol (cisplatin) in pancreatic ductal adenocarcinoma patients with either a germline BRCA1, BRCA2, or PALB2 inactivating mutation did not improve response rate (RR) compared to Gemzar (gemcitabine) and Platinol (cisplatin) alone, with 74.1% (20/27) vs 65.2% (15/23), P=0.55, and led to similar median progression-free survival, 10.1 vs 9.7 mo, P=0.73, and median overall survival, 15.5 vs 16.4 mo, P=0.6 (PMID: 31976786). | 31976786 |
| PALB2 inact mut | prostate cancer | sensitive | PARP Inhibitor (Pan) | Olaparib | Phase II | Actionable | In a Phase II (TOPARP-B) trial, Lynparza (olaparib) treatment resulted in a composite overall response rate of 57.1% (4/7) and a RECIST objective response rate of 33.3% (2/6) in patients with castration-resistant prostate cancer harboring deleterious PALB2 mutations (PMID: 31806540; NCT01682772). | 31806540 |
| PALB2 inact mut | breast cancer | sensitive | PARP Inhibitor (Pan) | Olaparib | Phase II | Actionable | In a Phase II trial (TBCRC 048), Lynparza (olaparib) treatment resulted in an objective response rate (ORR) of 33% (9/27) and a clinical benefit rate (CBR) at 18 weeks of 50% in patients with metastatic breast cancer harboring germline mutations in homologous recombination-related genes other than BRCA1/2, all responders harbored germline PALB2 inactivating mutations, ORR and CBR in PALB2-mutant patients (n=11) were 82% and 100%, respectively (PMID: 33119476; NCT03344965). | 33119476 |
| PALB2 inact mut | pancreatic ductal adenocarcinoma | sensitive | Cisplatin + Gemcitabine | Phase II | Actionable | In a Phase II trial, patients with pancreatic ductal adenocarcinoma harboring either a germline BRCA1, BRCA2, or PALB2 inactivating mutation demonstrated a response rate of 65.2% (15/23), a median progression-free survival of 9.7 months, a median overall survival of 16.4 months, and a disease control rate of 78.3% (18/23) when treated with a combination of Gemzar (gemcitabine) and Platinol (cisplatin) (PMID: 31976786). | 31976786 | |
| PALB2 inact mut | prostate cancer | predicted - sensitive | PARP Inhibitor (Pan) | unspecified PARP inhibitor | Clinical Study - Meta-analysis | Actionable | In a combined analysis of 6 clinical trials, PARP inhibitor therapy improved radiographic progression-free survival (14 vs 9 mo, HR 0.52) and overall survival (25 vs 20 mo, HR 0.78) compared to placebo when combined with AR pathway inhibitors in patients with metastatic castration-resistant prostate cancer harboring PALB2 mutations, and resulted in an objective response rate of 14% (1/7) as monotherapy (PMID: 38484203; NCT02987543, NCT03732820, NCT03395197, NCT03748641, NCT02952534, NCT03148795). | 38484203 |
| PALB2 inact mut | prostate cancer | predicted - sensitive | PARP Inhibitor (Pan) | Rucaparib | Case Reports/Case Series | Actionable | In a Phase II trial (TRITON2), 2 of 2 patients with metastatic castrate-resistant prostate cancer harboring deleterious PALB2 alterations demonstrated a PSA response after treatment with Rubraca (rucaparib), with one of those patients demonstrating partial radiographic response that was ongoing 3.9 months, and the other a 47% reduction in tumor volume (PMID: 32086346; NCT02952534). | 32086346 |
| PALB2 inact mut | Her2-receptor negative breast cancer | predicted - sensitive | PARP Inhibitor (Pan) | Talazoparib | Case Reports/Case Series | Actionable | In a Phase II trial, Talzenna (talazoparib) treatment was well tolerated, and among 12 evaluable ERBB2 (HER2)-negative breast cancer patients with a homologous repair pathway mutation resulted in response in 25% (3/12) of patients, including two patients with germline mutations in PALB2, and resulted in stable disease for >/= 6 months in 3 patients, including one patient with a germline PALB2 mutation (J Clin Oncol 37, no. 15_suppl (May 20, 2019) 3006). | detail... |
| PALB2 inact mut | pancreatic cancer | predicted - sensitive | PARP Inhibitor (Pan) | Rucaparib | Case Reports/Case Series | Actionable | In a Phase II trial, maintenance Rubraca (rucaparib) resulted in a median progression-free survival (mPFS) of 13.1 months and an objective response rate (ORR) of 41.7% (15/36, 3 complete responses, 12 partial responses) in patients with platinum-sensitive, advanced pancreatic cancer harboring deleterious mutations in BRCA1/2 or PALB2, ORR was 50% (3/6) in patients with PALB2 mutations (PMID: 33970687; NCT03140670). | 33970687 |
| PALB2 inact mut | triple-receptor negative breast cancer | predicted - sensitive | PARP Inhibitor (Pan) | Ceralasertib + Olaparib | Case Reports/Case Series | Actionable | In a Phase II trial (plasmaMATCH), treatment with the combination of Lynparza (olaparib) and Ceralasertib (AZD6738) resulted in limited efficacy in patients with advanced triple-negative breast cancer, with an objective response rate of 17.1% (12/70), including a complete response in a patient with a germline mutation in PALB2 (PMID: 37773077; NCT03182634). | 37773077 |
| PALB2 inact mut | Advanced Solid Tumor | sensitive | PARP Inhibitor (Pan) | Olaparib | Preclinical | Actionable | In a preclinical study, Lynparza (olaparib) resulted in decreased cell survival in a PALB2 deficient cell line derived from a Fanconi anemia patient (PMID: 20871615). | 20871615 |
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