Survival and treatment trends in BRCA-mutated metastatic pancreatic adenocarcinoma.

769 Background: Patients with metastatic pancreatic cancer and pathogenic germline BRCA mutations have improved survival with platinum-based chemotherapy and maintenance PARP inhibitor therapy. However, little is known about the impact of somatic BRCA mutations and BRCA Variants of Uncertain Significance (VUS) on treatment patterns and survival. Methods: The Flatiron Health Research Database contains de-identified patient-level data originating from over 280 cancer clinics in the United States. Using patient-level data from the Flatiron Health database collected between 2017 and 2024, we conducted multivariate analyses to evaluate the association of BRCA mutations with survival outcomes and treatment patterns in metastatic pancreatic cancer patients. A study protocol was developed prior to the implementation of the study. Results: Relative to benign variants, an overall survival benefit of germline and somatic pathogenic BRCA mutations was demonstrated. Multivariate Cox proportional analysis revealed a hazard ratio (HR) of 0.54 (95% CI: 0.41–0.70), p