Abstract
Pancreatic cancer is a challenging disease with a low 5-year survival rate. There are areas for improvement in the tools used for screening, diagnosis, prognosis, treatment selection, and assessing treatment response. Liquid biopsy, particularly cell free DNA liquid biopsy, has shown promise as an adjunct to our standard care for pancreatic cancer patients, but has not yet been universally adopted into regular use by clinicians. In this publication, we aim to review cfDNA liquid biopsy in pancreatic cancer with an emphasis on current techniques, clinical utility, and areas of active investigation. We feel that researchers and clinicians alike should be familiar with this exciting modality as it gains increasing importance in the care of cancer patients.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) has an incidence of 13.1 cases per 100,000 persons in the United States, where it is currently the third leading cause of cancer mortality, and is expected to rise [1]
While not the standard of care at present, cell free DNA (cfDNA)-based liquid biopsy in its current form can contribute to management of PDAC and a wide range of new indications for its use are under development
One of the most valuable areas in which circulating tumor DNA (ctDNA) can be utilized is as a guide toward or away from surgical resection based on detection of ctDNA, typically by the presence of mutated KRAS
Summary
Pancreatic ductal adenocarcinoma (PDAC) has an incidence of 13.1 cases per 100,000 persons in the United States, where it is currently the third leading cause of cancer mortality, and is expected to rise [1]. Stage disease can be treated with curative intent, 5-year OS even in this case is 20–40% [5,6,7]. In addition to the development of more effective treatment strategies for metastatic disease, the key to improve survival is early detection and implementation of curative-intent therapy. Detection of PDAC is limited by issues related to the tumor itself and the technology available for diagnosis. Assessment of liquid biopsy derived genetic material has the potential to contribute to the diagnosis, staging, and surveillance of PDAC or potentially guide precision targeted therapy based on the specific mutation identified. KRAS is often a founding mutation in pancreatic cancer, present in over 90% of primary tumors, and has become a primary target for analysis in ctDNA-based assays [30]. Tumors without KRAS mutations may harbor other mutations that can be detected with modern amplification and sequencing techniques [24]
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