Abstract
Novel technology has enabled researchers to better characterize pancreatic cancers at the molecular level. We wanted to explore some of the emerging discoveries, such as molecular subclassification, use of liquid biopsy and use of organoids in cancer assessment. A literature review with a search specific to the topic, with recent reviews in major journals and a focus on the last 5 years (until December 2018), was done. Pancreatic ductal adenocarcinoma (PDAC) may now be classified into clinical subgroups based on the predominant genomic profiles, but consensus on one classification system is lacking. Several subtypes have been suggested, including categories such as basal-like, stroma-activated, desmoplastic, pure classical and immune classical types. Further refinement may translate into clinically meaningful groups for therapeutic or prognostic purposes. Liquid biopsies (by means of circulating cancer cells, cell-free DNA, exosomes or other constituents of cancer cells in blood) may aid in earlier diagnosis, define prognostic groups and even predict therapy response and resistance. Organoids are increasingly used for the opportunity to investigate druggable and effective targets ex vivo and should facilitate personalized and precise, targeted therapy in the near future. While immunotherapy has not yet proved to be effective, a better understanding of molecular subgroups and specific immune profiles may help identify candidates for this approach in a more selective approach. Novel molecular techniques have the potential to accelerate the road to improved outcomes in patients with pancreatic cancer.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal of all cancers with mortality almost equal to the incidence of the disease [1]
Novel molecular techniques have the potential to accelerate the road to improved outcomes in patients with pancreatic cancer
Pancreatic cancer is increasingly understood at the molecular level, with attempts at subtyping groups with distinct outcomes and potential for therapeutic targets
Summary
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal of all cancers with mortality almost equal to the incidence of the disease [1]. Diagnosis is hampered by the hard-toaccess gland positioned in the posterior part of the abdomen While novel technologies such as endoscopic ultrasound (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) have made visualization of the gland more accurate [10], the criteria for selection of the population to be screened remains debatable [11]. Great interest exists in investigating biological factors and novel technologies that can facilitate an earlier diagnosis or be predictive or prognostic for patients with PDAC. The aim of this narrative review is to give a brief insight into some of the molecular mechanisms and technologies that may improve diagnosis and therapy for PDAC in the near future
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