Pancreatic cancer genomics: where can the science take us?
The incidence of pancreatic ductal adenocarcinoma (PDAC) is steadily increasing and the annual death-to-incidence ratio approaches one. This is a figure that has not changed for several decades. Surgery remains the only chance of cure; however, only less than 20% of patients are amenable to operative resection. Despite successful surgical resection, the majority of the patients still succumb to recurrent metastatic disease. Therefore, there is an urgent need to develop novel therapeutic strategies and to better select patients for current therapies. In this review, we will discuss current management by highlighting the landmark clinical trials that have shaped current care. We will then discuss the challenges of therapeutic development using the current randomized-controlled trial paradigm when confronted with the molecular heterogeneity of PDAC. Finally, we will discuss strategies that may help to shape the management of PDAC in the near future.
Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom.|Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
J S
JS
Graham
Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom.|Academic Unit of Surgery, School of Medicine, College of Medical, Veterinary and Life Sciences, Glasgow, United Kingdom.|West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom.
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NB
Jamieson
Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
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R
Rulach
Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom.|Queensland Centre for Medical Genomics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.
S M
SM
Grimmond
Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom.|The Kinghorn Cancer Centre, Cancer Division, Garvan Institute of Medical Research, University of New South Wales, Sydney, Australia.|Department of Surgery, Bankstown Hospital, Sydney, Australia.|St Vincent's Clinical School, Faculty of Medicine, Sydney, Australia.|South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
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DK
Chang
Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom.|The Kinghorn Cancer Centre, Cancer Division, Garvan Institute of Medical Research, University of New South Wales, Sydney, Australia.|Department of Surgery, Bankstown Hospital, Sydney, Australia.|St Vincent's Clinical School, Faculty of Medicine, Sydney, Australia.|South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
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Biankin
D000970:Antineoplastic Agents / Q000627:therapeutic use; D015415:Biomarkers; D021441:Carcinoma, Pancreatic Ductal / Q000235:genetics; D002986:Clinical Trials as Topic; D019468:Disease Management; D018450:Disease Progression; D023281:Genomics / Q000379:methods; D006801:Humans; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000628:therapy; D057285:Precision Medicine; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D015415:Biomarkers
genomics; next-generation sequencing; pancreatic cancer; stratified medicine; translational medicine