Moving the Needle on Precision Medicine in Pancreatic Cancer.
Grainne M O'KaneMaeve Aine LoweryPublished in: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (2022)
The management of pancreatic ductal adenocarcinoma (PDAC) has posed a considerable challenge for decades, with incidence and mortality rates almost mirroring each other. Despite this, a deeper understanding of the complex biology inherent to PDAC has provided a roadmap for a more precise approach to treatment. PDAC deficient in homologous recombination repair and mismatch repair is a subgroup that should be identified in the clinic for a targeted approach. In addition, KRAS wild-type PDAC, occurring in approximately 10% of patients, is enriched in highly actionable alterations including fusions, underscoring the importance of integrative germline and somatic sequencing. Comprehensive sequencing efforts over the past decade have documented genomic- and transcriptomic-based classifiers, with the latter emerging as two main subtypes: the classical and basal-like, which are now being evaluated in clinical trials. Together with promising, innovative strategies to target KRAS mutations and their pleotropic effects, a new era of precision medicine in PDAC is on the horizon.
Keyphrases
- wild type
- single cell
- dna repair
- clinical trial
- end stage renal disease
- dna damage
- ejection fraction
- risk factors
- newly diagnosed
- copy number
- chronic kidney disease
- primary care
- prognostic factors
- rna seq
- cardiovascular events
- peritoneal dialysis
- patient reported outcomes
- coronary artery disease
- randomized controlled trial
- gene expression
- oxidative stress
- ultrasound guided
- phase iii
- dna methylation
- genome wide
- network analysis
- replacement therapy