Liquid biopsy in pancreatic cancer: the beginning of a new era

Abstract

With dismal survival rate pancreatic cancer remains one of the most aggressive and devastating malignancy. Predominantly, due to the absence of a dependable methodology for early identification and limited therapeutic options for advanced disease. However, it takes over 17 years to develop pancreatic cancer from initiation of mutation to metastatic cancer; therefore, if diagnosed early; it may increase overall survival dramatically, thus, providing a window of opportunity for early detection. Recently, genomic expression analysis defined 4 subtypes of pancreatic cancer based on mutated genes. Hence, we need simple and standard, minimally invasive test that can monitor those altered genes or their associated pathways in time for the success of precision medicine, and liquid biopsy seems to be one answer to all these questions. Again, liquid biopsy has an ability to pair with genomic tests. Additionally, liquid biopsy based development of circulating tumor cells derived xenografts, 3D organoids system, real-time monitoring of genetic mutations by circulating tumor DNA and exosome as the targeted drug delivery vehicle holds lots of potential for the treatment and cure of pancreatic cancer. At present, diagnosis of pancreatic cancer is frantically done on the premise of CA19-9 and radiological features only, which doesn't give a picture of genetic mutations and epigenetic alteration involved. In this manner, the current diagnostic paradigm for pancreatic cancer diagnosis experiences low diagnostic accuracy. This review article discusses the current state of liquid biopsy in pancreatic cancer as diagnostic and therapeutic tools and future perspectives of research in the light of circulating tumor cells, circulating tumor DNA and exosomes.

Moving the Target on the Optimal Adjuvant Strategy for Resected Pancreatic Cancers: A Systematic Review with Meta-Analysis

“…In fact, liquid biopsy allows traditional limitations of tissue biopsy linked to spatial and temporal heterogeneity to be overcome, with the advantage of being less invasive and easily repeatable. Extensive evidence suggests that high levels of circulating tumor DNA (ctDNA) may predict disease progression in mPC [29][30][31]. To investigate ctDNA in an adjuvant setting could help to select patients with minimal residual disease at risk of post-surgical recurrence, probably even better than the use of circulating tumor cells (CTC) or CA19.9, although nowadays definitive data are not disposable [32][33][34].…”

The Translational Status of Cancer Liquid Biopsies

“…Similarly, pancreatic cancer, one of the most aggressive tumors, is asymptomatic at an early stage and most diagnosis are made at late stage where there are limited options for treatment [471]. The established biomarker for pancreatic cancer, CA19-9, is not suitable for screening and diagnosis.…”

“…The established biomarker for pancreatic cancer, CA19-9, is not suitable for screening and diagnosis. Moreover, pancreatic cancer has four different subtypes with complex molecular signatures, which are impossible to resolve using current diagnostic procedures [471].…”

Usefulness of rapid on-site evaluation specimens from endoscopic ultrasound-guided fine-needle aspiration for cancer gene panel testing: A retrospective study

“…However, the rate of surgical indication among patients with PC has been reported to be only 20% [3], and the approach for assessing target mutations in the remaining 80% of patients is unclear. Some studies have reported that genetic tests using cytological specimens and liquid biopsy are useful [15,16].…”