42IN - Tumor markers and biology in pancreatic cancer
|Date||01 October 2012|
|Event||ESMO Congress 2012|
|Session||From biology to treatment in advanced pancreatic and gastroesophageal cancer|
|Topics|| Pancreatic Cancer
As we move forward into precision medicine, biomarkers will be required to define critical targets or to distinguish the diverse components of all cancers. Using biomarkers in therapeutic strategies has been very successful for many malignancies, especially breast cancer, lung cancer, and hematologic malignancies. Many barriers exist for similar applications in pancreatic ductal adenocarcinoma. First, the unusual aggressiveness of this malignancy overall, suggests that the diversity in this disease is constrained within a more narrow spectrum. Second, until recently, drug therapy has been only minimally effective in this disease. Finally, because so few patients proceed to resection and diagnosis is often made on scant fine-needle aspirates, access to tissue has been limited. However, this landscape is changing. Studies show that there are distinct metastatic patterns which may be governed by early genetic aberrations. In addition, genetic subclasses exist which, when evaluated in available human cell lines, also track with varying sensitivity to available chemotherapy. New chemotherapy combinations, albeit with more traditional cytotoxic drugs, are producing striking improvements in survival, even in the setting of metastatic disease. New and more successful treatments, such as FOLFIRINOX and selected gemcitabine combinations, provide more options and enlarge the playing field for the introduction of targeted therapeutics. This also brings the importance of clinically actionable biomarkers to the foreground. As this story unfolds, attention must be given to the importance of building biorepositories from primary and secondary tumor sites, with associated germline DNA and providing clinical annotation for the specimens. As technology improves and the cost of genomic sequencing decreases, we can expect a dramatic escalation in our understanding of the critical biologic pathways amenable to therapeutic interventionDisclosure
The author has declared no conflicts of interest.