Reviewing the Utility of EUS FNA to Advance Precision Medicine in Pancreatic Cancer

Abstract

Advanced pancreatic cancer (PC) is an aggressive malignancy with few effective therapeutic options. While the evolution of precision medicine in recent decades has changed the treatment landscape in many cancers, at present no targeted therapies are used in the routine management of PC. Only a minority of patients with PC present with surgically resectable disease, and in the remainder obtaining high quality biopsy material for both diagnosis and molecular testing can prove challenging. Endoscopic ultrasound-guided fine needle aspiration (EUS FNA) is a widely used diagnostic procedure in PC, and allows tumour sampling in patients with both early and late stage disease. This review will provide an update on the role of EUS FNA as a diagnostic tool, as well as a source of genetic material which can be used both for molecular analysis and for the creation of valuable preclinical disease models. We will also consider relevant clinical applications of EUS FNA in the management of PC, and the path towards bringing precision medicine closer to the clinic in this challenging disease.

Keywords: EUS FNA; Pancreatic cancer; molecular oncology; precision medicine.

Figure 1

Forest plot demonstrating hazard ratio for phase III clinical trials in pancreatic cancer that included a control arm of gemcitabine monotherapy for a consistent comparison

Figure 2

Venn diagram showing the differences between the genes up-regulated in PC in two published diagnostic gene signatures. Bhasin et al. [68] presented a five-gene signature up-regulated in PC compared to normal pancreas; Rodriguez, et al. [66] presented an 83 gene signature of up- and down-regulated in PC, they only published 20 up-regulated genes and 20 down-regulated genes.