The Impact of Biomarkers in Pancreatic Ductal Adenocarcinoma on Diagnosis, Surveillance and Therapy

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is still difficult to treat due to insufficient methods for early diagnosis and prediction of therapy response. Furthermore, surveillance after curatively intended surgery lacks adequate methods for timely detection of recurrence. Therefore, several molecules have been analyzed as predictors of recurrence or early detection of PDAC. Enhanced understanding of molecular tumorigenesis and treatment response triggered the identification of novel biomarkers as predictors for response to conventional chemotherapy or targeted therapy. In conclusion, progress has been made especially in the prediction of therapy response with biomarkers. The use of molecules for early detection and recurrence of PDAC is still at an early stage, but there are promising approaches in noninvasive biomarkers, composite panels and scores that can already ameliorate the current clinical practice. The present review summarizes the current state of research on biomarkers for diagnosis and therapy of pancreatic cancer.

Keywords: biomarker; molecular diagnostics; pancreatic ductal adenocarcinoma; targeted therapy.

Figure 1

Established biomarkers to direct decision making in pancreatic cancer. Summary of biomarkers which should be considered for therapy decision in PDAC based on sufficient clinical evidence. For advanced PDAC, NTRK, KRAS^G12C, germline BRCA1/2, and MSI/dMMR should be tested for targeted therapy. To avoid excessive toxicity, DPD-mutation should be evaluated before therapy with a fluoropyrimidine. CA19-9 should be tested regularly before adjuvant therapy and can guide therapy in advanced disease. (gBRCA1/2 = germline BRCA1/2; MSI = microsatellite instability; dMMR = deficient mismatch repair; DPD = dihydropyrimidine dehydrogenase).