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Challenges of the current precision medicine approach for pancreatic cancer: A single institution experience between 2013 and 2017.

Abstract
Recent research on genomic profiling of pancreatic ductal adenocarcinoma (PDAC) has identified many potentially actionable alterations. However, the feasibility of using genomic profiling to guide routine clinical decision making for PDAC patients remains unclear. We retrospectively reviewed PDAC patients between October 2013 and December 2017, who underwent treatment at the Johns Hopkins Hospital and had clinical tumor next-generation sequencing (NGS) through commercial resources. Ninety-two patients with 93 tumors tested were included. Forty-eight (52%) patients had potentially curative surgeries. The median time from the tissue available to the NGS testing ordered was 229 days (interquartile range 62-415). A total of three (3%) patients had matched targeted therapies based on genomic profiling results. Genomic profiling guided personalized treatment for PDAC patients is feasible, but the percentage of patients who receive targeted therapy is low. The main challenges are ordering NGS testing early in the clinical course of the disease and the limited evidence of using a targeted approach in these patients. A real-time department level genomic testing ordering system in combination with an evidence-based flagging system for potentially actionable alterations could help address these shortcomings.
AuthorsDing Ding, Ammar A Javed, Dea Cunningham, Jonathan Teinor, Michael Wright, Zunaira N Javed, Cara Wilt, Lindsay Parish, Mary Hodgin, Amy Ryan, Carol Judkins, Keith McIntyre, Rachel Klein, Nilo Azad, Valerie Lee, Ross Donehower, Ana De Jesus-Acosta, Adrian Murphy, Dung T Le, Eun Ji Shin, Anne Marie Lennon, Mouen Khashab, Vikesh Singh, Alison P Klein, Nicholas J Roberts, Amy Hacker-Prietz, Lindsey Manos, Christi Walsh, Lara Groshek, Caitlin Brown, Chunhui Yuan, Alex B Blair, Vincent Groot, Georgios Gemenetzis, Jun Yu, Matthew J Weiss, Richard A Burkhart, William R Burns, Jin He, John L Cameron, Amol Narang, Atif Zaheer, Elliot K Fishman, Elizabeth D Thompson, Robert Anders, Ralph H Hruban, Elizabeth Jaffee, Christopher L Wolfgang, Lei Zheng, Daniel A Laheru
JournalCancer letters (Cancer Lett) Vol. 497 Pg. 221-228 (01 28 2021) ISSN: 1872-7980 [Electronic] Ireland
PMID33127389 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural)
CopyrightCopyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.
Chemical References
  • Biomarkers, Tumor
Topics
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Biomarkers, Tumor (genetics)
  • Carcinoma, Pancreatic Ductal (genetics, secondary, therapy)
  • Combined Modality Therapy
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Molecular Targeted Therapy (standards)
  • Mutation
  • Pancreatic Neoplasms (genetics, pathology, therapy)
  • Pancreaticoduodenectomy
  • Precision Medicine
  • Prognosis
  • Retrospective Studies
  • Time Factors

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