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Molecular Diagnostics

Circulating tumour DNA: a challenging innovation to develop “precision onco-surgery” in pancreatic adenocarcinoma

British Journal of Cancer volume 126, pages 1676–1683 (2022)Cite this article

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Abstract

Pancreatic ductal adenocarcinoma (PDAC) is predicted to become the third leading cause of cancer-related mortality within the next decade. Management of PDAC remains challenging with limited effective treatment options and a dismal long-term prognosis. Liquid biopsy and circulating biomarkers seem to be promising to improve the multidisciplinary approach in PDAC treatment. Circulating tumour DNA (ctDNA) is the most studied blood liquid biopsy analyte and can provide insight into the molecular profile and individual characteristics of the tumour in real-time and in advance of standard imaging modalities. This could pave the way for identifying new therapeutic targets and markers of tumour response to supplement diagnostic and provide enhanced stratified treatment. Although its specificity seems excellent, the current sensitivity of ctDNA remains a limitation for clinical use, especially in patients with a low tumour burden. Increasing evidence suggests that ctDNA is a pertinent candidate biomarker to assess minimal residual disease after surgery but also a strong independent prognostic biomarker. This review explores the current knowledge and recent developments in ctDNA as a screening, diagnostic, prognostic and predictive biomarker in the management of resectable PDAC but also technical and analytical challenges that must be overcome to move toward “precision onco-surgery.”

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Fig. 1: Genetic progression model of pancreatic adenocarcinoma.
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  1. APHP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Université Paris-Saclay, 94800, Villejuif, France

    Daniel Pietrasz

  2. Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy

    Daniel Pietrasz, Elisabetta Sereni, Francesco Lancelotti, Antonio Pea, Giulio Innamorati, Roberto Salvia & Claudio Bassi

  3. Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy

    Claudio Luchini

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Conception/design of the work: DP, AP, RS, CB. Literature review: DP, ES, FL. Analysis of the selected data: DP, ES, FL, AP. Drafting the work: DP, ES, FL, AP, CL, RS, CB. Revising it critically: all. Final approval of the version to be published: all.

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Pietrasz, D., Sereni, E., Lancelotti, F. et al. Circulating tumour DNA: a challenging innovation to develop “precision onco-surgery” in pancreatic adenocarcinoma. Br J Cancer 126, 1676–1683 (2022). https://doi.org/10.1038/s41416-022-01745-2

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