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

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Challenges of the current precision medicine approach for pancreatic cancer: A single institution experience between 2013 and 2017
Cancer Letters ( IF 9.1 ) Pub Date : 2020-10-28 , DOI: 10.1016/j.canlet.2020.10.039
Ding Ding ₁ , Ammar A Javed ₂ , Dea Cunningham ₃ , Jonathan Teinor ₂ , Michael Wright ₂ , Zunaira N Javed ₂ , Cara Wilt ₄ , Lindsay Parish ₃ , Mary Hodgin ₃ , Amy Ryan ₄ , Carol Judkins ₄ , Keith McIntyre ₄ , Rachel Klein ₄ , Nilo Azad ₄ , Valerie Lee ₄ , Ross Donehower ₄ , Ana De Jesus-Acosta ₄ , Adrian Murphy ₄ , Dung T Le ₄ , Eun Ji Shin ₅ , Anne Marie Lennon ₆ , Mouen Khashab ₅ , Vikesh Singh ₅ , Alison P Klein ₇ , Nicholas J Roberts ₇ , Amy Hacker-Prietz ₈ , Lindsey Manos ₂ , Christi Walsh ₂ , Lara Groshek ₂ , Caitlin Brown ₂ , Chunhui Yuan ₂ , Alex B Blair ₂ , Vincent Groot ₂ , Georgios Gemenetzis ₂ , Jun Yu ₂ , Matthew J Weiss ₂ , Richard A Burkhart ₂ , William R Burns ₂ , Jin He ₂ , John L Cameron ₂ , Amol Narang ₈ , Atif Zaheer ₉ , Elliot K Fishman ₉ , Elizabeth D Thompson ₁₀ , Robert Anders ₁₀ , Ralph H Hruban ₁₀ , Elizabeth Jaffee ₄ , Christopher L Wolfgang ₂ , Lei Zheng ₄ , Daniel A Laheru ₄

Affiliation

The Pancreatic Cancer "Precision Medicine" Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery the Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
The Pancreatic Cancer "Precision Medicine" Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery the Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
The Pancreatic Cancer "Precision Medicine" Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The Pancreatic Cancer "Precision Medicine" Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
The Pancreatic Cancer "Precision Medicine" Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
The Pancreatic Cancer "Precision Medicine" Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
The Pancreatic Cancer "Precision Medicine" Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
The Pancreatic Cancer "Precision Medicine" Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
The Pancreatic Cancer "Precision Medicine" Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.

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.

中文翻译：

当前胰腺癌精准医疗方法的挑战：2013 年至 2017 年单一机构的经验

最近对胰腺导管腺癌 (PDAC) 基因组分析的研究发现了许多潜在的可行改变。然而，使用基因组分析来指导 PDAC 患者的常规临床决策的可行性仍不清楚。我们回顾性分析了2013年10月至2017年12月期间在约翰·霍普金斯医院接受治疗并通过商业资源进行临床肿瘤下一代测序（NGS）的PDAC患者。 92 名患者的 93 个肿瘤被测试。四十八（52%）名患者接受了可能治愈的手术。从组织可用到进行 NGS 测试的中位时间为 229 天（四分位数范围 62-415）。根据基因组分析结果，共有三名 (3%) 患者接受了匹配的靶向治疗。基因组图谱指导下的PDAC患者个体化治疗是可行的，但接受靶向治疗的患者比例较低。主要挑战是在疾病临床病程的早期进行 NGS 检测，以及在这些患者中使用针对性方法的证据有限。实时部门级基因组测试订购系统与基于证据的标记系统相结合，以进行潜在可行的改变，可以帮助解决这些缺点。

更新日期：2020-11-12

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