Liquid biopsy approach to pancreatic cancer

Abstract

Pancreatic cancer (PC) continues to pose a major clinical challenge. There has been little improvement in patient survival over the past few decades, and it is projected to become the second leading cause of cancer mortality by 2030. The dismal 5-year survival rate of less than 10% after the diagnosis is attributable to the lack of early symptoms, the absence of specific biomarkers for an early diagnosis, and the inadequacy of available chemotherapies. Most patients are diagnosed when the disease has already metastasized and cannot be treated. Cancer interception is vital, actively intervening in the malignization process before the development of a full-blown advanced tumor. An early diagnosis of PC has a dramatic impact on the survival of patients, and improved techniques are urgently needed to detect and evaluate this disease at an early stage. It is difficult to obtain tissue biopsies from the pancreas due to its anatomical position; however, liquid biopsies are readily available and can provide useful information for the diagnosis, prognosis, stratification, and follow-up of patients with PC and for the design of individually tailored treatments. The aim of this review was to provide an update of the latest advances in knowledge on the application of carbohydrates, proteins, cell-free nucleic acids, circulating tumor cells, metabolome compounds, exosomes, and platelets in blood as potential biomarkers for PC, focusing on their clinical relevance and potential for improving patient outcomes.

Keywords: Pancreatic cancer; Biomarkers; Liquid biopsy; Clinical management; Cancer interception; Cancer monitoring

Core Tip: Pancreatic cancer (PC) is still an especially lethal malignancy, with a 5-year survival rate below 10%. Liquid biopsies are a readily-available source of biomarkers to determine the situation of patients. This review summarizes the most recent published findings on the diagnostic, prognostic, and predictive potential for PC of biomarkers identified in liquid biopsies, discussing the strengths, limitations, and drawbacks of their clinical application. There remains a need to validate and verify the clinical value of liquid biopsies for PC in large-scale human trials using appropriate controls.