The promise of a personalized genomic approach to pancreatic cancer and why targeted therapies have missed the mark.

TitleThe promise of a personalized genomic approach to pancreatic cancer and why targeted therapies have missed the mark.
Publication TypeJournal Article
Year of Publication2011
AuthorsFisher, WE
JournalWorld J Surg
Volume35
Issue8
Pagination1766-9
Date Published2011 Aug
ISSN1432-2323
KeywordsAntimetabolites, Antineoplastic, Antineoplastic Combined Chemotherapy Protocols, Combined Modality Therapy, Deoxycytidine, Drug Delivery Systems, Forecasting, Genetic Association Studies, Human Genome Project, Humans, Molecular Targeted Therapy, Pancreatic Neoplasms, Precision Medicine, Risk Factors, Sequence Analysis, DNA, Survival Rate, Treatment Failure
Abstract

Pancreatic cancer (PC) carries the highest mortality rate of any cancer type. Although minor advances in chemotherapy have been made, the mortality rate has remained the same over the last several decades. Clinical trials examining therapies targeting the epidermal growth factor (EGFR), vascular endothelial growth factor (VEGF), specific mutated proteins such as K-ras, immunotherapy employing tumor-associated antigens, and biologic therapy such as TNFerade (GenVec, Inc., Gaithersburg, MD) have all failed to substantially improve survival. Pancreatic cancer is likely a heterogeneous disease; therefore, a personalized genomic approach offers the possibility to tailor treatment to the unique characteristics of individual patients and their tumors. Rapid advances in sequencing technology are decreasing the time and cost of obtaining this information to a clinically useful level. However, many challenges remain to be faced in applying this technology in the field of PC. Even if patients with PC could be identified early in the course of the disease, localizing the disease and treating it in a minimally invasive fashion will remain problematic. Ethical issues including patient discrimination and access to care will be particularly important in PC. As the field advances, validation, education of clinicians, and determining the true value and source of funding will be difficult. Although the era of personalized genomic medicine has arrived, it will certainly take many years to begin to realize its potential. It is to be hoped that this new approach will result in a significant improvement in the survival curve for patients with PC.

DOI10.1007/s00268-010-0949-7
Alternate JournalWorld J Surg
PubMed ID21222122