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World J Gastroenterol. Jun 28, 2014; 20(24): 7849-7863
Published online Jun 28, 2014. doi: 10.3748/wjg.v20.i24.7849
Personalising pancreas cancer treatment: When tissue is the issue
Katrin M Sjoquist, Venessa T Chin, Lorraine A Chantrill, Chelsie O’Connor, Chris Hemmings, David K Chang, Angela Chou, Marina Pajic, Amber L Johns, Adnan M Nagrial, Andrew V Biankin, Desmond Yip
Katrin M Sjoquist, NHMRC Clinical Trials Centre, University of Sydney, Sydney NSW 1450, Australia
Katrin M Sjoquist, Cancer Care Centre, St George Hospital, Kogarah NSW 2217, Australia
Venessa T Chin, Lorraine A Chantrill, Chelsie O’Connor, David K Chang, Angela Chou, Marina Pajic, Amber L Johns, Adnan M Nagrial, Andrew V Biankin, The Kinghorn Cancer Centre, and the Cancer Research Program, Garvan Institute of Medical Research, Sydney NSW 2010, Australia
Lorraine A Chantrill, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown NSW 2560, Australia
Lorraine A Chantrill, David K Chang, Marina Pajic, St Vincents Hospital Clinical School, Sydney UNSW 2010, Australia
Chelsie O’Connor, Cancer Therapy Centre, Liverpool Hospital, Liverpool NSW 2170, Australia
Chris Hemmings, St John of God Pathology, Subiaco WA 6904, Australia
David K Chang, Andrew V Biankin, Department of Surgery, Bankstown Hospital, Eldridge Road, Bankstown, Sydney NSW 2200, Australia
David K Chang, Andrew V Biankin, Faculty of Medicine, South Western Sydney Clinical School, University of NSW, Liverpool NSW 2170, Australia
David K Chang, Andrew V Biankin, Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow G61 1BD, United Kingdom
Angela Chou, Department of Anatomical Pathology, St. Vincent’s Hospital, Darlinghurst, Sydney NSW 2010, Australia
Andrew V Biankin, West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
Desmond Yip, Department of Medical Oncology, The Canberra Hospital, Garran ACT 2605, Australia
Desmond Yip, ANU Medical School, Australian National University, Acton ACT 2601, Australia
Author contributions: Sjoquist KM, Chantrill LA and Yip D contributed to Conception and design; all authors contributed to drafting the article or revising it critically for important intellectual content, and final approval of the version to be published.
Supported by NHMRC, Pancare Australia, Sydney Catalyst, Royal Australasian College of Physicians to Chin VT; and NHMRC Programme Grant to Sjoquist KM
Correspondence to: Desmond Yip, Associate Professor, Clinical Director, Department of Medical Oncology, The Canberra Hospital, Yamba Drive, Garran ACT 2605, Australia. desmond.yip@anu.edu.au
Telephone: +612-6244-2220  Fax: +612-6244-4266
Received: November 28, 2013
Revised: February 15, 2014
Accepted: March 19, 2014
Published online: June 28, 2014
Abstract

The treatment of advanced pancreatic cancer has not moved much beyond single agent gemcitabine until recently when protocols such as FOLFIRINOX (fluorouracil, leucovorin, irinotecan and oxaliplatin) and nab-paclitaxel-gemcitabine have demonstrated some improved outcomes. Advances in technology especially in massively parallel genome sequencing has progressed our understanding of the biology of pancreatic cancer especially the candidate signalling pathways that are involved in tumourogenesis and disease course. This has allowed identification of potentially actionable mutations that may be targeted by new biological agents. The heterogeneity of pancreatic cancer makes tumour tissue collection important with the aim of being able to personalise therapies for the individual as opposed to a one size fits all approach to treatment of the condition. This paper reviews the developments in this area of translational research and the ongoing clinical studies that will attempt to move this into the everyday oncology practice.

Keywords: Pancreatic neoplasms, Molecular targeted therapy, Genomics, Tissue banks, Chemotherapy

Core tip: State of art review of genomic developments in pancreatic cancer that will hopefully lead to a new treatment paradigm of recognising that pancreatic cancer is a heterogenous disease. Adequate tissue collection is important to allow biomarker testing and molecular sequencing to allow determination of actionable mutations so that personalised therapies can be used in a rational manner.