Another potential biomarker is serum ferritin. Shorter OS among patients with metastatic pancreatic cancer was found to be predicted by higher pretreatment serum ferritin levels in a phase 3 trial7 presented by Lindsey Zubritsky, MD, of Penn State Hershey Medical Center, Hershey, PA, and colleagues. They reported that “pretreatment serum ferritin levels has prognostic biomarker utility in pancreatic cancer, and should be evaluated as a predictive factor for response to novel treatment regimens.”

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Predicting treatment response in pancreatic cancer and customizing treatment according to a patient’s genetic composition was an approach presented by Kenneth Yu, MD, assistant attending physician in the Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, and colleagues, during a press briefing in advance of the Symposium.

Calling pharmacogenomic (PGx) profiling “a promising and exploratory tool,” Dr. Yu reported that patients who received chemotherapy regimens predicted by the model to be more effective had a significantly longer median time to disease progression than those predicted to be resistant to the regimen.8

The ongoing study performed isolation and gene expression profiling of tumor progenitor cells in patients with unresectable pancreatic adenocarcinoma using 10 mL of peripheral blood collected prior to receipt of chemotherapy and at disease progression. PGx models were created for 12 different drug combinations, including FOLFIRINOX, gemcitabine, and docetaxel.8

“Changes in chemo-sensitivity patterns were evident at disease progression, reflecting treatment resistance,” Dr. Yu said. “Hedgehog pathway overexpression was associated with resistance to gemcitabine but clinical response to 5-FU-based treatment. Pathway analysis revealed that ErbB3, ARE/Nrf2 and insulin pathways distinguished patients with disease progression.” Among patients with stage IV cancers who experienced progression, major differences were seen in the E2F1 and NFκB pathways.8

PGx profiling of circulating tumor and invasive cells can be performed at both initial diagnosis and at disease progression, Dr. Yu noted.

Future Directions

Three other presentations during the Symposium outlined various approaches being undertaken in the detection and treatment of pancreatic cancer.

A retrospective review of 378 patients who underwent potentially curative resection for pancreatic adenocarcinoma found those with isolated lung metastases as a site of first recurrence had the longest median OS, 32 months, compared with 17 months for liver metastases (P<0.001). Time to recurrence for lung and liver metastases was 14.9 months versus 7.4 months, respectively (P<0.005),9 reported Kathryn Tzung-Kai Chen, of Fox Chase Cancer Center, Philadelphia, PA, and colleagues.