Dr Strickler on the Role of Biomarker Testing in Pancreatic Cancer

Biomarker testing is now critical for the management of all advanced solid tumors, more or less. It is now one of the first things we do whenever a patient is diagnosed with metastatic cancer, whether it be lung cancer, colon cancer, or pancreas cancer. The first thing we want to [do] is understand the biomarkers.”

John H. Strickler, MD, professor of medicine, Division of Medical Oncology, co-leader, Precision Cancer Medicine and Investigational Therapeutics Program, Duke Cancer Institute, discusses the role of biomarker testing in the management of advanced solid tumors, including metastatic pancreatic cancer. He shared these insights during Pancreatic Cancer Awareness Month, which occurs in November each year

Biomarker testing has become a cornerstone of the management of pancreatic cancer and other solid tumors, Strickler begins, noting that molecular testing should be among the first steps taken upon diagnosis. The goal is to identify actionable genetic alterations that can help guide treatment decisions, and these testing methods include tissue biopsy, liquid biopsy for circulating tumor DNA testing, and single-gene assays.

However, single-gene testing is less common due to inefficiency, especially for tumors associated with multiple actionable targets, Strickler adds. Instead, next-generation sequencing (NGS) or comprehensive genomic profiling (CGP) is the preferred approach, enabling simultaneous analysis of numerous genetic alterations in a single assay. This testing is intended to identify both somatic mutations found in tumors and germline mutations found in patients.

In pancreatic cancer, where RAS mutations occur in approximately 90% of patients, biomarker testing plays a pivotal role in identifying patients who may be eligible for emerging targeted therapies being investigated in clinical trials, Strickler explains. The integration of CGP and NGS into routine clinical practice has streamlined the process of identifying actionable mutations, enhancing the precision of therapeutic strategies. These advancements also highlight the importance of tumor genomic profiling in expanding treatment options and tailoring therapy to individual patients, Stricker concludes.