The main categories of methods for detecting and diagnosing pancreatic cancer today are: imaging and established single biomarkers, CEA and CA 19-9. The familial group is evaluated with oncogenetics panels for risk evaluation. These technologies are not sufficient for addressing the clinical needs of efficient early detection of pancreatic cancer and need to be complemented with new approaches based on emerging and innovative technologies.
The new developments cover the genomics and immunoproteomics based technologies. These new approaches are mainly multiplex technologies where information from many biomarkers is combined by bioinformatic algorithms. These powerful biomarker signatures are the new key to achieve high accuracy for diagnosis of early stage pancreatic cancer.
Single and multipanel biomarkers in combination with the existing technologies are also being developed, such as molecular-based imaging, tumor markers and metabolites, MS and microscopy.
Genomics based technologies usually detect circulating tumor cells, circulating tumor DNA, exosomes, nucleosomes and microRNAs shed by the tumors. Immunoproteomics technologies such as IMMray™, measure the immune system response by detecting the proteins that appear in blood in extremely small amounts very early in the cancer development as illustrated in fig 1. The immune system’s response to disease takes place first, at the point when a disease develops, and the potential of early detection is therefore the highest for technologies able to measure the immune response.
Technologies dependent on cancer in situ or metastatic cancer will have their strengths in solving clinical needs, for example determining the characteristics of the tumors and predicting the most appropriate treatment. Hence the genomics and immunoproteomics technologies are mostly complementary, providing answers to different clinical needs. Imaging has its place in determining the location of the tumour but needs to be complemented with genomics and/or immunoproteomics information to give timely and correct information.
This is illustrated below in fig 1, that shows the development of cancer from the first mutation to metastatic cancer and also illustrates how the different technologies fit in in the development of cancer.
Fig. 1: Pancreatic cancer morphology and diagnosis/detection technologies