Review
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2024; 16(7): 2902-2914
Published online Jul 15, 2024. doi: 10.4251/wjgo.v16.i7.2902
Role of molecular biology in the management of pancreatic cancer
Alice Boileve, Cristina Smolenschi, Aurélien Lambert, Valérie Boige, Anthony Tarabay, Marine Valery, Alina Fuerea, Thomas Pudlarz, Thierry Conroy, Antoine Hollebecque, Michel Ducreux
Alice Boileve, Cristina Smolenschi, Valérie Boige, Anthony Tarabay, Marine Valery, Alina Fuerea, Thomas Pudlarz, Antoine Hollebecque, Michel Ducreux, Department of Medical, Gustave Roussy, Villejuif 94800, France
Aurélien Lambert, Thierry Conroy, Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy 54519, France
Author contributions: Boilève A and Ducreux M wrote this manuscript and created figures; Smolenschi C, Lambert A, Boige V, Tarabay A, Valery M, Fuerea A, Pudlarz T, Conroy T, and Hollebecque A reviewed and validated the final version of the manuscript. All other authors reviewed and validated the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alice Boileve, MD, Assistant Professor, Department of Medical, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif 94800, France. alice.boileve@gustaveroussy.fr
Received: January 18, 2024
Revised: April 4, 2024
Accepted: May 21, 2024
Published online: July 15, 2024
Processing time: 176 Days and 6.6 Hours
Abstract

Pancreatic ductal adenocarcinoma (PDAC) presents significant challenges in patient management due to a dismal prognosis, increasing incidence, and limited treatment options. In this regard, precision medicine, which personalizes treatments based on tumour molecular characteristics, has gained great interest. However, its widespread implementation is not fully endorsed in current recommendations. This review explores key molecular alterations in PDAC, while emphasizing differences between KRAS-mutated and KRAS-wild-type tumours. It assesses the practical application of precision medicine in clinical settings and outlines potential future directions with respect to PDAC. Actionable molecular targets are examined with the aim of enhancing our understanding of PDAC molecular biology. Insights from this analysis may contribute to a more refined and personalized approach to pancreatic cancer treatment, ultimately improving patient outcomes.

Keywords: Pancreatic cancer; Precision medicine; KRAS; Molecular profile; Targeted therapies; Liquid biopsy

Core Tip: Management of patients with pancreatic cancer (PDAC) is a real challenge due to a poor prognosis, a rising incidence and few therapeutic options. Precision medicine is an approach that seeks to personalize treatments to the specific molecular characteristics of individual tumors. Despite a growing interest in applying molecular precision medicine for PDAC management, large scale precision medicine is not endorsed so far by the last recommendations. We review the main actionable molecular alterations found in PDAC, highlighting the differences between KRAS-mutated and KRAS-wild-type tumors, as well as precision medicine in clinical practice and future directions for precision medicine in PDAC.