Preparing for the Inevitable: Early Comprehensive Genomic Profiling for Patients With Localized Pancreatic Ductal Adenocarcinoma.

PURPOSE: Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal disease, even for patients diagnosed at a radiographically localized stage. Despite disease recurrence in most patients who undergo curative-intent therapy, national guidelines do not currently recommend comprehensive genomic profiling (CGP) until progression occurs following treatment. As the number of approved and investigational therapies expands for PDAC, ensuring access to early CGP data is critical for implementing molecularly informed treatment strategies. METHODS: We performed a single-institution, retrospective analysis of CGP utilization and treatment patterns in patients with localized PDAC who underwent curative-intent resection in the contemporary period during which CGP was recommended for all patients with advanced/recurrent disease (2019-2024). RESULTS: Among 380 patients, 215 (56.5%) developed recurrence at a median follow-up time of 19.4 months. Of patients with documented recurrence, we found that 43.2% never underwent CGP, and among those who did have CGP performed, only 61.5% had access to these data before initiating postrecurrence systemic therapy. In terms of barriers to CGP, we found that earlier testing (within 2 months of surgery) improved access to CGP before initiation of postrecurrence treatment, whereas deferred testing was associated with a greater chance of molecularly uninformed treatment. We also found that patients whose surgery and systemic therapy were fragmented across centers were less likely to receive CGP (65.6% v 28.8%, P < .0001). CGP data were successfully obtained using several modalities, and receipt of CGP was associated with higher rates of molecularly tailored treatment (10.6% v 1.1%, P = .004), including 10 patients (8.2%) who received treatment as part of a clinical trial. CONCLUSION: A uniform strategy for ensuring patients with resected PDAC receive CGP may improve access to clinical trials and molecularly tailored treatment.

Duke Scholars

Author Daniel Philip Nussbaum Surgical Oncology

Author John Strickler Medicine, Medical Oncology