Mutations in key driver genes of pancreatic cancer: molecularly targeted therapies and other clinical implications

• Published in: Acta pharmacologica Sinica Vol. 42; no. 11; pp. 1725 - 1741
• Main Authors: Hu, Hai-feng, Ye, Zeng, Qin, Yi, Xu, Xiao-wu, Yu, Xian-jun, Zhuo, Qi-feng, Ji, Shun-rong
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.11.2021; Nature Publishing Group
• Subjects: Adenocarcinoma; Biomarkers, Tumor - genetics; Biomedical and Life Sciences; Biomedicine; BRCA2 protein; Cancer; Carcinoma, Pancreatic Ductal - genetics; Carcinoma, Pancreatic Ductal - therapy; Chemotherapy; Clinical trials; Clinical Trials as Topic - methods; Diagnosis; High-Throughput Nucleotide Sequencing - methods; High-Throughput Nucleotide Sequencing - trends; Humans; Immunology; Internal Medicine; Medical Microbiology; Molecular Targeted Therapy - methods; Molecular Targeted Therapy - trends; Mortality; Mutation; Mutation - genetics; Next-generation sequencing; Oncogenes - genetics; p53 Protein; Pancreatic cancer; Pancreatic Neoplasms - genetics; Pancreatic Neoplasms - therapy; Pharmacology/Toxicology; Proto-Oncogene Proteins p21(ras) - genetics; Review; Review Article; Smad4 protein; Smad4 Protein - genetics; Survival; Tumor Suppressor Protein p53 - genetics; Tumors; Vaccine; pancreatic cancer; SMAD4; KRAS; clinical implication; CDKN2A; TP53
• ISSN: 1671-4083; 1745-7254; 1745-7254
• DOI: 10.1038/s41401-020-00584-2

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, with a minimal difference between its incidence rate and mortality rate. Advances in oncology over the past several decades have dramatically improved the overall survival of patients with multiple cancers due to the implementation of new techniques in early diagnosis, therapeutic drugs, and personalized therapy. However, pancreatic cancers remain recalcitrant, with a 5-year relative survival rate of <9%. The lack of measures for early diagnosis, strong resistance to chemotherapy, ineffective adjuvant chemotherapy and the unavailability of molecularly targeted therapy are responsible for the high mortality rate of this notorious disease. Genetically, PDAC progresses as a complex result of the activation of oncogenes and inactivation of tumor suppressors. Although next-generation sequencing has identified numerous new genetic alterations, their clinical implications remain unknown. Classically, oncogenic mutations in genes such as KRAS and loss-of-function mutations in tumor suppressors, such as TP53 , CDNK2A , DPC4 / SMAD4, and BRCA2 , are frequently observed in PDAC. Currently, research on these key driver genes is still the main focus. Therefore, studies assessing the functions of these genes and their potential clinical implications are of paramount importance. In this review, we summarize the biological function of key driver genes and pharmaceutical targets in PDAC. In addition, we conclude the results of molecularly targeted therapies in clinical trials and discuss how to utilize these genetic alterations in further clinical practice.