Subtypes of pancreatic ductal adenocarcinoma and their differing responses to therapy

Nat Med. 2011 Apr;17(4):500-3. doi: 10.1038/nm.2344. Epub 2011 Apr 3.

Abstract

Pancreatic ductal adenocarcinoma (PDA) is a lethal disease. Overall survival is typically 6 months from diagnosis. Numerous phase 3 trials of agents effective in other malignancies have failed to benefit unselected PDA populations, although patients do occasionally respond. Studies in other solid tumors have shown that heterogeneity in response is determined, in part, by molecular differences between tumors. Furthermore, treatment outcomes are improved by targeting drugs to tumor subtypes in which they are selectively effective, with breast and lung cancers providing recent examples. Identification of PDA molecular subtypes has been frustrated by a paucity of tumor specimens available for study. We have overcome this problem by combined analysis of transcriptional profiles of primary PDA samples from several studies, along with human and mouse PDA cell lines. We define three PDA subtypes: classical, quasimesenchymal and exocrine-like, and we present evidence for clinical outcome and therapeutic response differences between them. We further define gene signatures for these subtypes that may have utility in stratifying patients for treatment and present preclinical model systems that may be used to identify new subtype specific therapies.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Animals
  • Antineoplastic Agents / pharmacology
  • Carcinoma, Pancreatic Ductal / classification*
  • Carcinoma, Pancreatic Ductal / drug therapy
  • Carcinoma, Pancreatic Ductal / genetics*
  • Cell Line, Tumor
  • Deoxycytidine / analogs & derivatives
  • Deoxycytidine / pharmacology
  • Erlotinib Hydrochloride
  • Female
  • GATA6 Transcription Factor / genetics
  • Gemcitabine
  • Gene Expression Profiling
  • Humans
  • Male
  • Mice
  • Pancreatic Neoplasms / classification*
  • Pancreatic Neoplasms / drug therapy
  • Pancreatic Neoplasms / genetics*
  • Pharmacogenetics
  • Proto-Oncogene Proteins / genetics
  • Proto-Oncogene Proteins p21(ras)
  • Quinazolines / pharmacology
  • ras Proteins / genetics

Substances

  • Antineoplastic Agents
  • GATA6 Transcription Factor
  • GATA6 protein, human
  • KRAS protein, human
  • Proto-Oncogene Proteins
  • Quinazolines
  • Deoxycytidine
  • Erlotinib Hydrochloride
  • Proto-Oncogene Proteins p21(ras)
  • ras Proteins
  • Gemcitabine