Circulating Nucleic Acids as Novel Biomarkers for Pancreatic Ductal Adenocarcinoma

SIMPLE SUMMARY: Pancreatic ductal adenocarcinoma (PDAC) is a particularly aggressive and deadly cancer, primarily due to failure to identify early-stage disease. PDAC is often diagnosed at a late stage due to nonspecific symptoms, and a distinct lack of reliable biomarkers for timely diagnosis. Current PDAC biomarkers are inadequate for the monitoring of a patient’s response to treatment. The aim of this review is to highlight the potential use of circulating nucleic acid-based biomarkers, along with technology facilitating their detection, in liquid biopsies. These biomarkers primarily focus on the detection of PDAC-specific genetic mutations, both freely circulating and contained within exosomes. ABSTRACT: Despite considerable advancements in the clinical management of PDAC it remains a significant cause of mortality. PDAC is often diagnosed at advanced stages due to vague symptoms associated with early-stage disease and a lack of reliable diagnostic biomarkers. Late diagnosis results in a high proportion of cases being ineligible for surgical resection, the only potentially curative therapy for PDAC. Furthermore, a lack of prognostic biomarkers impedes clinician’s ability to properly assess the efficacy of therapeutic interventions. Advances in our ability to detect circulating nucleic acids allows for the advent of novel biomarkers for PDAC. Tumor derived circulating and exosomal nucleic acids allow for the detection of PDAC-specific mutations through a non-invasive blood sample. Such biomarkers could expand upon the currently limited repertoire of tests available. This review outlines recent developments in the use of molecular techniques for the detection of these nucleic acids and their potential roles, alongside current techniques, in the diagnosis, prognosis and therapeutic governance of PDAC.