Dr Goel on the Future of an Exosome-Based Liquid Biopsy Plus the Biomarker CA19-9 to Detect Early-Stage Pancreatic Cancer

“If we can show that this blood test works as [well] as we think [it does], then we hope that in the next few years this test will probably be available in the market to [use] in high-risk individuals.”

Ajay Goel, PhD, AGAF, professor and chair, Department of Molecular Diagnostics and Experimental Therapeutics, City of Hope, discusses upcoming clinical studies examining the prognostic biomarker CA19-9 in combination with an investigational exosome-based liquid biopsy for the detection of early-stage pancreatic cancer.

Pancreatic ductal adenocarcinoma (PDAC) accounts for more than 90% of pancreatic cancers and carries a 5-year overall survival (OS) rate of approximately 12%. It is the fourth leading cause of cancer-related deaths in the US and is projected to become the second leading cause of cancer-related deaths by 2030. Five-year OS for pancreatic cancer is stage-dependent and a potential window for early detection exists, but there is a lack of robust diagnostic biomarkers in this disease space.

CA19-9 is a potential prognostic biomarker of interest in pancreatic cancer, but it is not presently reliable on its own in terms of detecting early-stage disease, Goel explains. In a prior prospective study, CA19-9 in combination with an exosome-based liquid biopsy produced a diagnostic accuracy rate of 97% in detecting stage I/II PDAC in patients from the US (n = 139).

Investigators are actively licensing their technology to biotech and pharmaceutical companies to perform independent clinical trials to validate the findings in general high-risk PDAC populations, Goel says. These groups include individuals with a family history of pancreatic cancer, high-risk mutational profiles, and chronic pancreatitis, he continues. If clinical trial data indicate that the test is effective as was shown in the prospective study, the hope is that the test will be available in the next few years, Goel concludes.