Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium.

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Abstract

The International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals).

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Most cited references 89

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ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors

M. Falconi, B Eriksson, G. Kaltsas … (2016)

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European evidence-based guidelines on pancreatic cystic neoplasms

(2018)

Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring 5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.

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Elevated circulating branched chain amino acids are an early event in pancreatic adenocarcinoma development

Jared Mayers, Chen-Chen Wu, Clary Clish … (2014)

Most patients with pancreatic ductal adenocarcinoma (PDAC) are diagnosed with advanced disease and survive less than 12 months 1 . PDAC has been linked with obesity and glucose intolerance 2-4 , but whether changes in circulating metabolites are associated with early cancer progression is unknown. To better understand metabolic derangements associated with early disease, we profiled metabolites in prediagnostic plasma from pancreatic cancer cases and matched controls from four prospective cohort studies. We find that elevated plasma levels of branched chain amino acids (BCAAs) are associated with a greater than 2–fold increased risk of future pancreatic cancer diagnosis. This elevated risk was independent of known predisposing factors, with the strongest association observed among subjects with samples collected 2 to 5 years prior to diagnosis when occult disease is likely present. We show that plasma BCAAs are also elevated in mice with early stage pancreatic cancers driven by mutant Kras expression, and that breakdown of tissue protein accounts for the increase in plasma BCAAs that accompanies early stage disease. Together, these findings suggest that increased whole–body protein breakdown is an early event in development of PDAC.

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Author and article information

Journal

Journal ID (iso-abbrev): Gut

Title: Gut

Publisher: BMJ

ISSN (Electronic): 1468-3288

ISSN (Print): 0017-5749

Publication date (Electronic): January 2020

Volume: 69

Issue: 1

Affiliations

[1 ] Pathology, Medicine Oncology, Johns Hopkins University, Baltimore, Maryland, USA mgoggins@jhmi.edu.

[2 ] Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.

[3 ] Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

[4 ] GI Cancer Genetics and Prevention Program, Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA.

[5 ] Department of Surgery, Division of Surgical Oncology, Denver, Colorado, USA.

[6 ] Division of Visceral, Thoracic and Vascular Surgery, University of Marburg, Marburg, Germany.

[7 ] Department of Surgey, University of Verona, Verona, Italy.

[8 ] Medical Oncology, Hospital Ramón y Cajal, Madrid, Spain.

[9 ] Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.

[10 ] The Russell H Morgan Department of Radiology and Radiological Science, Baltimore, Maryland, USA.

[11 ] Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands.

[12 ] Gastroenterology, Endocrinology, Metabolism and Infectiology, University of Marburg, Marburg, Germany.

[13 ] Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.

[14 ] Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.

[15 ] Division of Digestive and Liver Diseases, Columbia University Medical Center, New York City, New York, USA.

[16 ] Division of Digestive and Liver Diseases, Columbia University, New York City, New York, USA.

[17 ] Oncology, Johns Hopkins University, Baltimore, Maryland, USA.

[18 ] Medicine, Johns Hopkins University, Baltimore, Maryland, USA.

[19 ] Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

[20 ] New York University Medical Center, New York City, New York, USA.

[21 ] University of Michigan, Ann Arbor, Michigan, USA.

[22 ] Gastroenterology and Hepatology, Leiden University, Leiden, The Netherlands.

Article

Publisher Item ID: gutjnl-2019-319352

DOI: 10.1136/gutjnl-2019-319352

PubMed ID: 31672839

SO-VID: c30d548a-d2eb-4684-be21-3235fc7f0fc4

History

Keywords: genetic predisposition,early detection,pancreatic ductal adenocarcinoma,familial pancreatic cancer,surveillance

Data availability:

Keywords: genetic predisposition, early detection, pancreatic ductal adenocarcinoma, familial pancreatic cancer, surveillance

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Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium.

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Cancer Metabolism

Most cited references 89

ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors

European evidence-based guidelines on pancreatic cystic neoplasms

Elevated circulating branched chain amino acids are an early event in pancreatic adenocarcinoma development

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