Pancreatic Cancer Evolution Upon Treatment

Study Overview
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Brief Summary
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This project aims at evaluating the different subtypes of pancreatic cancer on EUS-tissue acquisition of pancreatic cancer patients, and their possible modifications throughout time. The study takes advantage of a systematic evaluation of pancreatic cancers through diagnostic EUS-guided fine needle biopsy (FNB) sampling of the mass performed during a restaging EUS. FNB samples represent a valuable source of cancer cells, both for the histological diagnosis and as the source of tumor macromolecules, including DNA and RNA. Study design This is a prospective study enrolling patients with non-metastatic pancreatic cancer who already underwent diagnostic EUS with tissue acquisition and rapid on-site evaluation (ROSE) by cytologist positive for pancreatic cancer, with a first sample acquired for diagnostic purposes and a second sample stored for RNA extraction acquired with the already approved protocol BIOGASTRO. As recommended by guidelines, patients will follow the standard pathway of treatment, being sent to chemotherapy and will then undergo restaging of the lesion and re-evaluation of vascular invasion by CT and EUS. During this second session of EUS a new specimen of the tumor will be sampled for diagnostic purposes, with a second pass undergoing for RNA extraction.

Official Title
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Pancreatic Cancer Evolution Upon Treatment

Conditions
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Pancreatic Cancer

Intervention / Treatment
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* Procedure: Fine Needle Biopsy or Aspiration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years Willing to sign informed consent Patient with CT scan or MRI or EUS defining the lesion as locally advanced Patient who already underwent EUS-TA for solid lesion of the pancreas positive for pancreatic ductal adenocarcinoma (PDAC) Patient undergoing neoadjuvant chemotherapy Patient primarily followed at San Raffaele Hospital Exclusion Criteria: Patients not willing to sign informed consent Pregnancy and breastfeeding Cytology positive for malignancies other than PDAC Patient undergoing progression at re-staging CT scan

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Repetition of EUS-FNA or FNB for RNA extraction<br> | Procedure: Fine Needle Biopsy or Aspiration<br>* A new sampling of the tumor will be performed after 4-6 months of neoadjuvant chemotherapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of molecular subtype modification | As all patients are having baseline (at diagnosis) molecular subtype (classical or basal-like) evaluation through RNAsequencing, patients enrolled in the PACEUT trial will undergo a new evaluation of the molecular subtype (based on RNAsequencing performed on the EUS-FNA or FNB) and evaluation of gene expression | 6 months |