IN THE FUTURE, a stool test may be enough to detect pancreatic cancer. The hypothesis was advanced by an international group of researchers who, in patients with the most common type of pancreatic cancer (pancreatic ductal adenocarcinoma), have identified alterations in the composition of the intestinal microbiome. According to what they report on Gutthese alterations, if confirmed, could be used to develop a test for early diagnosis, through the examination of the feces.
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Pancreatic cancers are one of the most difficult cancers to treat, in large part because, by the time symptoms appear, the disease is already advanced. Confirming the diagnosis also involves invasive tests, which are not suitable for screening or monitoring. For this reason, the research works to find biomarkers on the basis of which to develop tests that can make it possible to diagnose cancer early. The new study, conducted by the Spanish National Cancer Research Center (Cnio) and the European Molecular Biology Laboratory (EMBL) in Heidelberg (in Germany), is heading precisely in this direction.
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Pancreatic ductal adenocarcinoma
Previous studies had already suggested how the microorganisms that populate our body can play a role in the origin and development of certain diseases, including tumors. So the Spanish and German scientists decided to investigate this relationship further, focusing on ductal adenocarcinoma of the pancreas, the most common pancreatic cancer and also one of the malignancies with the lowest survival rate five years after diagnosis.
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An “unprecedented” study
The researchers involved 136 people in the study (57 patients with ductal adenocarcinoma, 50 healthy controls and 27 patients with chronic pancreatitis) by analyzing the microbiome of saliva, stool and pancreatic tissue samples. While the results of the saliva analysis were not indicative, those of the stool allowed to identify a genetic signature of 27 bacteria (some species become more abundant and others almost disappear) that discriminates fairly accurately cases of pancreatic cancer from controls, regardless of the stage of the disease. The accuracy of the test was further increased by combining the analysis of the microbiome with that of blood levels of carbohydrate antigen 19-9, a protein used to monitor pancreatic cancer and the only non-invasive test approved by the US Food and Drug Administration. .
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The system was then validated on a further 76 people (44 pancreatic cancer patients and 32 controls) from a German institute. Furthermore, the scientists applied it to 5,792 samples collected in 25 different studies, which also included people with other types of cancers and health conditions, so as to ascertain that the genetic signature in the microbiome was associated with pancreatic cancer and not also with pancreatic cancer. other cancers. “This level of analysis – the researchers argue – is unprecedented in studies on pancreatic cancer metagenome”.
Towards a Stool Test for Pancreatic Cancer Diagnosis?
According to the authors, a stool test for the search for this genetic signature would have a high predictive value: within populations at risk (and perhaps in the future also a wider screening), it could allow early diagnosis of pancreatic cancer. Not only that, this discovery could also be relevant in terms of prevention and therapeutic intervention. “Our data are observational – emphasize the researchers – but there are strong indications that the changes in the fecal microbiome identified are not simply a consequence of impaired pancreatic function or its systemic effects, although indirect effects cannot be excluded”.
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In a commentary accompanying the scientific publication, however, Rachel Newsome and Christian Jobin of the University of Florida curb their enthusiasm. The research is promising, makes an important contribution to the identification of predictive markers and highlights the key role of the microbiota in cancer surveillance. However, “these results have limited clinical value due to the cross-sectional nature of the study, and therefore predictive markers will need to be tested using a prospective cohort before reaching a conclusion on their clinical impact.” The specificity of the microbial profile for pancreatic cancer with other types of cancers will also need to be further investigated.