1st-order laboratory parameters-obligatory laboratory tests.
- Small blood count
- Differential blood count
- Inflammatory parameter – CRP (C-reactive protein)
- Pancreatic parameters – amylase, lipase, trypsin and elastase [increase in serum lipase value = early alarm].
Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification (and treatment planning).
- Renal parameters – creatinine, urea.
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), gamma-glutamyl transferase (γ-GT, gamma-GT; GGT); alkaline phosphatase [elevated cholestasis parameters].
- Bilirubin
- Tumor markers such as
- CA 19-9 (initial marker) [not suitable for screening; only for follow-up in advanced stages].
- CA 125 (detectable in 80% of cases).
- CA 15-3 (detectable in 40-60% of cases).
- CA 72-4 (detectable in 15-35% of cases).
- CA 50
- CEA
- Insulin, glucagon, gastrin, pancreatic polypeptide (PP), vasoactive intestinal polypeptide (VIP) – if tumor is suspected to originate from endocrine tissue.
- Thrombospondin-2 (THBS2) – screening for pancreatic ductal adenocarcinoma (sensitivity (percentage of diseased patients in whom the disease is detected by use of the test, i.e., a positive test result occurs) 52% and specificity (probability that actually healthy people who do not have the disease in question are also detected as healthy in the test) 99%; in combination with Ca 19-9: sensitivity 87% and specificity 98%]
- BRCA1/2 germline mutation (affects about 5-7% of patients with pancreatic cancer) – determination due togene-adapted the treatment, ie, here: Inhibition of poly(ADP-ribose) polymerase (PARP) In a large phase III study, PANAP inhibition was shown to delay progression in patients with metastatic pancreatic cancer and the presence of a BRCA mutation. The primary endpoint of “progression-free survival” was a median of 7.4 months in the olaparib arm and 3.8 months with placebo.
- Detection of circulating tumor DNA containing mutant KRAS (mutKRAS ctDNA) In one study, mutKRAS ctDNA was detectable in 67% of patients and indicated status with respect to tissue KRAS mutation with high sensitivity (75%) and specificity (100%). Detection of mutKRAS ctDNA before initiation of first-line chemotherapy was significantly correlated with poorer overall survival.CONCLUSION: Determination of mutKRAS ctDNA in patients with advanced pancreatic cancer before and repeatedly during chemotherapy appears to be a suitable parameter to determine early response and also serves as a therapy monitoring tool.
