The evolutionary origins of recurrent pancreatic cancer

Hitomi Sakamoto, Marc A. Attiyeh, Jeffrey M. Gerold, Alvin P. Makohon-Moore, Akimasa Hayashi, Jungeui Hong, Rajya Kappagantula, Lance Zhang, Jerry P. Melchor, Johannes G. Reiter, Alexander Heyde, Craig M. Bielski, Alexander V. Penson, Mithat Gönen, Debyani Chakravarty, Eileen M. O’reilly, Laura D. Wood, Ralph H. Hruban, Martin A. Nowak, Nicholas D. SocciBarry S. Taylor, Christine A. Iacobuzio-Donahue

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Surgery is the only curative option for stage I/II pancreatic cancer; nonetheless, most patients will experience a recurrence after surgery and die of their disease. To identify novel opportunities for management of recurrent pancreatic cancer, we performed whole-exome or targeted sequencing of 10 resected primary cancers and matched intrapancreatic recur-rences or distant metastases. We identified that recurrent disease after adjuvant or first-line platinum therapy corresponds to an increased mutational burden. Recurrent disease is enriched for genetic alterations predicted to activate MAPK/ERK and PI3K–AKT signaling and develops from a monophyl-etic or polyphyletic origin. Treatment-induced genetic bottlenecks lead to a modified genetic landscape and subclonal heterogeneity for driver gene alterations in part due to intermetastatic seeding. In 1 patient what was believed to be recurrent disease was an independent (second) primary tumor. These findings suggest routine post-treatment sampling may have value in the management of recurrent pancreatic cancer. SIGnIFICAnCE: The biological features or clinical vulnerabilities of recurrent pancreatic cancer after pancreaticoduodenectomy are unknown. Using whole-exome sequencing we find that recurrent disease has a distinct genomic landscape, intermetastatic genetic heterogeneity, diverse clonal origins, and higher mutational burden than found for treatment-naïve disease. See related commentary by Bednar and Pasca di Magliano, p. 762.

Original languageEnglish (US)
Pages (from-to)792-805
Number of pages14
JournalCancer discovery
Issue number6
StatePublished - Jun 2020

ASJC Scopus subject areas

  • Oncology


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