Protein-Metabolite Panel for Detection of Early-Stage Pancreatic Cancer


Key Points

  • The five-metabolite panel had an AUC value of 0.892 for distinguishing early-stage PDAC.
  • The addition of a previously validated protein panel increased the AUC value to 0.924.

In a study reported in the Journal of the National Cancer Institute, Fahrmann et al developed and validated a plasma-derived metabolite panel that distinguished early-stage pancreatic ductal adenocarcinoma (PDAC) with high accuracy. Accuracy was further improved with the addition of a previously validated protein panel.

Study Details

In the study, a metabolomics platform was used in plasma samples from 20 PDAC cases and 80 controls to identify candidate metabolite markers. Candidate markers were investigated using a second independent cohort including samples from 9 patients with PDAC (5 early- and 4 late-stage) and benign pancreatic cysts from 51 controls. A resulting metabolite panel underwent blinded validation in an independent cohort consisting of samples from 39 patients with resectable PDAC and 82 matched healthy controls. The effect of combining the metabolite panel with a previously validated protein panel for early-stage PDAC was also investigated.

Panel Performance

Five metabolites—consisting of acetylspermidine, diacetylspermine, an indole-derivative, and two lysophosphatidylcholines—were selected for use in the metabolite panel. Each of the 5 markers was associated with significant differences (all P < .001) in the 39 PDAC cases vs 82 healthy controls, with individual receiver operating characteristic area under the curve (AUC) values ranging from 0.726 to 0.842. A fixed logistic regression model for the five-metabolite panel yielded an AUC of 0.892, with sensitivity of 66.7% and specificity of 95.0%.  The addition of the previously validated protein marker panel for early-stage PDAC consisting of CA 19–9, LRG1, and TIMP1 to the five-metabolite panel improved performance in the cohort, yielding an AUC value of 0.924 vs an AUC value of 0.863 with the protein panel alone (P = .02).

The investigators concluded, “A metabolite panel in combination with CA19-9, TIMP1, and LRG1 exhibited substantially improved performance in the detection of early-stage PDAC compared with a protein panel alone.”

The study was supported by MD Anderson Cancer Center’s Moonshot Program, National Cancer Institute Early Detection Network, Pancreatic Cancer Action Network, and others.

C. Max Schmidt, MD, PhD, MBA, of the Indiana University School of Medicine, and Samir M. Hanash, MD, PhD, of The University of Texas MD Anderson Cancer Center, are the corresponding authors for the Journal of the National Cancer Institute article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.