High Hopes for Pancreatic Cancer Urine Test

Cancer mortality is going down across the board as patients with a wide variety of cancers experience earlier diagnosis and longer overall survival (1). But not every type of disease shares in the good news. Pancreatic cancer still has one of the lowest survival rates of any cancer, with a median survival of six months or less – and almost no improvement over the last three decades. As with most cancers, the main obstacle to successful treatment is timely diagnosis; although five-year survival rates for patients with incidental diagnosis and resection of early-stage tumors can reach 60 percent (2), very few people fit into this category. The reason: lack of symptoms in the early stages of disease and poor diagnostic modalities – meaning most pancreatic cancer cases are diagnosed after metastasis has occurred (3).

One group of scientists from Queen Mary University of London is hoping to change this poor outlook. They have identified three biomarkers in urine that may signal the presence of pancreatic cancer before symptoms even emerge (4). Could this mean that physicians might soon be able to identify patients with early-stage disease inexpensively and noninvasively? That’s the hope. The research team base their optimism on the findings of an in-depth proteomics analysis of 18 urine samples (three male and three female, each with pancreatic ductal adenocarcinoma, chronic pancreatitis or no disease), which revealed that three specific proteins – LYVE-1 (a marker of lymphatic endothelial cells), TFF1 (a mucosal protein), and REG1A (a member of the regenerating protein family secreted by the exocrine pancreas) – were deregulated in both males and females with pancreatic cancer. Scaling up to 371 urine samples (from London, Liverpool and Madrid) added further weight to the evidence: all pancreatic cancer patients showed higher urine concentrations of the candidate biomarkers. Best of all, the elevated biomarkers were not only present in the later stages of disease, but even in patients with stage I disease. This provides hope that such a test could distinguish patients with early-stage pancreatic ductal adenocarcinoma from healthy individuals or, potentially, those with other hepatobiliary disease.

The study is a strong one – after identifying the biomarkers by mass spectrometry, the researchers validated them by ELISA and examined them in 488 urine samples from three separate healthcare centers. But the work isn’t finished yet; the biomarkers need further validation. The study’s authors point out that their control population was younger than their cancer patient population, and suggest conducting a similar study with older controls. They also suggest testing the biomarker panel on high-risk groups, collecting more long-term data, and further comparing their biomarkers to the known pancreatic tumor marker CA19-9, which when combined with the new biomarker panel, may increase accuracy. So there’s a lot still to be done before clinical testing with this panel becomes a reality – but identifying and validating the biomarkers is still a significant first step.