MUC5AC protein could predict pancreatic cancer prognosis: Study
Researchers sought to correlate biomarker with outcomes, disease features
Blood levels of the MUC5AC protein could help predict outcomes in people who have surgery for pancreatic ductal adenocarcinoma (PDA), the most common type of pancreatic cancer, a study shows.
In people whose treatment plan involved chemotherapy before surgery (neoadjuvant treatment), higher MUC5AC levels were generally linked to less favorable disease characteristics and a worse prognosis. For those who had surgery followed by chemotherapy (adjuvant treatment), the biomarker tended to correlate with survival.
“This study provides compelling evidence for the clinical utility of [blood MUC5AC] as a prognostic biomarker among patients with [surgically removed] PDA,” the researchers wrote. “Future large-scale studies are needed to validate these findings and establish standard thresholds for … integration into clinical practice.” The study, “Prognostic significance of serum MUC5AC in resected pancreatic ductal adenocarcinoma: initial insights,” was published in Frontiers in Oncology.
The cornerstone of PDA treatment is surgery to remove as much cancer as possible. This has been historically followed by adjuvant chemotherapy to keep it from coming back.
A newer approach is neoadjuvant therapy, where chemotherapy is given to help shrink the cancer before surgery. This approach leads to good disease control and a high treatment response, but that it doesn’t necessarily improve survival, data suggest.
The study’s authors said establishing reliable biomarkers is needed to identify which patients may benefit from neoadjuvant therapy and to monitor responses to treatment, allowing for better therapeutic decision making.
MUC5AC levels and PFS in pancreatic cancer
MUC5AC normally helps protect organs against infection, inflammation, and stress, but it’s also believed to contribute to the process by which pancreatic cells become cancerous.
Various studies have shown that blood levels of MUC5AC are elevated in early-stage PDA and that it could thus serve as a good diagnostic biomarker, either alone or with CA19-9, another established pancreatic cancer biomarker. But whether it could also have prognostic value for predicting outcomes after treatment hasn’t been fully established, leading the scientists to measure MUC5AC in blood samples from adults with PDA who had surgery at a cancer center in Ohio to correlate the biomarker with clinical outcomes and disease features.
The researchers analyzed 23 people who received neoadjuvant therapy, with blood samples collected during treatment and before surgery. The analyses indicated MUC5AC blood levels before surgery were correlated with key disease-related features. For example, higher MUC5AC levels were seen in people who had incomplete tumor resection or residual disease after treatment, “highlighting its potential as a biomarker for aggressive pathological features,” the researchers wrote.
Among the 21 people who ultimately received a complete or nearly complete tumor removal surgery, the median progression-free survival (PFS), or time alive without cancer progression, was 7.6 months, and the median overall survival was 15 months.
Higher MUC5AC levels were predictive of a significantly shorter PFS and tended to be associated with shorter survival, but receiving additional chemotherapy after surgery was associated with significantly better PFS and overall survival. These findings were largely consistent in the subgroup of people who received Folfirinox, a chemotherapy regimen, as their neoadjuvant treatment.
The researchers also evaluated blood samples from 17 people who received a more traditional therapy approach, with samples collected after surgery and before the first dose of adjuvant chemotherapy. For those patients, the median PFS was 15 months and overall survival was 26 months, or a little over two years. Higher blood levels of MUC5AC tended to be associated with worse PFS and overall survival, but not other disease-related features.
The scientists also reviewed data from 11 people who also had samples collected before any surgery or treatment and, while some data indicated MUC5AC levels correlated with clinical features, they concluded that a larger patient group was needed to better assess its effect on the outcomes.
As neoadjuvant therapy is increasingly adopted, MUC5AC could serve as a “valuable prognostic biomarker,” showing better predictive abilities than CA19-9 in most analyses, they said. Combining MUC5AC with other biomarkers like CA19-9 could also be of benefit.
“By offering an additional biomarker for disease monitoring, [blood MUC5AC] could help refine real-time treatment decisions, potentially guiding the intensification or modification of therapeutic strategies based on response,” they wrote, noting they believe MUC5AC, beyond its use as a biomarker, might also serve as a therapeutic target as it contributes to pancreatic cancer cell growth.
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