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CC BY 4.0 · Endosc Int Open 2026; 14: a27331068
DOI: 10.1055/a-2733-1068
Original article

Endoscopic ultrasound molecular evaluation of pancreatic cancer trial to profile molecular landscape of inoperable pancreatic ductal adenocarcinoma

Authors

  • Owen McKay 

    1   Gastroenterology and Hepatology, Monash Health, Melbourne, Australia (Ringgold ID: RIN2538)
    2   Upper Gastrointestinal Surgery, Monash Health, Clayton, Australia (Ringgold ID: RIN2538)

  • Joanne Lundy

    3   Medical Oncology, Peninsula Health, Frankston, Australia (Ringgold ID: RIN5644)
    2   Upper Gastrointestinal Surgery, Monash Health, Clayton, Australia (Ringgold ID: RIN2538)
    4   Cancer and Immune Signalling, Hudson Institute of Medical Research, Clayton, Australia (Ringgold ID: RIN518514)
    5   Faculty of Medicine, Nursing and Health Sciences, Department of Surgery, Monash University, Melbourne, Australia (Ringgold ID: RIN2541)

  • Sally Bell

    1   Gastroenterology and Hepatology, Monash Health, Melbourne, Australia (Ringgold ID: RIN2538)
    5   Faculty of Medicine, Nursing and Health Sciences, Department of Surgery, Monash University, Melbourne, Australia (Ringgold ID: RIN2541)

  • Phil Ha

    6   Gastroenterology & Hepatology, Peninsula Health, Frankston, Australia (Ringgold ID: RIN5644)
    1   Gastroenterology and Hepatology, Monash Health, Melbourne, Australia (Ringgold ID: RIN2538)

  • Hugh Gao

    5   Faculty of Medicine, Nursing and Health Sciences, Department of Surgery, Monash University, Melbourne, Australia (Ringgold ID: RIN2541)

  • Brendan Jenkins

    7   South Australian ImmunoGENomics Cancer Institute (SAiGENCI), Adelaide University, Adelaide, Australia (Ringgold ID: RIN695511)

  • Chamkaushalya Bulathsinghalage

    2   Upper Gastrointestinal Surgery, Monash Health, Clayton, Australia (Ringgold ID: RIN2538)

  • Michael Swan

    8   Gastroenterology & Hepatology, Monash Health, Clayton, Australia (Ringgold ID: RIN2538)
    5   Faculty of Medicine, Nursing and Health Sciences, Department of Surgery, Monash University, Melbourne, Australia (Ringgold ID: RIN2541)

  • Simon Hew

    8   Gastroenterology & Hepatology, Monash Health, Clayton, Australia (Ringgold ID: RIN2538)
    5   Faculty of Medicine, Nursing and Health Sciences, Department of Surgery, Monash University, Melbourne, Australia (Ringgold ID: RIN2541)

  • Belinda Lee

    9   Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia (Ringgold ID: RIN3085)
    10   Medical Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia (Ringgold ID: RIN5388)

  • Pranav Dorwal

    11   Genomics & Anatomical Pathology, Monash Health, Clayton, Australia (Ringgold ID: RIN2538)

  • Manoop S Bhutani

    12   Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, United States (Ringgold ID: RIN4002)

  • Vivek Rathi

    13   Genomics & Anatomical Pathology and Lifestrands Genomics Australia, Monash Health, Clayton, Australia (Ringgold ID: RIN2538)

  • Sean Grimmond

    14   Collaborative Centre for Genomic Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (Ringgold ID: RIN3085)

  • Andrew Perry

    15   Monash Genomics & Bioinformatics Platform, Monash University, Melbourne, Australia (Ringgold ID: RIN2541)

  • Trevor Wilson

    16   Hudson Genomics Facility, Hudson Institute of Medical Research, Clayton, Australia (Ringgold ID: RIN518514)

  • Andrew Strickland

    17   Medical Oncology, Monash Health, Clayton, Australia (Ringgold ID: RIN2538)

  • John Zalcberg

    18   Medical Oncology, Alfred Health, Melbourne, Australia (Ringgold ID: RIN5392)
    19   Nursing and Health Sciences, Public Health, Faculty of Medicine, Monash University, Melbourne, Australia (Ringgold ID: RIN22457)

  • Daniel Croagh

    2   Upper Gastrointestinal Surgery, Monash Health, Clayton, Australia (Ringgold ID: RIN2538)
    4   Cancer and Immune Signalling, Hudson Institute of Medical Research, Clayton, Australia (Ringgold ID: RIN518514)
    5   Faculty of Medicine, Nursing and Health Sciences, Department of Surgery, Monash University, Melbourne, Australia (Ringgold ID: RIN2541)

Clinical Trial:

Registration number (trial ID): ACTRN12620000762954, Trial registry: Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/), Type of Study: Prospective, multi-centre


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Abstract

Background and study aims

Pancreatic ductal adenocarcinoma (PDAC) is a poor prognostic malignancy. Comprehensive genomic profiling (CGP) has improved outcomes in many cancers, but widespread uptake in PDAC remains elusive. This study investigated the feasibility of using endoscopic ultrasound with fine-needle biopsy (EUS-FNB) for CGP in advanced PDAC.

Patients and methods (experimental design)

A multicenter prospective cohort study was conducted to assess the feasibility of using DNA and RNA extracted from fresh frozen or archival formalin-fixed paraffin-embedded (FFPE) EUS-FNB for CGP on advanced PDAC using the TSO-500 gene panel testing. Results of the CGP were reviewed at a molecular tumor board (MTB) and subsequent treatment recommendations were forwarded to the referring clinicians.

Results

CGP was successful in 129 of 143 patients (90%) enrolled between May 2020 to September 2023. Fresh frozen EUS-FNB provided suitable genetic material for CGP in 123 of 133 patients (92%). Conversely, CGP was successful on FFPE biopsy blocks from only six of 16 patients (38%). Fifty-two of 143 patients (36%) had a potentially targetable mutation detected, and eight of these patients (6%) were treated with targeted therapy based on their EUS-FNB-derived molecular profile. Patients who received personalized therapy had a significant (P < 0.0001) increase in survival versus standard or no therapy at 12 and 36 months. Median patient survival on standard therapy was 9.47 months versus > 18 months for personalized therapy.

Conclusions

This real-world study confirms the feasibility and utility of CGP using EUS-FNB in advanced PDAC. It illustrates the importance of timely access to personalized therapy informed by CGP, which can impact the treatment pathway and improve survival outcomes.

Keywords

Endoscopic ultrasonography - Pancreas - Tissue diagnosis - Fine-needle aspiration/biopsy

Supplementary Material



Publication History

Received: 02 May 2025

Accepted after revision: 24 October 2025

Accepted Manuscript online:
27 October 2025

Article published online:
13 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Owen McKay, Joanne Lundy, Sally Bell, Phil Ha, Hugh Gao, Brendan Jenkins, Chamkaushalya Bulathsinghalage, Michael Swan, Simon Hew, Belinda Lee, Pranav Dorwal, Manoop S Bhutani, Vivek Rathi, Sean Grimmond, Andrew Perry, Trevor Wilson, Andrew Strickland, John Zalcberg, Daniel Croagh. Endoscopic ultrasound molecular evaluation of pancreatic cancer trial to profile molecular landscape of inoperable pancreatic ductal adenocarcinoma. Endosc Int Open 2026; 14: a27331068.
DOI: 10.1055/a-2733-1068
 

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