Unveilling the potential of liquid biopsy in pancreatic cancer for molecular diagnosis and treatment guidance

Pancreatic cancer is usually diagnosed at advance stages leading to a poor prognosis and high mortality rates. Furthermore, only a small fraction of patients are elegible for surgery, which is the only curative treatment available. Obtaining tissue biopsies in pancreatic cancer is challenging, often resulting in limited material for molecular tumour analysis. In addition, this procedure involves a considerable risk for patients. The emergence of liquid biopsy in pancreatic cancer has provided a minimally invasive tool for biomarker analysis, improving the diagnosis, prognosis and follow-up of the disease. Consequently, there has been a growing interest in the study of different liquid biopsy-based components, with a special focus on circulating tumor cells (CTCs) and cell-free DNA (cfDNA), but also exploring additional biomarkers such as circulating microRNAs (miRNAs), extracellular vesicles (EVs) or tumor-educated platelets (TEPs). Therefore, this review aims to offer an updated perspective on how these diverse liquid biopsy components can improve the diagnosis, prognosis and monitoring of pancreatic cancer. Additionally, it delves into clinical trials demonstrating that liquid biopsy in pancreatic cancer is becoming an increasingly tangible reality that is ready to integrate into clinical practice.