When time is short and standard lines are few, a functional profile of circulating tumour cells can help the team choose the next move faster.
Hong Kong context Pancreatic cancer is less common than the top five in Hong Kong but punches far above its incidence in mortality. In recent Registry tables it sits in the lower end of the top ten for deaths, and most patients are still diagnosed at a stage where surgery is not possible. |
Why this cancer is hard to manage with a single protocol
The standard systemic backbones are still FOLFIRINOX (or modified FOLFIRINOX) and gemcitabine plus nab-paclitaxel. After that, options thin out quickly. BRCA / HRD and rare fusions (NTRK, NRG1) matter when they are present. Most patients do not have them.
CA19-9 is helpful when it is secreted and tracks disease. It fails in Lewis-antigen-negative patients and can rise with biliary obstruction. Scans lag behind biology in a cancer that can progress in weeks.
RGCC-linked investigators have published preliminary work on using circulating tumour cells to adjust second-line therapy in advanced pancreatic cancer. That is exactly the use-case: not a screening slogan, but a faster, cell-level way to pick the next line when the first has failed.
What circulating tumor cells add
Pancreatic CTCs can be isolated from blood even when the primary is small. Oncotrace provides count, phenotype and stemness. Onconomics Plus then tests those cells against cytotoxics, targeted agents and natural substances.
Because many patients will only get one good shot at a well-chosen regimen, doing the comprehensive panel early — at diagnosis of advanced disease, not after two failed lines — is the more rational sequence.
The RGCC pathway for this cancer
A typical sequence is screening or baseline first, then a comprehensive profile when treatment choices matter, then serial follow-up. The exact panel is chosen by the accredited practitioner.
Clinical question | RGCC test to consider |
High-risk adult (strong family history, inherited syndrome), no diagnosis | Onco-D-clare as a conversation tool only; it does not replace endoscopic ultrasound or MRI in high-risk clinics |
Confirmed pancreatic adenocarcinoma; baseline and monitoring | Oncotrace or Oncocount |
Choosing first or second systemic line | Onconomics Plus — preferably before the first cycle of the next line |
Need mutational / fusion / immunotherapy context | CAMBISeq plus any tissue NGS already done |
Spread-risk proteins | Metastat |
What the report can change in practice
The useful output is a ranked list of agents that induced apoptosis in that patient’s CTCs, plus resistance-marker context. The oncologist still chooses among approved regimens. The report is there to avoid spending six weeks on a backbone those cells already ignore.
Supportive and integrative care is common in this diagnosis because symptom burden is high. The Extracts results let that part of the plan be specific rather than generic “anti-cancer supplements”.
Turnaround time matters here more than in almost any other article in this series. Flag the case as urgent with the collection centre and the practitioner so the blood draw is not delayed by paperwork.
Who this article is for
• Anyone with newly diagnosed locally advanced or metastatic pancreatic cancer.
• Patients progressing on FOLFIRINOX or gemcitabine / nab-paclitaxel.
• People whose CA19-9 does not track their disease.
• Selected high-risk families, only as an adjunct to a proper high-risk screening programme.
Next step
Do not wait for the next scheduled clinic if a new line is being chosen this fortnight. Ask an RGCC-accredited practitioner whether Onconomics Plus can be drawn now so the result is in the file before the first dose of the next regimen.
Disclaimer. This article is educational and is intended for patients, families, and referring practitioners. RGCC tests are laboratory investigations that support clinical decision-making. They do not replace imaging, tissue diagnosis, or a treating oncologist’s judgement. Results must be interpreted by an RGCC-accredited practitioner in the context of the full medical history. RGCC circulating tumor cell (CTC) assays are not designed to detect primary cancers of the brain or central nervous system. Always discuss findings with your own doctor before changing any treatment.