LETTER
Identification of K-ras Mutations in Pancreatic Juice
Andres A. Gutierrez, MD;
Francisco Martinez, MD; and
Jaime Mas-Oliva, MD, PhD
1 June 1996 | Volume 124 Issue 11 | Page 1014
TO THE EDITOR:
We are concerned that the brief communication by Berthelemy and colleagues [1] may have overstated the clinical implications of a K-ras mutation found in the pancreatic juice of patients with chronic abdominal pain leading to pancreatic cancer.
No doubt exists that the authors brought out a powerful approach for the early diagnosis of pancreatic cancer by combining endoscopic retrograde pancreatography with a sensitive diagnostic tool such as polymerase chain reaction (PCR)-mediated restriction fragment-length polymorphism. It is well known, however, that tumorigenesis is a multistep process in which several genetic alterations must accumulate before the malignant phenotype is produced. For example, the exhaustive work done by Vogelstein and Kinzler [2] has shown that several mutation-activated oncogenes must accompany the inactivation of other tumor suppressor genes to produce colorectal cancer [2, 3]. It is clear from these series that no single genetic alteration pattern or specific chronologic order of symptom appearance has been noted within a studied population. Therefore, it is not surprising that only half of the patients with colonic carcinoma showed a mutational-activated ras oncogene in one of these series [3]. Furthermore, and despite the vast knowledge accumulated in this area, practical assays to detect these genetic alterations are still being developed. These assays must be validated as screening tools for colorectal cancer in high-risk families, particularly in those with a history of adenomatous polyposis.
On the contrary, information on the molecular pathogenesis of pancreatic cancer is insufficient to recommend a risk-assessment program for this fatal disease based on a single mutated oncogene detected by PCR. The authors are to be commended for their innovative approach, and their findings represent a good starting point. More studies on the molecular events that lead to pancreatic cancer are needed, however, to fully develop a panel of genetic tests to be used as prognostic and risk-assessment tools. Only then will it be possible to properly advise patients with pancreatic cancer about their therapeutic options.
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Author and Article Information
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Universidad Nacional Autonoma de Mexico School of Medicine; Mexico 04510
1. Berthelemy P, Bouisson M, Escourrou J, Vaysse N, Rumeau JL, Pradayrol L. Identification of K-ras mutations in pancreatic juice in the early diagnosis of pancreatic cancer. Ann Intern Med. 1995; 123:188-91.
2. Vogelstein B, Kinzler KW. The multistep nature of cancer. Trends Genet. 1993; 9:138-41.
3. Cho KR, Vogelstein B. Genetic alterations in the adenoma-carcinoma sequence. Cancer. 1992; 70(6 Suppl):1727-31.
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