Background: Pancreatic adenocarcinoma (PC) is a highly lethal malignancy with a survival rate of only 12%. Surveillance is recommended for high-risk individuals (HRIs), but it is not widely adopted. To address this unmet clinical need and drive early diagnosis research, we established the Pancreatic Cancer Early Detection (PRECEDE) Consortium. Methods: PRECEDE is a multi-institutional international collaboration that has undertaken an observational prospective cohort study. Individuals (aged 18–90 years) are enrolled into 1 of 7 cohorts based on family history and pathogenic germline variant (PGV) status. From April 1, 2020, to November 21, 2022, a total of 3,402 participants were enrolled in 1 of 7 study cohorts, with 1,759 (51.7%) meeting criteria for the highest-risk cohort (Cohort 1). Cohort 1 HRIs underwent germline testing and pancreas imaging by MRI/MR-cholangiopancreatography or endoscopic ultrasound. Results: A total of 1,400 participants in Cohort 1 (79.6%) had completed baseline imaging and were subclassified into 3 groups based on familial PC (FPC; n=670), a PGV and FPC (PGV+/FPC+; n=115), and a PGV with a pedigree that does not meet FPC criteria (PGV+/FPC–; n=615). One HRI was diagnosed with stage IIB PC on study entry, and 35.1% of HRIs harbored pancreatic cysts. Increasing age (odds ratio, 1.05; P<.001) and FPC group assignment (odds ratio, 1.57; P<.001; relative to PGV+/FPC–) were independent predictors of harboring a pancreatic cyst. Conclusions: PRECEDE provides infrastructure support to increase access to clinical surveillance for HRIs worldwide, while aiming to drive early PC detection advancements through longitudinal standardized clinical data, imaging, and biospecimen captures. Increased cyst prevalence in HRIs with FPC suggests that FPC may infer distinct biological processes. To enable the development of PC surveillance approaches better tailored to risk category, we recommend adoption of subclassification of HRIs into FPC, PGV+/FPC+, and PGV+/FPC– risk groups by surveillance protocols.
Submitted July 25, 2023; final revision received October 9, 2023; accepted for publication October 9, 2023.
A list of the PRECEDE Consortium collaborators is provided in Appendix 1 in the supplementary materials (available online with this article).
Author contributions: Study concept and design: Zogopoulos, Haimi, Simeone. Data acquisition: All authors. Data analysis and interpretation: Zogopoulos, Haimi, Sanoba, Everett, Wang, Parmigiani, Simeone. Funding acquisition: Zogopoulos, Kastrinos, Kupfer, Lucas, Sears, Brand, Parmigiani, Simeone. Administrative, technical, or material support: All authors. Supervision: Zogopoulos, Simeone. Writing—original draft: Zogopoulos, Haimi, Sanoba, Everett, Wang, Parmigiani, Simeone. Writing—review & editing: All authors.
Disclosures: Dr. Zogopoulos has disclosed receiving grant/research support from Immunovia. Dr. Farrell has disclosed serving as a member of the speaker’s bureau for Interpace Diagnostics. Dr. Paiella has disclosed serving as a consultant for Alpha Tau Medical. Dr. Golan has disclosed receiving grant/research support from AstraZeneca and Bristol Myers Squibb; serving as a consultant for AbbVie, AstraZeneca, Teva, and MSD Merck; and serving on a speaker’s bureau for AbbVie and Roche. Dr. Schrader has disclosed serving as a consultant for AstraZeneca Canada, Merck, and Precision Rx-Dx. Dr. Lucas has disclosed participating in research for Immunovia; serving as a scientific advisor for ClearNote Health and Immunovia; and serving as a consultant for Immunovia. Dr. Sears has disclosed serving as a scientific advisor for Rappta Therapeutics and Larkspur Biosciences; and receiving grant/research support from AstraZeneca and Cardiff Oncology. Dr. Brand has disclosed receiving grant/research support from Immunova and Freenome. Dr. Parmigiani has disclosed cofounding Phaeno Biotech; serving as a consultant for Delfi Diagnostics; and serving as a scientific advisor for REALM IDx. Dr. Simeone has disclosed serving as a scientific advisor for ClearNote Health, Interpace, Merck & Co., Bayer, and FibroGen; and receiving grant/research support from Micronoma, Immunovia, ClearNote Health, Biological Dynamics, and Tempus. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research reported in this publication was supported by an anonymous donor through NYU Langone (D.M. Simeone) and Ambry Genetics, TrovaNOW, Amazon Web Services, Project Purple, REALM IDx, and Invicro through the PRECEDE Consortium.
Disclaimer: The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; or the decision to submit the manuscript for publication.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2023.7097. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.