• Toni T Seppälä, Jacquelyn W Zimmerman, Elisabetta Sereni, Dennis Plenker, Reecha Suri, Noah Rozich, Alex Blair, Dwayne L Thomas, Jonathan Teinor, Ammar Javed, Hardik Patel, John L Cameron, William R Burns, Jin He, David A Tuveson, Elizabeth M Jaffee, James Eshleman, Annamaria Szabolcs, David P Ryan, David T Ting, Christopher L Wolfgang, and Richard A Burkhart.
• Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
• Ann. Surg. 2020 Sep 1; 272 (3): 427-435.

ObjectivePDAC patients who undergo surgical resection and receive effective chemotherapy have the best chance of long-term survival. Unfortunately, we lack predictive biomarkers to guide optimal systemic treatment. Ex-vivo generation of PDO for pharmacotyping may serve as predictive biomarkers in PDAC. The goal of the current study was to demonstrate the clinical feasibility of a PDO-guided precision medicine framework of care.MethodsPDO cultures were established from surgical specimens and endoscopic biopsies, expanded in Matrigel, and used for high-throughput drug testing (pharmacotyping). Efficacy of standard-of-care chemotherapeutics was assessed by measuring cell viability after drug exposure.ResultsA framework for rapid pharmacotyping of PDOs was established across a multi-institutional consortium of academic medical centers. Specimens obtained remotely and shipped to a central biorepository maintain viability and allowed generation of PDOs with 77% success. Early cultures maintain the clonal heterogeneity seen in PDAC with similar phenotypes (cystic-solid). Late cultures exhibit a dominant clone with a pharmacotyping profile similar to early passages. The biomass required for accurate pharmacotyping can be minimized by leveraging a high-throughput technology. Twenty-nine cultures were pharmacotyped to derive a population distribution of chemotherapeutic sensitivity at our center. Pharmacotyping rapidly-expanded PDOs was completed in a median of 48 (range 18-102) days.ConclusionsRapid development of PDOs from patients undergoing surgery for PDAC is eminently feasible within the perioperative recovery period, enabling the potential for pharmacotyping to guide postoperative adjuvant chemotherapeutic selection. Studies validating PDOs as a promising predictive biomarker are ongoing.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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