What is Tempus (temporal) testing for pancreatic cancer?

From the Guidelines

Tempus testing for pancreatic cancer is a crucial diagnostic tool that can help identify genetic mutations and biomarkers specific to pancreatic cancer, guiding treatment decisions and potentially improving treatment outcomes. This comprehensive molecular testing examines DNA, RNA, and protein markers to detect actionable genetic alterations. The test requires a tissue sample obtained through biopsy or surgical resection, which is then sent to Tempus laboratories for analysis. Results typically take 10-14 days and provide information about mutations in genes like KRAS, TP53, CDKN2A, and SMAD4, which are commonly altered in pancreatic cancer 1.

Key Considerations

• Tempus testing can help oncologists select targeted therapies or immunotherapies that may be more effective based on the specific genetic profile of the tumor, potentially improving treatment outcomes compared to standard approaches.
• This personalized medicine approach is particularly valuable for pancreatic cancer, which has historically been difficult to treat effectively with conventional therapies alone.
• The test may also identify patients who might benefit from clinical trials testing novel targeted agents.
• According to the NCCN guidelines, universal genetic testing for patients with pancreatic cancer is warranted, especially for those with a family history of cancer or Ashkenazi Jewish ancestry 1.
• The International Cancer of the Pancreas Screening (CAPS) Consortium recommends using MRI/MRCP and EUS as first-line tests for pancreatic surveillance, with CT reserved for individuals unable to have MRI or EUS 1.

Surveillance and Screening

• Pancreatic surveillance protocols for high-risk individuals use pancreatic imaging with MRI/MRCP and/or EUS, with pancreatic-protocol CT reserved for individuals unable to have MRI or EUS 1.
• CA19-9 testing and glucose testing (fasting glucose or HbA1C) to detect new-onset diabetes are also considered reasonable for high-risk individuals, although their diagnostic performance characteristics require further investigation 1.
• Circulating tumor DNA (ctDNA) testing is beginning to emerge as a clinical test, but further studies are needed to define its role for patients under pancreatic surveillance 1.

Genetic Mutations and Biomarkers

• Germline mutations commonly found in pancreatic adenocarcinoma include BRCA1, BRCA2, CDKN2A, mismatch repair genes associated with Lynch syndrome, ATM, PALB2, STK11, and TP53 1.
• BRCA2 and CDKN2A are generally the most prevalent, with rates in moderate- to high-risk families ranging from 2% to 6% for BRCA2 and 1.5% to 2.5% for CDKN2A 1.
• Detecting a germline mutation can potentially aid in treatment decision-making, particularly regarding systemic therapy options 1.

From the Research

Tempus Testing for Pancreatic Cancer

• Tempus testing is a type of genetic testing that can help identify genetic mutations associated with pancreatic cancer 2.
• The test can detect mutations in genes such as BRCA1, BRCA2, and PALB2, which are associated with an increased risk of pancreatic cancer 3, 4, 5.
• Tempus testing can also identify other genetic mutations that may be associated with pancreatic cancer, such as those involved in the homologous recombination repair (HRR) pathway 6.
• The results of Tempus testing can be used to guide treatment decisions, such as the use of PARP inhibitors, which have been shown to be effective in patients with pancreatic cancer and certain genetic mutations 3, 4, 5.

Benefits of Tempus Testing

• Tempus testing can help identify patients who may be at high risk of developing pancreatic cancer, allowing for earlier intervention and potentially improving outcomes 2.
• The test can also help guide treatment decisions, such as the use of targeted therapies or clinical trials 3, 4, 5.
• Tempus testing can provide valuable information for patients and their families, including the risk of developing other cancers and the potential need for genetic counseling 6.

Limitations of Tempus Testing

• Tempus testing is not a diagnostic test for pancreatic cancer, but rather a tool to identify genetic mutations that may be associated with the disease 2.
• The test may not detect all genetic mutations associated with pancreatic cancer, and additional testing may be necessary in some cases 3, 4, 5.
• The results of Tempus testing should be interpreted in the context of other clinical and diagnostic information, and should not be used as the sole basis for treatment decisions 6.