Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

It was a pleasure to review your manuscript. The paper is well designed, the narrative is easy to follow, and the text covers the current information on PDAC molecular targets, with clear information on up-to-date guidelines and recommendations, ready for clinical use. The tables are appropriate and usefully summarize the available data. I did not find any aspects requiring correction. My only concern is that the Special Issue topic is "Advances in the Management of Gastrointestinal and Liver Diseases" and a review on PDAC may not reach readers interested in pancreatic malignancies.

Author Response

Dear Reviewer,

We thank you for your suggestions.

Regarding your first comment on the efficacy of EUS-FNB (particularly using 19G needles) for tissue procurement in molecular testing, we have implemented a brief note in the revised version of the manuscript. Specifically, we added the following sentence:

" However, obtaining adequate tissue for such analyses can be challenging due to the dense stromal reaction, necrosis, and low tumor cellularity typical of PDAC, particularly in small biopsy samples [66]. EUS-guided fine needle biopsy, especially with 19G needles, has shown good performance in acquiring sufficient core tissue for next-generation sequencing and enabling precision oncology approaches [67,68]."

66 Kandel P, Nassar A, Zhang X, Dawson DW, Wang H-L, Monaghan T, et al. EUS-guided fine needle biopsy sampling for genomic profiling of pancreatic ductal adenocarcinoma: A multicenter experience. Pancreatology. 2021;21(1):151–7. doi:10.1016/j.pan.2020.11.013

67 Song T.J., Kim J.H., Lee S.S., Eum J.B., Moon S.H., Park D.Y., Seo D.W., Lee S.K., Jang S.J., Yun S.C., et al. The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses. Am. J. Gastroenterol. 2010;105:1739–1745. doi: 10.1038/ajg.2010.108.

68 Tanaka H, Matsusaki S. The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions. Diagnostics (Basel). 2022 Mar 19;12(3):753. doi: 10.3390/diagnostics12030753. PMID: 35328306; PMCID: PMC8947755.

As for your second suggestion concerning the potential role of EUS-guided radiofrequency ablation (RFA) in enhancing chemotherapy, we believe that discussing RFA would lead us beyond the specific scope of our manuscript, which focuses primarily on pharmacological targeted therapies. Including RFA would necessitate covering other locoregional treatments such as stereotactic body radiation therapy and novel combinatory techniques, potentially diverting the focus from our central theme.

We hope this clarifies our editorial decisions.

Kind regards,

The Authors.

Reviewer 2 Report

Comments and Suggestions for Authors

This review discusses the efficacy of genomic testing in guiding treatment in advanced PDAC.

It is concise and informative.

Comments: 

They should touch briefly about the efficacy of EUS-FNB (especially with 19 G needle) in the procurement of enough tissue for these testings.

They should also briefly touch about the role of EUS guided Radiofrequency ablation in boosting chemotherapy. 

 

Author Response

Dear Reviewer,

We thank you for your suggestions.

Regarding your first comment on the efficacy of EUS-FNB (particularly using 19G needles) for tissue procurement in molecular testing, we have implemented a brief note in the revised version of the manuscript. Specifically, we added the following sentence:

" However, obtaining adequate tissue for such analyses can be challenging due to the dense stromal reaction, necrosis, and low tumor cellularity typical of PDAC, particularly in small biopsy samples [66]. EUS-guided fine needle biopsy, especially with 19G needles, has shown good performance in acquiring sufficient core tissue for next-generation sequencing and enabling precision oncology approaches [67,68]."

66 Kandel P, Nassar A, Zhang X, Dawson DW, Wang H-L, Monaghan T, et al. EUS-guided fine needle biopsy sampling for genomic profiling of pancreatic ductal adenocarcinoma: A multicenter experience. Pancreatology. 2021;21(1):151–7. doi:10.1016/j.pan.2020.11.013

67 Song T.J., Kim J.H., Lee S.S., Eum J.B., Moon S.H., Park D.Y., Seo D.W., Lee S.K., Jang S.J., Yun S.C., et al. The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses. Am. J. Gastroenterol. 2010;105:1739–1745. doi: 10.1038/ajg.2010.108.

68 Tanaka H, Matsusaki S. The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions. Diagnostics (Basel). 2022 Mar 19;12(3):753. doi: 10.3390/diagnostics12030753. PMID: 35328306; PMCID: PMC8947755.

As for your second suggestion concerning the potential role of EUS-guided radiofrequency ablation (RFA) in enhancing chemotherapy, we believe that discussing RFA would lead us beyond the specific scope of our manuscript, which focuses primarily on pharmacological targeted therapies. Including RFA would necessitate covering other locoregional treatments such as stereotactic body radiation therapy and novel combinatory techniques, potentially diverting the focus from our central theme.

We hope this clarifies our editorial decisions.

Kind regards,

The Authors.