Many patients who undergo complete resection of “localized” pancreatic cancer nonetheless develop distant metastases following surgery, predominantly to the liver. Thus, a critical challenge in our ability to cure patients is the occult dissemination of malignant cells early in the disease process, before diagnosis and curative-intent treatment, yet at a time point when these cells are undetectable by modern imaging and blood testing capabilities.

Theoretically, this limited disease burden should be uniquely susceptible to treatment, but clinical outcomes demonstrate that occult metastatic cells are overwhelming difficult to eradicate with conventional therapies alone. Thus, there is a critical need for strategies that effectively target this disease state in order to offer truly curative treatment for patients with “localized” pancreatic cancer.

In order to identify the unique vulnerabilities of occult metastatic cells, it is necessary to study the tissues in which they reside, but “normal” liver tissue and serial blood acquisition has historically been excluded from pancreatic cancer biobanking programs. To overcome this challenge, we have introduced a first-of-kind, IRB-approved biorepository to obtain “normal” liver biopsies and serial blood samples from patients with localized pancreatic cancer (Duke IRB Pro00108288). We have coupled this resource with cell-type-specific, multi-dimensional experimental pipelines to profile the hepatic pre-metastatic microenvironment, improve early detection with the long-term goal of devising therapeutic strategies to intercept the metastatic process.