Table 4.

Barriers to implementation of precision medicine for pancreatic cancer

Sample-specific	Technology-specific	Practical/organisational	Therapeutic development
Tissue acquisition: •Difficult anatomy •Small-volume and heterogeneous nature of samples •Ethical considerations of repeated biopsies Tissue analysis: •Low cellularity •Abundant stroma •Intratumoural heterogeneity	Inconsistency in molecular test selection: •DNA: targeted-NGS, WES, WGS •RNA sequencing •IHC Challenges in: •Computational analysis •Data collection and storage •Data interpretation (actionability) •Integration between molecular information and clinical data •Data sharing and data mining	Timing of molecular testing: •Time to schedule biopsy •Turnaround times for molecular test results Geographical barriers to access precision medicine programs Lack of bioinformatic capacity Lack of provider awareness and education Lack of patient awareness Financial concerns: •Cost effectiveness •Reimbursement	Identification and validation of therapeutic targets Lack of specific molecular-targeted drugs Lack of biomarker-based clinical trials Challenges in conducting adequately powered clinical trials in small molecular subgroups Primary therapeutic resistance

IHC, immunohistochemistry; NGS, next-generation sequencing; WES, whole exome sequencing; WGS, whole-genome sequencing.