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David. J Cancer Metastasis Treat 2022;8:32 Journal of Cancer
DOI: 10.20517/2394-4722.2022.71
Metastasis and Treatment

Review Open Access

A shifting adversary: control of pancreatic cancer
transcriptomic subtypes

Charles J. David

Department of Basic Medicine, Tsinghua University School of Medicine, Beijing 100084, China.
Correspondence to: Dr. Charles J. David, Department of Basic Medicine, Tsinghua University School of Medicine, Beijing
100084, China. E-mail: cdavid@mail.tsinghua.edu.cn

How to cite this article: David CJ. A shifting adversary: control of pancreatic cancer transcriptomic subtypes. J Cancer Metastasis
Treat 2022;8:32. https://dx.doi.org/10.20517/2394-4722.2022.71

Received: 21 Jun 2022 First Decision: 1 Aug 2022 Revised: 2 Aug 2022 Accepted: 11 Aug 2022 Published: 22 Aug 2022

Academic Editors: Marco Falasca, Antonio Facciorusso Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
Cellular plasticity, the dynamic ability of cells to adopt distinct transcriptional states, plays a well-known role in the
pancreas during the initiation of pancreatic ductal adenocarcinoma (PDA), the most common form of pancreatic
cancer. It is now becoming clear that plasticity also plays an important role after the emergence of PDA. PDA is
composed of two major transcriptional subtypes, classical and basal-like, with important biological differences.
Recent work has indicated that individual tumors can be comprised of cells of each subtype, and that tumor
subtype can change during the evolution of a tumor. This suggests that PDA cells can transit between
transcriptional states, with important implications for disease progression. This review discusses what is currently
known about inter-subtype plasticity and how this process is controlled.

Keywords: Pancreatic ductal adenocarcinoma, transcriptional subtypes, classical, basal-like, squamous, quasi-
mesenchymal, cellular plasticity, transcription factors, tumor microenvironment

PANCREATIC CANCER INITIATION AND PROGRESSION
Pancreatic ductal adenocarcinoma (PDA) carries the bleakest prognosis of any common malignancy, with
five-year survival rates hovering around 10% . Because of difficulties in early detection, most PDA patients
[1,2]
present at an advanced stage, precluding surgical resection. However, even among patients eligible for
surgical resection, the five-year survival rate remains no higher than 20% , arguing that poor survival in
[1]

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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