Clinical Implementation Gap of Comprehensive Genomic Profiling in Pancreatic Cancer: A Real-world Study

<h3>Background/Aim:</h3> Comprehensive genomic profiling (CGP) is increasingly used in pancreatic ductal adenocarcinoma (PDAC), yet its real-world clinical impact remains unclear. This study aimed to evaluate stepwise attrition from genomic detection to treatment implementation in routine practice. <h3>Patients and Methods:</h3> We conducted a retrospective single-institution study of consecutive patients with PDAC who underwent CGP. Stepwise attrition was assessed across genomic detection, expert panel recommendation, and treatment execution. Clinical characteristics and exploratory overall survival (OS) were analyzed. <h3>Results:</h3> Among 57 patients, five (8.8%) harbored potentially actionable genomic alterations, whereas only two (3.5%) ultimately received genotype-matched therapy. Attrition was primarily attributable to regulatory and companion diagnostic constraints rather than clinical deterioration, as most patients had preserved performance status at CGP (ECOG 0-1: 91.2%). The median interval from diagnosis to CGP was 259 days. No significant difference in OS was observed between patients with and without CGP-attributed clinical impact (log-rank <i>p</i>=0.73). <h3>Conclusion:</h3> In PDAC, actionable genomic alterations were identified in 8.8% of patients, yet only 3.5% received genotype-matched therapy. These findings indicate that the clinical impact of CGP is limited primarily by implementation barriers rather than genomic detection itself. Earlier integration of CGP and improved access to matched therapies may enhance its real-world utility.