Several studies also delineated the RNF43 mutations in intraductal papillary mucinous neoplasms.79–81 Another exome sequencing of genomic DNA, extracted from blood and the cancer biopsy from a patient with stage IV metastatic pancreatic cancer, showed a splice site mutation in RBCK1 (RNF54 or HOIL-1), which genetic alteration may be the most promising driver of pancreatic cancer.82 This evidence concerns the gene RBCK1 and familial pancreatic carcinoma.