# Pancreatic ductal adenocarcinoma

Source: https://onco.cc/cancers/pancreatic/  
OnCo record `pancreatic` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Almost every pancreatic tumour carries a KRAS mutation, and for the first time drugs against it work: daraxonrasib nearly doubled survival in previously treated disease in 2026. Pancreatic cancer has been the hardest common cancer to treat once advanced; that is what is starting to change.

## Summary

Pancreatic ductal adenocarcinoma is defined by late presentation, a near-universal KRAS mutation (G12D about 40%, G12V about 32%, G12R about 16%, G12C 1 to 2%; 6 to 12% KRAS-wild-type with actionable fusions in NRG1, NTRK, ALK, or BRAF), a desmoplastic stroma that occupies most of the tumour, and an immunologically cold microenvironment. Surgery is the only cure and only ~20% of patients present resectable; five-year survival remains ~13% overall but exceeds 40% for resected patients who complete adjuvant mFOLFIRINOX.

For thirty years the story was chemotherapy: gemcitabine (1997), FOLFIRINOX (2011), gemcitabine/nab-paclitaxel (2013), adjuvant mFOLFIRINOX (PRODIGE 24, 2018), NALIRIFOX (2024), with olaparib maintenance for germline BRCA carriers (POLO, 2019) and zenocutuzumab for NRG1 fusions (2024) as the only biomarker-directed drugs. 2026 changed the trajectory. Optune Pax tumour treating fields were approved for locally advanced disease (PANOVA-3). Daraxonrasib, a pan-RAS(ON) inhibitor, nearly doubled overall survival in previously treated metastatic disease in RASolute 302 (13.2 vs 6.7 months, HR 0.40), presented in the ASCO 2026 plenary with simultaneous NEJM publication, and the FDA approved it on 26 August 2026 for metastatic disease after at least one systemic therapy or when multi-agent chemotherapy is unsuitable; no European or UK decision had been made by 24 September 2026. The G12D-selective zoldonrasib, combined with daraxonrasib or with chemotherapy, produced response rates never before seen in this disease.

What remains unsolved: detection (no screening outside high-risk surveillance; MCED tests and new-onset-diabetes enrichment are the leading ideas), the stroma and immune exclusion that have defeated every checkpoint inhibitor trial, resistance to RAS inhibitors (already emerging), and the fact that half of patients are too frail for the most effective regimens. The most promising directions are RAS inhibitors moving into first line and neoadjuvant settings, personalised (autogene cevumeran) and shared-antigen (ELI-002 7P) vaccines in the adjuvant setting despite AMPLIFY-7P's miss, CLDN18.2 and FAP-directed delivery, and blood-based early detection.

How common it is, world and United States. The IARC pancreas fact sheet, served with the GLOBOCAN 2024 estimates, counts 531,318 new pancreatic cancers a year (the 11th commonest cancer, age-standardised rate 4.7 per 100,000) and 490,786 deaths (the 6th commonest cause of cancer death, 4.2 per 100,000). Asia has 45.9 percent of cases, Europe 27.7 percent, Northern America 13.6 percent, Latin America and the Caribbean 7.8 percent, Africa 3.9 percent and Oceania 1.1 percent, and the highest rates are in Western Europe and Northern America, the lowest in South Central Asia. Countries with very high human development had the highest incidence and mortality (age-standardised rates 7.7 and 4.9 in 2018), incidence rose in 14 of 48 countries with registry data for men and 17 for women over the decade to 2017, and higher national rates travel with smoking, alcohol, inactivity, obesity, hypertension and high cholesterol (Huang 2021). In the United States the SEER programme projects 67,530 new cases (3.2 percent of cancers) and 52,740 deaths (8.4 percent of cancer deaths) for 2026; the rate of new cases is 13.9 per 100,000 a year (2019 to 2023) and the death rate 11.3 (2020 to 2024); it is the third leading cause of cancer death; 113,931 people were living with it in 2023. Applying current rates to population growth, pancreatic cancer is projected to become the second leading cause of cancer death in the United States by 2040 (46,000 deaths, behind lung cancer's 63,000), overtaking colorectal cancer (Rahib 2021; the 2014 Rahib projection is in the key papers).

United Kingdom (Cancer Research UK, drawing on the four national registries). Pancreatic cancer is the 10th commonest cancer with 11,479 new cases a year (2019 and 2021 to 2022), 31 a day and 3 percent of all cancers, about 5,600 in females and 5,800 in males; almost half (48 percent) are diagnosed at 75 or over and rates are highest at 90 and over. Incidence rates have risen by about a fifth (21 percent) since the early 1990s and by 7 percent in the last decade, and are projected to rise a further 4 percent by 2038 to 2040 with the count reaching about 16,000 a year; rates are lower in the Asian and mixed ethnic groups and higher in the Black ethnic group than in the White group in England (2013 to 2017). It is the 5th commonest cause of cancer death with about 10,200 deaths a year (2022 to 2024), 28 a day, more than half (54 percent) at 75 or over; mortality rates have stayed flat since the early 1970s, and although rates are projected to fall 4 percent, deaths are projected to reach about 12,600 a year by 2038 to 2040 as the population ages. Mortality is 20 percent higher for men and 25 percent higher for women in the most deprived areas of England than the least deprived (2007 to 2011). The lifetime risk of a diagnosis is 1 in 59 for females and 1 in 55 for males born in 1961. Cancer Research UK's summary page says 37 percent of cases are preventable and its risk page 31 percent; both figures are recorded here. In England in 2022, 26 percent of cases with a known stage (around 1,600) were stage I or II; Northern Ireland reports 30 percent, Scotland 19 percent (2023) and Wales 19 percent. In 2024 there were around 310 curative and 370 palliative radiotherapy episodes for pancreatic cancer in England.

Who gets it. Age is the main risk factor: the US median age at diagnosis is 71, 32.7 percent of cases are diagnosed at 65 to 74 and only 3 percent under 45 (SEER 21, 2019 to 2023); the US rate is slightly higher in men (15.7 against 12.4 per 100,000) and highest in non-Hispanic Black men and women (18.0 and 15.4) against 16.3 and 12.3 in non-Hispanic White, 13.6 and 12.1 in Hispanic and 11.5 and 9.8 in Asian and Pacific Islander people. Smoking: current smokers have 2.2 times the risk of never smokers, former smokers 1.2 times, rising to 3.4 times at 35 or more cigarettes a day, and the risk returns to that of never smokers about 20 years after quitting (Bosetti 2012, 6,507 cases in the PanC4 consortium); 22 percent of UK cases are caused by smoking (Cancer Research UK). Body size: obesity (body mass index 30 or more) carries 1.47 times the risk of a normal weight, being overweight in early adulthood and obese later 1.54 times, and a high waist-to-hip ratio 1.35 times, in 846,340 people across 14 cohorts (Genkinger 2011); Cancer Research UK puts 12 percent of UK cases down to overweight and obesity, with a 10 percent rise in risk per 5 units of body mass index. Diabetes: type 2 diabetes carries about 1.8 to 1.9 times the risk (odds ratio 1.82 in 36 studies, Huxley 2005; relative risk 1.94 in 35 cohorts, Ben 2011), and the association is strongest when the diabetes is recent, which is where cause and consequence blur: 47 percent of 512 newly diagnosed patients had diabetes against 7 percent of controls, much of it new-onset and resolving after resection, so the tumour itself is diabetogenic (Pannala 2008). Chronic pancreatitis: about 16 times the risk within two years of the pancreatitis diagnosis, falling to about 8 times at five years and 3.5 times at nine years or more, part of the early excess being cancers first misread as pancreatitis (Kirkegard 2017); hereditary pancreatitis with a PRSS1 mutation raises risk more than 50-fold (Cancer Research UK). Alcohol at 3 or more units a day raises risk by 15 to 19 percent; gallstones by 25 percent, mostly soon after diagnosis; metabolic syndrome by 58 percent in women; red meat by 21 percent in men (Cancer Research UK risk page). The same factors, with alcohol most strongly, apply to cancers diagnosed before 60 (McWilliams 2016).

Family history and inherited genes. A first-degree relative with pancreatic cancer raises risk by 62 to 76 percent (Cancer Research UK); in the Johns Hopkins registry, members of familial kindreds (at least one pair of affected first-degree relatives) had 9.0 times the expected incidence, rising to 6.4 times with two and 32 times with three affected first-degree relatives, while spouses and unrelated relatives had no excess (Klein 2004). Germline testing of 3,030 unselected patients found a pathogenic variant in one of six genes in 5.5 percent (7.9 percent with a family history of pancreatic cancer, 5.2 percent without): ATM 2.3 percent of cases (odds ratio 5.71), BRCA2 1.9 percent (6.20), BRCA1 0.6 percent (2.58), CDKN2A 0.3 percent (12.33), TP53 0.2 percent (6.70) and MLH1 0.13 percent (6.66) (Hu 2018); 3.9 percent of 854 apparently sporadic resected cancers carried a deleterious germline mutation, and only 3 of those 33 patients had reported a family history (Shindo 2017), which is why guidelines now offer germline testing to every patient. Syndromes: Peutz-Jeghers more than 100 times the risk, familial atypical multiple mole melanoma (CDKN2A) 13 to 38 times, Lynch syndrome up to about 9 times, BRCA2 3.5 times and BRCA1 up to 2.3 times (Cancer Research UK). Pancreatic cysts: intraductal papillary mucinous and mucinous cystic neoplasms are precursors, and cysts of 2 mm or more were found on MRCP in 49.1 percent of 1,077 adults in a German population study, though only about 6 percent of cysts were over 1 cm and no cancer arose in five years of follow-up (Kromrey 2018); the cyst pages of this record carry the surveillance rules.

How it presents, and why late. The pancreas sits deep behind the stomach and the early tumour is silent; roughly 75 percent of cancers start in the head (Cancer Research UK types page), where they block the bile duct and cause painless jaundice, dark urine, pale stools and itching, while body and tail tumours present later with pain in the upper abdomen or back that is worse after eating or lying down and eased by leaning forward, weight loss, loss of appetite, fatty stools (steatorrhoea), nausea, indigestion, new diabetes, fever and blood clots (Cancer Research UK symptoms page; NHS). In the SYMPTOM pancreatic study of 391 people referred with suspected pancreatic cancer, 119 (30 percent) had it and 34 percent of those were already metastatic; no first symptom separated cancer from no cancer, but jaundice as a later symptom did (49 percent against 12 percent), and the authors asked clinicians to stay alert to evolving gut and systemic symptoms, particularly in people with diabetes or mental health conditions (Walter 2016). NICE NG12 (1.2.4) sends anyone aged 40 or over with jaundice on the suspected cancer pathway and (1.2.5) asks for an urgent direct-access CT, or ultrasound if CT is unavailable, for anyone 60 or over with weight loss and any of diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation or new-onset diabetes; the NHS page asks for an urgent GP appointment or NHS 111 for yellowing of the eyes or skin, vomiting for more than two days or diarrhoea for more than seven. Even so, in England in 2019 only 22 percent of cases were diagnosed through an urgent suspected cancer referral and 45 percent through an emergency presentation (Cancer Research UK), the route that carries substantially lower one-year survival across cancers (Elliss-Brookes 2012); a 2026 US Veterans Affairs measure found 60.9 percent of 4,415 patients presenting as emergencies, with 1.38 times the odds of advanced stage and 1.64 times the mortality, and missed diagnostic opportunities in nearly one in five (Br J Cancer 2026). In the United States 51 percent of cases are distant at diagnosis, 28 percent regional and 15 percent localised (SEER). Weight loss is part of the presentation, not only a complication: 85 percent of patients meet the definition of cancer cachexia (Hendifar 2019) and 40.5 percent of 227 patients scheduled for surgery were already cachectic, which halved their chance of a resection (48.9 against 77.8 percent) because metastases were found more often (Bachmann 2008).

How it is diagnosed. NICE NG85 (1.1) sets the UK sequence: for obstructive jaundice with suspected pancreatic cancer, a pancreatic protocol CT before the bile duct is drained (1.1.1); if the diagnosis is still unclear, FDG PET-CT and or endoscopic ultrasound with EUS-guided tissue sampling (1.1.2), and a biliary brushing for cytology if ERCP is used to relieve the obstruction without a tissue diagnosis (1.1.3); for pancreatic abnormalities without jaundice, the same CT then PET-CT or EUS (1.1.4 to 1.1.6); for cysts, CT or MRI with MRCP, the other test if more is needed, EUS with fine-needle aspiration and CEA on the fluid when malignancy is in question (1.1.7 to 1.1.13). The pancreas protocol CT is a thin-slice, dual-phase scan read against a standard template that names each artery and vein the tumour touches and by how many degrees (Al-Hawary 2014); Cancer Research UK adds that a biopsy is often not taken when the tumour looks removable, the diagnosis then resting on imaging until the specimen is examined, and that EUS, ERCP, ultrasound- or CT-guided biopsy or laparoscopy are the routes when tissue is needed. Blood tests include liver function and the tumour markers CA 19-9 and CEA. CA 19-9 has a sensitivity of 79 to 81 percent and specificity of 82 to 90 percent in symptomatic patients but a positive predictive value of 0.5 to 0.9 percent as a screening test, is falsely negative in the 5 to 10 percent of people who are Lewis antigen-negative, and levels above 100 U/mL suggest unresectable or metastatic disease (Ballehaninna 2012); in 1,482 Chinese patients 8.4 percent were Lewis-negative and, contrary to the textbook, 27.4 percent of them still had a raised CA 19-9, while Lewis-negative status itself predicted shorter survival (hazard ratio 1.30, Luo 2018). Germline testing and tumour sequencing (KRAS status, fusions when KRAS is wild-type, mismatch repair) are offered at diagnosis (NCCN; the subtype pages carry the detail). The specialist pancreatic multidisciplinary team makes the shared decision (NG85 1.2.1) and partners with local units to deliver it.

How it is staged. Two systems run side by side. The TNM 8th edition (2017) sizes the tumour: T1 is 2 cm or less (T1a to 0.5 cm, T1b over 0.5 to 1 cm, T1c 1 to 2 cm), T2 over 2 to 4 cm, T3 over 4 cm, T4 growing into the coeliac axis, superior mesenteric artery or common hepatic artery; N1 is one to three regional nodes, N2 four or more; M1 is spread to the liver, lungs, peritoneum or distant nodes (Cancer Research UK TNM page). Stage 1 is T1 or T2 without nodes (1A and 1B by size), stage 2 is T3 without nodes (2A) or T1 to T3 with one to three nodes (2B), stage 3 is four or more nodes or a T4 tumour, and stage 4 is any metastasis (Cancer Research UK stages page). The 8th edition's size-based T and count-based N categories were validated in 2,318 margin-negative resections from three US centres (Allen 2017) and in 8,960 SEER resections, where they discriminated survival about as well as the 7th edition (c-index 0.60 against 0.59) while stratifying resected patients more finely by nodal burden (Kamarajah 2017). The second system is resectability, which is what decides treatment: the NCCN classes of resectable, borderline resectable and locally advanced (unresectable) are defined by the tumour's contact with the superior mesenteric artery, coeliac axis and common hepatic artery (arterial contact of less than 180 degrees without stenosis is borderline; more, or encasement, is locally advanced) and with the superior mesenteric and portal veins (contact with narrowing or occlusion that can be reconstructed is borderline; unreconstructable occlusion is locally advanced), and the 2017 international consensus added a biological dimension (suspected but unproven metastases or nodes on PET-CT or biopsy, or a CA 19-9 above 500 U/mL) and a conditional one (performance status 2 or worse) (Isaji 2018; Tempero 2021). Staging tests in the UK are a pancreatic protocol CT of chest, abdomen and pelvis for every new diagnosis (NG85 1.3.1), FDG PET-CT for everyone with localised disease on CT who will have treatment (1.3.2), and, when the decision still turns on it, MRI for suspected liver metastases, EUS for tumour and node staging, or laparoscopy with laparoscopic ultrasound for small-volume peritoneal or liver disease before an attempted resection (1.3.3).

What the pathologist sees. About 80 percent of pancreatic cancers are ductal adenocarcinomas (Cancer Research UK types page), the entity this record describes: gland-forming tumours in a dense desmoplastic stroma, with the KRAS, CDKN2A, TP53 and SMAD4 alterations set out in the biomarkers list. The 2019 WHO classification of digestive tumours (5th edition, Nagtegaal 2020) lists its variants, each with a page linked from this record: adenosquamous carcinoma, colloid (mucinous non-cystic) carcinoma, undifferentiated carcinoma with or without osteoclast-like giant cells, and the carcinomas arising in intraductal papillary mucinous and mucinous cystic neoplasms; acinar cell carcinoma, solid pseudopapillary neoplasm and pancreatoblastoma are separate non-ductal tumours, and the neuroendocrine tumours of the islets are a different disease with their own record. Precursors: pancreatic intraepithelial neoplasia (PanIN), the microscopic duct lesion named and graded in 2001 (Hruban 2001) and reduced to two tiers, low grade and high grade, by the 2015 Baltimore consensus, which also set 0.5 to 1 cm as the boundary between a large PanIN and a small (incipient) IPMN (Basturk 2015); high-grade PanIN was present in 4 percent of 173 autopsy pancreata without cancer, always multifocal and more often in the body and tail, in people with diabetes and in the old (Matsuda 2017). Margins are reported by the 1 mm rule: the Royal College of Pathologists calls tumour within 1 mm of a margin R1, a definition that, applied with inked margins and axial slicing, raised the reported R1 rate to 76 to 85 percent of head resections (Verbeke 2006; Esposito 2008; Campbell 2009), and in the ESPAC-3 trial 43.9 percent of 1,151 patients were R1, with direct margin involvement carrying the worst survival and more local recurrence (Ghaneh 2019).

Screening and surveillance. There is no population screening: the UK National Screening Committee does not recommend it and Cancer Research UK explains why (the cancer is relatively uncommon, so many people would have unnecessary tests, and the benefits do not outweigh the costs), and the US Preventive Services Task Force reaffirmed a grade D recommendation against screening asymptomatic adults in 2019 (Owens 2019). Surveillance of high-risk people is different. NICE NG85 offers it (1.1.15) to people with hereditary pancreatitis and a PRSS1 mutation, to carriers of BRCA1, BRCA2, PALB2 or CDKN2A with one or more first-degree relatives with pancreatic cancer, and to Peutz-Jeghers syndrome, and asks clinicians to consider it (1.1.16) for two or more first-degree relatives across two generations and for Lynch syndrome with an affected first-degree relative, by MRI with MRCP or EUS (1.1.17), or by pancreatic protocol CT in hereditary pancreatitis where EUS is not used (1.1.18, 1.1.19). The International CAPS consortium (2020) sets the goal as high-grade dysplasia and T1N0M0 cancer, starts familial surveillance at 50 or 55 or ten years before the youngest affected relative, uses EUS and MRI/MRCP yearly, and added ATM carriers with one affected relative (Goggins 2020). The programmes: in CAPS, 7 percent of 354 high-risk people progressed over 16 years, 1.6 percent a year, and 93 percent had worrisome features first (Canto 2018); in CAPS5, 1,461 people were enrolled, 7 of 9 cancers found under surveillance were stage I (77.8 percent), and across CAPS1 to 5 (1,731 people) 57.9 percent of the 19 surveillance-detected cancers were stage I against 85.7 percent stage IV for the seven found outside surveillance, with five-year survival of 73.3 percent and a median of 9.8 years for screen-detected disease (Dbouk 2022); in the Netherlands the cumulative incidence was 9.3 percent in mutation carriers and 0 percent in mutation-negative familial kindreds over an average of 63 months, with EUS outperforming MRI and four of ten cancers presenting between visits (Overbeek 2022); in 347 CDKN2A carriers 8.9 percent developed cancer (20.7 percent by age 70), 83.3 percent resectable at imaging and 33.3 percent stage I, with five-year survival of 32.4 percent (Klatte 2022). EUROPAC, the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer based in Liverpool, screened 321 people from 258 kindreds and found one cancer, two low-grade neuroendocrine tumours and 41 cystic lesions, the branch-duct IPMNs being unrelated to inherited risk (Sheel 2019). PRECEDE (Pancreatic Cancer Early Detection consortium) published its recommendations for an organised approach in 2021 (Gonda 2021) and its 20,000-person registry study has a trial record on this site. New-onset diabetes after 50 is the other route: about 1 percent are diagnosed with pancreatic cancer within three years (Chari 2005), the ENDPAC score (weight change, glucose change, age) picks out a group with 3.6 percent prevalence (Sharma 2018), and in over a fifth of cancers the diabetes began while the cancer was still asymptomatic, a median of 6.5 months before diagnosis (Aggarwal 2012); the glossary term and the ideas linked from this record carry the detail.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: Pancreatic cancer; PDAC; Cancer of the pancreas; Exocrine pancreatic cancer; Pancreatic adenocarcinoma
- Tags: gi; spike
- Group: gastrointestinal
- Burden: 531,318 new cases and 490,786 deaths a year worldwide (GLOBOCAN 2024; 11th commonest cancer, 6th commonest cause of cancer death). 11,479 UK cases and about 10,200 UK deaths a year (Cancer Research UK); 67,530 US cases and 52,740 deaths projected for 2026 (SEER). Incidence is rising (21 percent in the UK since the early 1990s) and 45 percent of English cases arrive as emergencies.
- Subtypes: Classical (GATA6-high, better prognosis, more chemosensitive); Basal-like / squamous (GATA6-low, chemotherapy-resistant); KRAS-wild-type (~10%; NRG1, NTRK, ALK, BRAF fusions; MSI-H); Germline-driven (BRCA2, PALB2, ATM, CDKN2A, STK11); Pancreatic neuroendocrine tumours (a different disease with its own record, linked from this page); Adenosquamous carcinoma of the pancreas (squamous component of at least 30 percent; about 1 percent of cases; body and tail; worse after resection); Colloid (mucinous non-cystic) carcinoma of the pancreas (mucin pools; usually the invasive part of an intestinal-type IPMN; better outlook); Undifferentiated carcinoma with osteoclast-like giant cells (1.4 percent of resected pancreatic cancers; five-year survival 59 percent); Undifferentiated (anaplastic) carcinoma without giant cells (aggressive; treated as ductal PDAC); Invasive carcinoma arising in an IPMN (tubular or colloid type; 10 percent of resections; staged and treated as ductal adenocarcinoma); Mucinous cystic neoplasm with associated invasive carcinoma (women, body and tail; 4 to 12 percent of resected MCNs); Solid pseudopapillary neoplasm (young women; CTNNB1; low-grade malignant; cured by resection in about 95 percent)
- Biomarkers: CA 19-9 (prognosis and monitoring); KRAS mutation subtype (G12D about 40%, G12V about 32%, G12R about 16%, Q61 about 7%, G12C 1 to 2%; cohort ranges in the molecular table; wild-type triggers fusion testing); Germline panel (BRCA1/2, PALB2, ATM, CDKN2A, STK11, Lynch); HRD / platinum sensitivity; GATA6 (classical vs basal-like); ctDNA (KRAS-mutant cfDNA) for MRD and response; FAPI PET avidity (investigational); CLDN18.2 IHC (trials); CA 19-9 with Lewis status: falsely low in the 5 to 10 percent who are Lewis-negative; above 500 U/mL counts as biological borderline resectability; Resectability class on pancreas protocol CT (degrees of arterial contact; venous contact and reconstructability), reported on a standard template; Resection margin by the 1 mm rule (R0 more than 1 mm; R1 within 1 mm; R1 direct), the strongest surgeon- and pathologist-controlled prognostic factor; KRAS activating mutation (any allele): 88-94%; KRAS G12D g12d allele (share of kras mutation records): 39-41%; KRAS G12V g12v allele (share of kras mutation records): 28-37%; KRAS G12R g12r allele (share of kras mutation records): 12-21%; KRAS Q61 q61h, q61r, q61l or q61k allele (share of kras mutation records): 5-8%; KRAS G12C g12c allele (share of kras mutation records): 1-2%; KRAS wild-type no kras mutation (fusion and alternative-driver search): 6-12%; NRG1 gene fusion (atp1b1-nrg1, cd44-nrg1 and others): 0.3-1%; BRAF mutation (v600e, in-frame deletion) or fusion: 1-3%; ALK gene fusion (eml4-alk, strn-alk): 0.2%; NTRK1 / NTRK3 gene fusion (etv6-ntrk3, ctrc-ntrk1): 0.4%; FGFR2 gene fusion: 0.2%; TP53 mutation: 66-76%; CDKN2A mutation or deep deletion (with cdkn2b and mtap co-deletion): 37-48%; SMAD4 (DPC4) mutation or deep deletion: 17-33%; BRCA2 germline pathogenic variant: 1.4-2%; BRCA1 germline pathogenic variant: 0.4-1%; PALB2 germline or somatic pathogenic variant: 0.2-0.6%; ATM germline pathogenic variant (somatic in a further 3 to 4%): 1.2-2.3%; Any germline susceptibility gene pathogenic germline variant (multigene panel): 4-10%; Homologous recombination deficiency hrd (core or biallelic hr gene mutation, unstable genome or signature 3): 11-19%; MLH1 / MSH2 / MSH6 / PMS2 mismatch repair deficiency or microsatellite instability: 0.5-2%; Tumour mutational burden tmb 10 or more mutations per megabase: 1-2%; GNAS r201 hotspot mutation (ipmn-derived tumours): 2-4%; RNF43 inactivating mutation: 5-8%; KDM6A inactivating mutation or structural disruption: 3-4%; MYC amplification: 4-13%; ARID1A inactivating mutation (swi/snf and chromatin genes): 5-9%; GATA6 amplification (classical lineage marker): 15-17%; ERBB2 (HER2) amplification (mutation in a further 1%): 1-5%

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/pancreatic/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/pancreatic/#overview [17 subtypes, 13 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/pancreatic/#what-it-is [29 subtypes, 5 staging notes, 5 sites of spread]
- Symptoms and diagnosis (own page): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/pancreatic/finding-it/ [6 symptoms, 41 biomarkers, 37 prevalence rows]
- Treatment (own page): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/pancreatic/treating-it/ [31 settings, 9 regimens, 26 decisions with options]
- Trials and papers (own page): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/pancreatic/evidence/ [224 trials, 258 trials in the subtypes, 150 key papers, 43 milestones]
- Biology and targets (own page): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/pancreatic/science/ [131 targets, 28 pathways, 9 preclinical models]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/pancreatic/where-you-are/ [67 centres, 45 centres in the subtypes, 32 UK centres]
- Decisions and support (own page): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/pancreatic/living-with-it/ [80 questions, 6 red cards, 1 decision aid]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/pancreatic/coming/ [100 medicines, 10 medicines in the subtypes, 222 trials, 70 ideas, 22 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/pancreatic/data/ [1213 connected records, 22 notes]

## Standard of care

- High-risk surveillance: Annual MRI/MRCP or EUS for germline carriers and familial kindreds (CAPS/PRECEDE); germline testing for every diagnosed patient and first-degree relatives. ([High-risk pancreatic surveillance (CAPS / PRECEDE)](https://onco.cc/technologies/pancreatic-surveillance/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [MRI](https://onco.cc/technologies/mri/), [PRECEDE](https://onco.cc/trials/precede/))
- Resectable / borderline: Neoadjuvant mFOLFIRINOX (borderline; increasingly resectable), surgery, then adjuvant mFOLFIRINOX to complete ~6 months (PRODIGE 24); gemcitabine/capecitabine if unfit. Chemoradiation selectively (PREOPANC). ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [PREOPANC-1](https://onco.cc/trials/preopanc/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/))
- Locally advanced unresectable: FOLFIRINOX or gem/nab-paclitaxel; TTFields with gem/nab-paclitaxel (Optune Pax, 2026); SBRT or MR-guided ablative radiotherapy; IRE in selected centres; reassess for conversion surgery. ([PANOVA-3](https://onco.cc/trials/panova-3/), [Optune / Optune Pax (TTFields)](https://onco.cc/drugs/optune/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/))
- Metastatic, first line: mFOLFIRINOX or NALIRIFOX (fit) or gemcitabine/nab-paclitaxel; olaparib maintenance if gBRCA after ≥16 weeks platinum; zenocutuzumab if NRG1 fusion; pembrolizumab if MSI-H; trials of RAS inhibitors + chemotherapy. ([NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/), [NAPOLI 3](https://onco.cc/trials/napoli-3/), [POLO](https://onco.cc/trials/polo/), [Zoldonrasib](https://onco.cc/drugs/zoldonrasib/))
- Metastatic, second line: Daraxonrasib after one prior line (FDA approval 26 August 2026; RASolute 302: OS 13.2 vs 6.7 months, HR 0.40); otherwise switch backbone (gem/nab-pac after FOLFIRINOX, or liposomal irinotecan/5-FU after gemcitabine). No European or UK decision on daraxonrasib by 24 September 2026. ([RASolute 302](https://onco.cc/trials/rasolute-302/), [Daraxonrasib](https://onco.cc/drugs/daraxonrasib/))
- Diagnosis and staging (UK pathway): Pancreatic protocol CT of chest, abdomen and pelvis before any biliary drainage; FDG PET-CT for localised disease before treatment; EUS with tissue sampling when a diagnosis or node staging is needed; MRI for suspected liver metastases and laparoscopy with laparoscopic ultrasound before an attempted resection when small-volume spread is suspected; CA 19-9 at baseline; germline testing for every patient; decision by a specialist pancreatic multidisciplinary team. ([CT (computed tomography)](https://onco.cc/technologies/ct/), [PET/CT](https://onco.cc/technologies/pet-ct/), [Endoscopic ultrasound and EBUS systems](https://onco.cc/technologies/endoscopic-ultrasound-systems/), [MRI](https://onco.cc/technologies/mri/), [Laparoscopy (keyhole surgery)](https://onco.cc/terms/staging-laparoscopy/), [CA 19-9](https://onco.cc/terms/ca19-9/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Pancreas protocol CT (pancreatic protocol CT, dual-phase thin-slice CT with structured reporting)](https://onco.cc/terms/pancreas-protocol-ct/), [Resectability classes for pancreatic cancer (NCCN anatomical criteria and the 2017 international consensus)](https://onco.cc/terms/nccn-resectability-criteria-pancreatic/))
- Nutrition and pancreatic enzyme replacement: Enteric-coated pancreatin for everyone with unresectable disease and consideration before and after resection; early enteral rather than parenteral nutrition after pancreatoduodenectomy; no fish oils for weight loss in unresectable disease; dietitian assessment for the weight loss, malabsorption and cachexia that affect most patients. ([Pancreatic enzyme replacement therapy (PERT, pancreatin, Creon) for pancreatic exocrine insufficiency: why and how to take it](https://onco.cc/terms/pancreatic-enzyme-replacement/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Oncology nutrition assessment and medical nutrition therapy](https://onco.cc/technologies/nutrition-screening-mnt/), [Cancer cachexia](https://onco.cc/terms/cachexia/))
- Resectable or borderline: surgery first or chemotherapy first: About one in five pancreatic cancers can be removed at diagnosis (the OnCo record; Pancreatic Cancer UK says only a small number of people can have surgery), and the word the multidisciplinary team gives you decides the order. Resectable (no contact with the main arteries, no more than abutment of the veins, no spread): NICE NG85 says surgery first, and only consider chemotherapy before surgery within a clinical trial; the operation is usually a Whipple procedure for the head of the pancreas or a distal pancreatectomy for the body and tail, followed by six months of chemotherapy. Borderline resectable (the tumour touches a main vein or artery, so an operation straight away would probably leave cancer behind): chemotherapy first for two to four months, usually modified FOLFIRINOX, then restaging, with surgery about 6 to 8 weeks after chemotherapy if the disease has not spread; NICE NG85 also places this within a trial, and Cancer Research UK says your doctor may offer one because the best treatment is uncertain. In the Dutch PREOPANC trial, chemoradiotherapy before surgery improved five-year survival over surgery first (20.5% against 6.5%), most clearly for borderline disease; the record's open problems note the question is unresolved for resectable disease after PREOPANC-2, NORPACT-1 and Alliance A021806. Fitness matters as much as anatomy: only people well enough for a major operation are offered one, prehabilitation (exercise, nutrition, stopping smoking) is offered in some hospitals, and if jaundice needs relieving first a metal stent is placed. A second opinion from a specialist pancreatic centre is reasonable when the scan is read differently by different teams. ([Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [PREOPANC-1](https://onco.cc/trials/preopanc/), [ESPAC-5](https://onco.cc/trials/espac-5/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/), [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/))
- Which chemotherapy: FOLFIRINOX, gemcitabine with nab-paclitaxel or NALIRIFOX, by fitness: Three combinations are used for cancer that cannot be removed, chosen by how well you are (performance status), your liver tests, any nerve damage and what you prefer. FOLFIRINOX (fluorouracil, folinic acid, irinotecan and oxaliplatin, every two weeks with a 46-hour pump): NICE NG85 offers it to people with metastatic disease and a performance status of 0 to 1; in the 2011 trial median survival was 11.1 months against 6.8 with gemcitabine, with more diarrhoea, neuropathy and low blood counts, so most UK units give the modified doses. Gemcitabine with nab-paclitaxel (weekly drips for three weeks in four): improved survival over gemcitabine alone in MPACT (8.5 against 6.7 months) and causes hair loss, neuropathy and low counts; NICE TA476 funds it on the NHS only when other combinations are unsuitable and gemcitabine alone would otherwise be given. NALIRIFOX (liposomal irinotecan, oxaliplatin, fluorouracil): in NAPOLI 3 median survival was 11.1 months against 9.2 with gemcitabine and nab-paclitaxel; it is on the OnCo record beside modified FOLFIRINOX for fit patients but NHS funding follows NICE appraisals, so ask what applies where you are treated. Gemcitabine alone, or GemCap, for people not well enough for these; best supportive care when chemotherapy would do harm. Everyone has a DPD blood test before fluorouracil or capecitabine, blood counts before each dose, scans about every three months, and the same temperature rule for the 24-hour line. Second line follows NICE NG85: an oxaliplatin-based regimen if you have not had oxaliplatin, a gemcitabine-based one after FOLFIRINOX; liposomal irinotecan with fluorouracil after gemcitabine is not NICE-recommended (TA440). Daraxonrasib after first-line chemotherapy is on the record's second-line row. ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [NAPOLI 3](https://onco.cc/trials/napoli-3/), [Peripheral neuropathy (chemotherapy-induced)](https://onco.cc/terms/peripheral-neuropathy/), [Performance status (ECOG, Karnofsky)](https://onco.cc/terms/performance-status/), [Metastatic pancreatic ductal adenocarcinoma](https://onco.cc/cancers/metastatic-pdac/), [Locally advanced unresectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/locally-advanced-pdac/))
- Chemotherapy after a Whipple operation: Chemotherapy after the operation is what turns surgery into a real chance of cure. NICE NG85 says start once you have had time to recover and as soon as you are well enough to tolerate all six cycles, offers gemcitabine plus capecitabine (GemCap, from ESPAC-4: median survival 28.0 months against 25.5 with gemcitabine alone) and considers gemcitabine alone for those not well enough for a combination; since PRODIGE 24 (2018), modified FOLFIRINOX has become the standard for fit patients, with a median survival of 54.4 months against 35.0 with gemcitabine in the 2018 report (53.5 against 35.5 months at the five-year update in 2022), at the cost of more diarrhoea, neuropathy and tiredness, and Pancreatic Cancer UK lists all three as the options, chosen by how well you are. Cancer Research UK and Pancreatic Cancer UK say it should start within 12 weeks (3 months) of surgery and lasts up to 6 months, so sorting out eating, weight, enzyme doses and blood sugar in the weeks after the operation matters: they are the usual reasons for a delay. Ask what the pathology showed about the resection margin (R0 or R1) and the lymph nodes. Follow-up after chemotherapy is usually a CT scan every 6 months for 5 years with blood tests and sometimes CA 19-9; contact the team about any new symptom between visits. ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/), [CA 19-9](https://onco.cc/terms/ca19-9/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/))
- Germline testing: what a BRCA result means for olaparib and for your family: About one in ten pancreatic cancers runs in families (Pancreatic Cancer UK), and the OnCo record asks for a germline panel (BRCA1, BRCA2, PALB2, ATM, CDKN2A, STK11 and the Lynch genes) for everyone diagnosed. Three things follow from a BRCA1 or BRCA2 (or PALB2) result. Treatment: platinum chemotherapy (FOLFIRINOX or NALIRIFOX, which contain oxaliplatin) is favoured, and in the POLO trial maintenance olaparib after at least 16 weeks of platinum without progression lengthened the time before the cancer grew (7.4 against 3.8 months) without lengthening survival overall; NICE could not make a recommendation on olaparib in pancreatic cancer (TA750, terminated December 2021) because the company made no submission, so ask what is funded where you are treated. Family: Macmillan says each child of a carrier has a 1 in 2 chance of inheriting the variant; the genetics team can offer relatives predictive testing, and NICE NG85 says offer pancreatic surveillance (MRI/MRCP or EUS) to people with BRCA1, BRCA2, PALB2 or CDKN2A variants who have a first-degree relative with pancreatic cancer, and to those with Peutz-Jeghers syndrome or hereditary pancreatitis. Time: results usually take weeks to a few months; a variant of uncertain significance means the effect on risk is not yet known and the genetics team will explain it. Tumour testing (KRAS subtype, NRG1 and other fusions, mismatch repair) is separate and decides trial eligibility and the rare targeted drugs on the record. ([Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [Olaparib](https://onco.cc/drugs/olaparib/), [POLO](https://onco.cc/trials/polo/), [BRCA or PALB2-mutant pancreatic ductal adenocarcinoma](https://onco.cc/cancers/brca-palb2-pdac/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/))
- Jaundice: a stent or surgery: Jaundice (yellow eyes or skin, dark urine, pale stools, itch) means the tumour is blocking the bile duct, and how it is relieved depends on the plan for the cancer. NICE NG85 says: if the cancer is resectable and you are well enough, offer the operation rather than draining the duct first (unless a trial requires drainage); if you are not yet fit for surgery, or will have chemotherapy first, offer a self-expanding metal stent placed by endoscopy (ERCP), a fully covered one where it may need removing later; if the cancer cannot be removed, offer a metal stent rather than a surgical bypass; and consider a surgical bypass (and a prophylactic gastrojejunostomy) only when the cancer turns out to be unresectable during an attempted resection. Pancreatic Cancer UK says most people feel better within a couple of days of a stent, the jaundice takes two to three weeks to clear completely, and that relieving it may be what allows chemotherapy to start; the problems are blockage (symptoms return), infection (antibiotics), the stent moving, and pancreatitis from the procedure. If ERCP fails the stent is placed through the skin (PTC). Macmillan says plastic stents may need replacing and metal ones usually do not. A blocked duodenum (vomiting large amounts, feeling full) is treated with a duodenal stent, or a gastrojejunostomy for people expected to live longer. ([Biliary stenting and drainage](https://onco.cc/technologies/biliary-stenting-drainage/), [Stent or bypass for jaundice: the choice](https://onco.cc/terms/stent-or-bypass-for-jaundice/), [Biliary stent problems: blockage and infection](https://onco.cc/terms/biliary-stent-problems/), [Cholangitis: infection of a blocked bile duct](https://onco.cc/terms/acute-cholangitis/), [Obstructive jaundice and biliary obstruction](https://onco.cc/terms/obstructive-jaundice/), [Duodenal stenting and gastrojejunostomy for malignant gastric outlet obstruction](https://onco.cc/terms/duodenal-stenting-gastric-outlet/))
- Pain, including a coeliac plexus block: Many people with pancreatic cancer have pain in the upper tummy or back, often because the tumour presses on the coeliac plexus, the bundle of nerves behind the pancreas; Pancreatic Cancer UK says asking for help early makes it easier to control. The steps Cancer Research UK describes: paracetamol and anti-inflammatories, then weak and strong opioids (morphine-based medicines as tablets, liquids, patches or injections) with regular laxatives because opioids constipate, and anti-sickness medicine for the first week; amitriptyline or gabapentin for burning, tingling or shooting nerve pain; radiotherapy or chemotherapy to shrink what is pressing on the nerves, which takes weeks to work; and relaxation, TENS, acupuncture and distraction alongside. NICE NG85 says consider an EUS-guided or image-guided coeliac plexus block for uncontrolled pain, unacceptable opioid side effects or escalating doses, and not to offer thoracic splanchnicectomy; Macmillan describes the injection through the back or from inside the stomach during an endoscopic ultrasound, and a randomised trial (Wyse 2011) found early EUS-guided neurolysis reduced pain at three months. Pain after a Whipple operation is normal for weeks and eases; sudden worse pain with a temperature means A&E. Palliative care and pain teams can be involved at any stage, alongside treatment. ([Cancer pain management](https://onco.cc/technologies/pain-management/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Palliative radiotherapy](https://onco.cc/technologies/palliative-radiotherapy/), [Endoscopic ultrasound and EBUS systems](https://onco.cc/technologies/endoscopic-ultrasound-systems/))
- Pancreatic enzymes and diabetes, after surgery or with the tumour: The pancreas digests food and controls blood sugar, and the cancer, the operation or both can take away either job. Enzymes: Pancreatic Cancer UK says most people with pancreatic cancer will need pancreatic enzyme replacement therapy (PERT: Creon, Nutrizym, Pancrex) for life, and that the signs of needing it are weight loss, bloating, wind, tummy pain after eating and pale, oily, floating stools. NICE NG85 says offer enteric-coated pancreatin in unresectable disease and consider it before and after resection. How to take it: with all meals, snacks and milky drinks, half with the first mouthfuls and half spread through the meal, swallowed with a cool drink, starting at about 50,000 to 75,000 units for a main meal and 25,000 to 50,000 for a snack, more for larger or fattier meals, reviewed by the dietitian and increased until symptoms settle; if it is not working, a proton pump inhibitor, another brand, or another cause (bile acid diarrhoea, bacterial overgrowth, medicines) is looked for. Supplies have been disrupted since 2024; NICE points prescribers to the Specialist Pharmacy Service tool for equivalents. Diabetes: pancreatic cancer or surgery can cause type 3c diabetes, which differs from type 1 and 2, usually needs tablets or insulin, and is managed by a diabetes nurse and specialist dietitian who know you have pancreatic cancer; a systematic review found new diabetes in about 16 in 100 people after a Whipple operation, and removing the whole pancreas means insulin for life. If you take insulin, tell the DVLA before driving. Ask both questions at the first appointment: they are the most fixable causes of feeling terrible. ([Cancer cachexia](https://onco.cc/terms/cachexia/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/), [Enzyme](https://onco.cc/terms/enzyme/), [Nutrition impact symptoms](https://onco.cc/terms/nutrition-impact-symptoms/))
- Feeding and weight: Most people with pancreatic cancer lose appetite and weight (Cancer Research UK), and the loss has two parts: undigested food, which enzymes fix, and the cancer's own effect on appetite and muscle (cachexia), which needs a dietitian early. Cancer Research UK says most pancreatic teams include a dietitian, and its advice is small frequent meals, high-calorie and high-protein snacks and full-fat versions, prescribed supplement drinks sipped through the day (with enzymes, and checked against diabetes), and eating what you feel like rather than what you think you should. Pancreatic Cancer UK says there is no special diet and no foods to avoid, and not to cut fat but to take more PERT with it. Medicines for appetite: Macmillan says steroids or an appetite stimulant may help for a time; the ASCO cachexia guideline recommends dietary counselling and says no drug is established. NICE NG85 says do not offer fish oils to manage weight loss in unresectable disease, and after a Whipple operation to offer early feeding by mouth or tube rather than into a vein when the gut works. With a duodenal stent: soft, moist, lower-fibre foods, little and often, chewed well, upright after eating. Weight and muscle are also what decide whether chemotherapy can be given on time and in full, so ask for the referral in the first weeks, not when the weight has gone. ([Cancer cachexia](https://onco.cc/terms/cachexia/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Enteral and parenteral nutrition support](https://onco.cc/technologies/enteral-parenteral-nutrition/), [Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)](https://onco.cc/terms/malnutrition-screening/), [Duodenal stenting and gastrojejunostomy for malignant gastric outlet obstruction](https://onco.cc/terms/duodenal-stenting-gastric-outlet/))
- A clinical trial or standard treatment: At every stage a trial can be a reasonable choice beside standard treatment, and in pancreatic cancer it is where the next answers are coming from: NICE NG85 itself places chemotherapy before surgery for resectable or borderline disease within trials, Cancer Research UK says your doctor may offer a trial for borderline disease because the best treatment is uncertain, and the record's pipeline is led by RAS inhibitors (daraxonrasib after first-line chemotherapy in RASolute 302, G12D-selective drugs, vaccines) that Pancreatic Cancer UK describes as a promising group of treatments. Ask what the comparison arm is, whether a placebo is used (the NHS says only where no proven treatment exists), whether a biopsy or tumour gene test is needed to qualify and whether tissue already taken can be used, what extra visits, scans and travel are involved and whether costs are paid, and what happens to your standard treatment if you leave; the NHS says you can leave at any time without giving a reason and without it affecting your care. Pancreatic Cancer UK has a trial finder and its nurses can talk through what a trial would mean for you. ([Daraxonrasib](https://onco.cc/drugs/daraxonrasib/), [RASolute 302](https://onco.cc/trials/rasolute-302/), [PRECEDE](https://onco.cc/trials/precede/), [Pancreatic Cancer Action Network (PanCAN)](https://onco.cc/collections/pancan/))
- Palliative care early, alongside treatment: Palliative care is symptom control and support, not a stage; Pancreatic Cancer UK says these services are not just for the end of life and are available at any point for cancer that cannot be cured, and a randomised trial (Temel 2010) found early palliative care alongside cancer treatment improved quality of life and mood. In pancreatic cancer the reasons to involve the team early are concrete: pain that may need a nerve block, sickness from a slow or blocked stomach, itch from jaundice, poor appetite and weight loss, fatigue, low mood, sleep, and the practical side (a written plan with numbers to ring at night, help at home, district nurses, a hospice's day services, money and work). The NHS says people whose cancer cannot be cured are referred to the palliative care or symptom control team, which works with you, your GP and the clinical nurse specialist, and that this team can help your loved ones too. NICE NG85 asks teams to assess the psychological impact of fatigue, pain, gut symptoms, nutrition, anxiety and depression throughout care. It is also the place to talk about what matters most to you and to record your wishes (advance care planning) while you are well enough to do it in your own words; Pancreatic Cancer UK's end of life pages, Marie Curie and Maggie's cover the conversations, and Pancreatic Cancer UK's nurses can be reached by phone, email or WhatsApp. ([Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Cancer pain management](https://onco.cc/technologies/pain-management/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Emotional support and helplines (UK)](https://onco.cc/terms/emotional-support-cancer-uk/), [Cognitive behavioural therapy for fatigue and distress](https://onco.cc/technologies/cbt-fatigue-distress/))
- Resectable disease: upfront surgery or neoadjuvant treatment: Upfront pancreatoduodenectomy or distal pancreatectomy followed by six months of adjuvant chemotherapy remains the reference for clearly resectable tumours: NORPACT-1 found 18-month survival 60 percent with neoadjuvant FOLFIRINOX against 73 percent with surgery first, SWOG S1505 found two-year survival of 47 to 48 percent with either perioperative regimen (no better than adjuvant history), and NEONAX missed its 18-month disease-free target in both arms. In favour of treating first: PREOPANC-1's neoadjuvant gemcitabine chemoradiotherapy gave five-year survival 20.5 against 6.5 percent (hazard ratio 0.73) across resectable and borderline patients, and PREOPANC-2 found neoadjuvant FOLFIRINOX and neoadjuvant chemoradiotherapy equivalent (21.9 against 21.3 months). Alliance A021806 (358 patients, perioperative against adjuvant modified FOLFIRINOX, primary completion December 2028) and PREOPANC-3 (378 patients) will settle the question; NICE NG85 restricts neoadjuvant therapy to trials (1.8.1, 1.8.2). ([Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [NORPACT-1](https://onco.cc/trials/norpact-1/), [SWOG S1505](https://onco.cc/trials/swog-s1505/), [NEONAX](https://onco.cc/trials/neonax/), [PREOPANC-1](https://onco.cc/trials/preopanc/), [PREOPANC-2](https://onco.cc/trials/preopanc-2/), [Alliance A021806](https://onco.cc/trials/alliance-a021806/), [PREOPANC-3](https://onco.cc/trials/preopanc-3/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/))
- Adjuvant chemotherapy after resection: Modified FOLFIRINOX for six months in fit patients (PRODIGE 24: median overall survival 53.5 against 35.5 months with gemcitabine, hazard ratio 0.68, five-year survival 43.2 against 31.4 percent). Gemcitabine plus capecitabine for those not eligible (ESPAC-4: 28.0 against 25.5 months, hazard ratio 0.82; long-term 31.6 against 28.4 months, and 49.9 against 32.2 months after R0 resection); this is the NICE NG85 recommendation for England (1.8.6, off-label). Gemcitabine alone for the frail (CONKO-001: five-year survival 20.7 against 10.4 percent with observation; NG85 1.8.7). S-1 for six months in Japan (JASPAC 01: five-year survival 44.1 against 24.4 percent with gemcitabine, hazard ratio 0.57), not licensed for this use in Europe. Nab-paclitaxel with gemcitabine missed its primary endpoint (APACT) and is not a standard. Start within 12 weeks of surgery once recovered. ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [ESPAC-4](https://onco.cc/trials/espac-4/), [CONKO-001](https://onco.cc/trials/conko-001/), [Tegafur, gimeracil and oteracil (S-1)](https://onco.cc/drugs/tegafur-gimeracil-oteracil/), [JASPAC 01](https://onco.cc/trials/jaspac-01/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [APACT](https://onco.cc/trials/apact/))
- Borderline resectable disease: Neoadjuvant chemotherapy for two to four months, then restaging and surgery: ESPAC-5 (90 patients, UK and Germany) found one-year survival 39 percent with immediate surgery against 78 percent after gemcitabine plus capecitabine, 84 percent after FOLFIRINOX and 60 percent after chemoradiotherapy. Alliance A021501 established modified FOLFIRINOX alone as the reference regimen (18-month survival 66.7 percent, median 29.8 months) after its stereotactic radiotherapy arm closed at interim analysis for fewer R0 resections (10 against 17 of the first 30). PREOPANC-1 and PREOPANC-2 included borderline patients with the same conclusions as above. NICE NG85 still asks for neoadjuvant therapy to be given within a trial (1.8.1). ([ESPAC-5](https://onco.cc/trials/espac-5/), [Alliance A021501](https://onco.cc/trials/alliance-a021501/), [PREOPANC-1](https://onco.cc/trials/preopanc/), [PREOPANC-2](https://onco.cc/trials/preopanc-2/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [CA 19-9](https://onco.cc/terms/ca19-9/))
- Locally advanced unresectable disease: chemotherapy, chemoradiation, stereotactic radiotherapy and ablation: Four to six months of modified FOLFIRINOX or gemcitabine plus nab-paclitaxel (NEOLAP: conversion to resection in 36 to 44 percent of randomised patients with either sequence, median survival 18.5 to 20.7 months). Chemoradiotherapy after induction improves local control but not survival: LAP07 (15.2 against 16.5 months; local progression 32 against 46 percent), CONKO-007 (R0 resection 25 against 18 percent overall, not significant; 69 against 50 percent among those operated; survival hazard ratio 0.94). When it is used, capecitabine is the radiosensitiser (SCALOP: median survival 15.2 against 13.4 months with gemcitabine; NG85 1.9.3). Stereotactic radiotherapy and irreversible electroporation are options in centres with experience: CROSSFIRE (68 patients after FOLFIRINOX) found MRI-guided stereotactic radiotherapy and electroporation equivalent (16.1 against 12.5 months, hazard ratio 1.39, stopped for futility), and PANFIRE-2 (50 patients) reported median survival 17 months from diagnosis with major complications in 42 percent. Tumour treating fields added to gemcitabine plus nab-paclitaxel are approved in the United States (PANOVA-3). ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [NEOLAP](https://onco.cc/trials/neolap/), [LAP07](https://onco.cc/trials/lap07/), [CONKO-007](https://onco.cc/trials/conko-007/), [SCALOP](https://onco.cc/trials/scalop/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [MR-guided adaptive radiotherapy](https://onco.cc/technologies/mr-linac/), [Irreversible electroporation (NanoKnife)](https://onco.cc/technologies/irreversible-electroporation/), [CROSSFIRE](https://onco.cc/trials/crossfire/), [PANFIRE-2](https://onco.cc/trials/panfire-2/), [PANOVA-3](https://onco.cc/trials/panova-3/), [Optune / Optune Pax (TTFields)](https://onco.cc/drugs/optune/))
- Metastatic disease, first line: FOLFIRINOX for performance status 0 to 1 (PRODIGE 4/ACCORD 11: median overall survival 11.1 against 6.8 months with gemcitabine, hazard ratio 0.57; febrile neutropenia 5.4 percent) or NALIRIFOX (NAPOLI 3: 11.1 against 9.2 months with nab-paclitaxel and gemcitabine, hazard ratio 0.83 in the Lancet report and 0.84 on the Onivyde label; FDA approval 13 February 2024, EU indication listed; NICE appraisal TA1052 terminated on 2 April 2025 without a company submission). Gemcitabine plus nab-paclitaxel for those less fit or with biliary stents (MPACT: 8.5 against 6.7 months, hazard ratio 0.72; grade 3 or worse neuropathy 17 percent); in England only when other combinations are unsuitable (NICE TA476). Gemcitabine alone for the frail. Four months of FOLFIRINOX then fluorouracil and leucovorin maintenance is an alternative to six months (PANOPTIMOX-PRODIGE 35: six-month progression-free survival 42.9 against 47.1 percent, survival without quality-of-life deterioration 11.4 against 7.2 months). Germline and tumour testing at diagnosis (BRCA, PALB2, mismatch repair, KRAS subtype, NRG1 and NTRK fusions) steers maintenance and later lines. ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [PRODIGE 4 / ACCORD 11](https://onco.cc/trials/prodige-4-accord-11/), [NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/), [NAPOLI 3](https://onco.cc/trials/napoli-3/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [MPACT](https://onco.cc/trials/mpact/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [PANOPTIMOX-PRODIGE 35](https://onco.cc/trials/panoptimox-prodige-35/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Performance status (ECOG, Karnofsky)](https://onco.cc/terms/performance-status/))
- Metastatic disease, second line: Daraxonrasib after one prior line (RASolute 302: median overall survival 13.2 against 6.7 months with chemotherapy, hazard ratio 0.40; progression-free 7.2 against 3.6 months; FDA approval 26 August 2026 for metastatic pancreatic adenocarcinoma after one systemic therapy or for people not fit for multi-agent chemotherapy; no EU or UK decision). Otherwise switch backbone: after gemcitabine, liposomal irinotecan with fluorouracil and leucovorin (NAPOLI-1: 6.1 against 4.2 months, hazard ratio 0.67; FDA 2015, EU 2016, not recommended by NICE TA440) or OFF (CONKO-003: 5.9 against 3.3 months, hazard ratio 0.66), noting that PANCREOX found modified FOLFOX6 worse than fluorouracil alone; after FOLFIRINOX, gemcitabine plus nab-paclitaxel. NG85 recommends oxaliplatin-based or gemcitabine-based second line (1.9.7, 1.9.8). Pegilodecakin (SEQUOIA) and eryaspase (TRYbeCA-1) failed here. ([Daraxonrasib](https://onco.cc/drugs/daraxonrasib/), [RASolute 302](https://onco.cc/trials/rasolute-302/), [Liposomal irinotecan](https://onco.cc/drugs/liposomal-irinotecan/), [NAPOLI-1](https://onco.cc/trials/napoli-1/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [CONKO-003 (OFF)](https://onco.cc/trials/conko-003/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [SEQUOIA](https://onco.cc/trials/sequoia/), [TRYbeCA-1](https://onco.cc/trials/trybeca-1/))
- Maintenance after first-line platinum: germline BRCA carriers: Olaparib 300 mg twice daily for people with a germline BRCA1 or BRCA2 mutation whose metastatic disease has not progressed after at least 16 weeks of platinum chemotherapy (POLO: progression-free survival 7.4 against 3.8 months, hazard ratio 0.53; overall survival 19.0 against 19.2 months, hazard ratio 0.83, not significant; three-year survival 33.9 against 17.8 percent; FDA approval 2019, EU indication listed; NICE appraisal TA750 terminated on 8 December 2021 without a company submission). Continued chemotherapy, or fluorouracil and leucovorin maintenance after FOLFIRINOX (PANOPTIMOX), are the alternatives for everyone else. About 2 to 3 percent of unselected patients carry a germline BRCA1 or BRCA2 variant (Hu 2018, 3,030 patients: BRCA2 1.9 percent, BRCA1 0.6 percent), more in familial disease; 7.5 percent of the 3,315 screened for POLO carried one and 154 were randomised. ([Olaparib](https://onco.cc/drugs/olaparib/), [POLO](https://onco.cc/trials/polo/), [Germline BRCA mutation (gBRCA)](https://onco.cc/terms/gbrca-mutation/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [PARP inhibitors](https://onco.cc/technologies/parp-inhibitor/), [PANOPTIMOX-PRODIGE 35](https://onco.cc/trials/panoptimox-prodige-35/), [Platinum-sensitive / platinum-resistant](https://onco.cc/terms/platinum-sensitivity/))
- Targeted and biomarker-directed therapy: RAS: daraxonrasib works across RAS G12 mutations (91.8 percent of RASolute 302) and is approved regardless of subtype; KRAS G12C (1 to 2 percent of tumours) responds to sotorasib (CodeBreaK 100 pancreatic cohort, 38 patients: response 21 percent, median survival 6.9 months) and adagrasib (KRYSTAL-1: 7 of 21 responses), which NCCN lists but no regulator has approved for pancreatic cancer; KRAS G12D (about 40 percent) has zoldonrasib in phase 3 first line (RASolute 305 with chemotherapy, RASolute 309 with daraxonrasib) after MRTX1133 was stopped. NRG1 fusions (KRAS wild-type tumours): zenocutuzumab (eNRGy: response 42 percent in 36 pancreatic patients; FDA accelerated approval 4 December 2024; not authorised in the EU). Mismatch repair deficiency (about 1 percent): pembrolizumab (KEYNOTE-158 pancreatic cohort: 4 of 22 responses, 18 percent) or dostarlimab under tumour-agnostic US approvals; NICE TA914 does not cover pancreatic cancer. NTRK fusions: larotrectinib (NICE TA630, Cancer Drugs Fund) or entrectinib (TA644 replaced by the terminated TA1118); repotrectinib after resistance. BRAF V600E: dabrafenib plus trametinib. Erlotinib with gemcitabine is licensed for metastatic disease in the US and EU but added under two weeks in its pivotal trial and nothing in later trials, and is not used. ([Daraxonrasib](https://onco.cc/drugs/daraxonrasib/), [Sotorasib](https://onco.cc/drugs/sotorasib/), [CodeBreaK 100 (pancreatic cancer cohort)](https://onco.cc/trials/codebreak-100/), [Adagrasib](https://onco.cc/drugs/adagrasib/), [Phase 1/2 Study of MRTX849 in Patients With Cancer Having a KRAS G12C Mutation KRYSTAL-1](https://onco.cc/trials/nct03785249/), [Zoldonrasib](https://onco.cc/drugs/zoldonrasib/), [Study of Zoldonrasib + Chemo of Investigator's Choice vs Placebo + Chemo of Investigator's Choice as First-line Treatment in Metastatic KRAS G12D-muta](https://onco.cc/trials/nct07621718/), [Study of Zoldonrasib (RMC-9805) Plus Daraxonrasib (RMC-6236) Versus Gemcitabine and Nab-Paclitaxel as First-Line Treatment in Metastatic KRAS G12D-Mut](https://onco.cc/trials/nct07805954/), [MRTX1133](https://onco.cc/drugs/mrtx1133/), [Zenocutuzumab](https://onco.cc/drugs/zenocutuzumab/), [A Study of Zenocutuzumab (MCLA-128) in Patients With Solid Tumors Harboring an NRG1 Fusion (eNRGy)](https://onco.cc/trials/nct02912949/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [KEYNOTE-158](https://onco.cc/trials/keynote-158/), [Dostarlimab](https://onco.cc/drugs/dostarlimab/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [Repotrectinib](https://onco.cc/drugs/repotrectinib/), [Dabrafenib + trametinib](https://onco.cc/drugs/dabrafenib-trametinib/), [Erlotinib](https://onco.cc/drugs/erlotinib/), [KRAS mutation subtypes (G12C, G12D, G12V)](https://onco.cc/terms/kras-mutation-subtypes/), [Gene fusion](https://onco.cc/terms/gene-fusion/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/))
- Tumour treating fields for locally advanced disease: Alternating electric fields at 150 kHz worn for at least 18 hours a day through skin arrays, with gemcitabine plus nab-paclitaxel (PANOVA-3, 571 patients: median overall survival 16.2 against 14.2 months, hazard ratio 0.82; pain-free survival 15.2 against 9.1 months; progression-free survival, local control and response not improved; device-related skin events in 76.3 percent, grade 3 in 7.7 percent). FDA approval of Optune Pax in 2026; no NICE appraisal. Open-label design and the modest effect are debated, and the device is not yet part of European guidelines. ([Optune / Optune Pax (TTFields)](https://onco.cc/drugs/optune/), [Tumour treating fields (TTFields)](https://onco.cc/technologies/ttfields/), [PANOVA-3](https://onco.cc/trials/panova-3/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/))
- Vaccines and cellular therapy: trials only: Personalised mRNA neoantigen vaccine: in the 16-patient phase 1, autogene cevumeran after surgery with atezolizumab and modified FOLFIRINOX induced T cells in 8, whose recurrence-free survival was not reached against 13.4 months in non-responders at 3.2 years, with vaccine-induced T cell clones estimated to live 7.7 years; the randomised phase 2 IMCODE003 (260 patients, eight UK sites) is closed to recruitment with disease-free survival due in 2031. Shared KRAS peptide vaccine ELI-002 7P missed its primary endpoint in AMPLIFY-7P (2026). GVAX with CRS-207 failed in ECLIPSE. Claudin 18.2 CAR-T (satricabtagene autoleucel) and mesothelin-directed cells are in early trials. Checkpoint inhibitors alone do not work outside mismatch repair deficient disease. ([Autogene cevumeran](https://onco.cc/drugs/autogene-cevumeran/), [Autogene cevumeran phase 1 in resected pancreatic cancer (Memorial Sloan Kettering)](https://onco.cc/trials/autogene-cevumeran-phase-1/), [A Study of the Efficacy and Safety of Adjuvant Autogene Cevumeran Plus Atezolizumab and mFOLFIRINOX Versus mFOLFIRINOX Alone in Participants With Resected PDAC](https://onco.cc/trials/nct05968326/), [ELI-002 7P](https://onco.cc/drugs/eli-002-7p/), [AMPLIFY-7P](https://onco.cc/trials/amplify-7p/), [ECLIPSE (GVAX pancreas and CRS-207)](https://onco.cc/trials/eclipse/), [CAR-T cell therapy](https://onco.cc/technologies/car-t/), [Personalised neoantigen (mRNA) vaccines](https://onco.cc/technologies/neoantigen-mrna-vaccine/), [Off-the-shelf cancer vaccines](https://onco.cc/technologies/shared-antigen-vaccine/), [Hot vs cold tumours](https://onco.cc/terms/cold-vs-hot/))
- The failed or stopped programmes: Added to chemotherapy without survival benefit in phase 3: pegvorhyaluronidase alfa (HALO-301), pegilodecakin (SEQUOIA), napabucasin (CanStem111P), ibrutinib (RESOLVE), devimistat (AVENGER 500), pamrevlumab (LAPIS), eryaspase (TRYbeCA-1), algenpantucel-L (IMPRESS), erlotinib as adjuvant (CONKO-005, RTOG 0848) and in locally advanced disease (LAP07). Chemoradiotherapy after induction improved local control or R0 rates but not survival (LAP07, CONKO-007), and adjuvant chemoradiotherapy was harmful in ESPAC-1. MRTX1133 (KRAS G12D) was terminated in 2025 and the ELI-002 7P vaccine missed in 2026. Neoadjuvant FOLFIRINOX for clearly resectable disease was not better than surgery first (NORPACT-1) or than chemoradiotherapy (PREOPANC-2), and adjuvant nab-paclitaxel with gemcitabine missed its primary endpoint (APACT). ([Pancreatic cancer: the failed and stopped programmes and why](https://onco.cc/terms/pancreatic-failed-programmes/), [ESPAC-1](https://onco.cc/trials/espac-1/), [HALO 109-301](https://onco.cc/trials/halo-301/), [SEQUOIA](https://onco.cc/trials/sequoia/), [CanStem111P](https://onco.cc/trials/canstem111p/), [RESOLVE](https://onco.cc/trials/resolve/), [AVENGER 500](https://onco.cc/trials/avenger-500/), [LAPIS](https://onco.cc/trials/lapis-trial/), [TRYbeCA-1](https://onco.cc/trials/trybeca-1/), [IMPRESS (algenpantucel-L)](https://onco.cc/trials/impress-trial/), [CONKO-005](https://onco.cc/trials/conko-005/), [LAP07](https://onco.cc/trials/lap07/), [CONKO-007](https://onco.cc/trials/conko-007/), [Study of MRTX1133 in Patients With Advanced Solid Tumors Harboring a KRAS G12D Mutation](https://onco.cc/trials/nct05737706/), [AMPLIFY-7P](https://onco.cc/trials/amplify-7p/), [NORPACT-1](https://onco.cc/trials/norpact-1/), [PREOPANC-2](https://onco.cc/trials/preopanc-2/), [APACT](https://onco.cc/trials/apact/))
- UK access to treatments (NICE, September 2026): Commissioned in England: FOLFIRINOX first line for performance status 0 to 1 and gemcitabine combinations or gemcitabine alone otherwise (NG85 1.9.4 to 1.9.6, several off-label); nab-paclitaxel with gemcitabine only when other combinations are unsuitable (TA476); adjuvant gemcitabine plus capecitabine or gemcitabine (NG85 1.8.6, 1.8.7); oxaliplatin-based or gemcitabine-based second line (1.9.7, 1.9.8); larotrectinib for NTRK fusions through the Cancer Drugs Fund (TA630). Not recommended: liposomal irinotecan with fluorouracil after gemcitabine (TA440). Ended: entrectinib (TA1118 terminated, January 2026). Terminated without a recommendation because the company made no submission: olaparib maintenance for germline BRCA carriers (TA750, December 2021) and NALIRIFOX (TA1052, April 2025). Not appraised: daraxonrasib, zenocutuzumab, tumour treating fields, sotorasib and adagrasib for pancreatic cancer; pembrolizumab for mismatch repair deficient tumours (TA914) does not include pancreatic cancer. Neoadjuvant therapy is trial-only under NG85. ([Pancreatic cancer drugs in England: NICE appraisals and the Cancer Drugs Fund (September 2026)](https://onco.cc/terms/pancreatic-cancer-uk-drug-access/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Liposomal irinotecan](https://onco.cc/drugs/liposomal-irinotecan/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/), [Olaparib](https://onco.cc/drugs/olaparib/), [Daraxonrasib](https://onco.cc/drugs/daraxonrasib/), [Cancer Drugs Fund (England)](https://onco.cc/terms/cancer-drugs-fund/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/))
- Palliation: biliary and duodenal obstruction: Self-expanding metal stent by ERCP for jaundice in unresectable disease and, when drainage is needed before surgery, in resectable disease (NG85 1.7.3 to 1.7.5); metal stents stay open 4.45 months longer than plastic with fewer cholangitis episodes and re-interventions (Almadi 2017, 20 trials). Endoscopic ultrasound-guided drainage when ERCP fails or is expected to be difficult (Paik 2018; DRA-MBO 2023). Surgery first rather than preoperative drainage in fit resectable patients (1.7.1). For duodenal obstruction, an enteral stent relieves symptoms within days and gastrojejunostomy lasts longer (SUSTENT); choose bypass for people with a better prognosis (1.7.8) and consider prophylactic gastrojejunostomy when a tumour is found unresectable at operation (1.7.6). ([Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia](https://onco.cc/terms/pancreatic-palliation-obstruction-pain-nutrition/), [Biliary stenting and drainage](https://onco.cc/technologies/biliary-stenting-drainage/), [Stenting (biliary, oesophageal, airway)](https://onco.cc/terms/biliary-stent/), [Obstructive jaundice and biliary obstruction](https://onco.cc/terms/obstructive-jaundice/), [Stent or bypass for jaundice: the choice](https://onco.cc/terms/stent-or-bypass-for-jaundice/), [Biliary stent problems: blockage and infection](https://onco.cc/terms/biliary-stent-problems/), [Cholangitis: infection of a blocked bile duct](https://onco.cc/terms/acute-cholangitis/), [Endoscopic ultrasound and EBUS systems](https://onco.cc/technologies/endoscopic-ultrasound-systems/))
- Palliation: pain, digestion, weight loss and thrombosis: Opioid analgesia with endoscopic ultrasound-guided or percutaneous coeliac plexus block for uncontrolled pain, opioid side effects or escalating doses (NG85 1.5.1; Wyse 2011 randomised trial: pain scores lower at three months, no survival effect); no thoracic splanchnicectomy (1.5.2). Enteric-coated pancreatin with every meal for everyone with unresectable disease and around surgery (1.6.1, 1.6.2); no fish oils for weight loss (1.6.3); early enteral rather than parenteral nutrition after pancreatoduodenectomy (1.6.4). Dietetic review and early palliative care from diagnosis. Cachexia drugs are in trials (ponsegromab, seven UK sites). Thromboprophylaxis is decided by risk score under the NICE venous thromboembolism guideline; in CASSINI's pancreatic subgroup rivaroxaban cut clots during treatment (3.7 against 10.1 percent) but not over 180 days. ([Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia](https://onco.cc/terms/pancreatic-palliation-obstruction-pain-nutrition/), [Pancrelipase (pancreatic enzyme replacement therapy)](https://onco.cc/drugs/pancrelipase/), [Cancer cachexia](https://onco.cc/terms/cachexia/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Cancer-associated thrombosis prevention and treatment](https://onco.cc/technologies/cancer-associated-thrombosis/), [Ponsegromab](https://onco.cc/drugs/ponsegromab/), [A Study to Learn About the Medicine Ponsegromab in Adults With Cancer of the Pancreas Which Has Spread and Caused Significant Body Weight Loss and Fatigue](https://onco.cc/trials/nct06989437/), [Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)](https://onco.cc/terms/malnutrition-screening/))

## State of the art

- First TTFields approval (2026).
- RASolute 302 (2026): first targeted therapy to nearly double survival in pancreatic cancer; daraxonrasib approved by the FDA on 26 August 2026 for previously treated metastatic disease.
- G12D-selective zoldonrasib combinations with 50% response rates in previously treated disease.
- Adjuvant mFOLFIRINOX gives median OS beyond 4 years in resected fit patients.
- High-risk surveillance shifts ~3 in 4 detected cancers to stage I in carriers.
- Personalised mRNA vaccine responders remain recurrence-free for years (autogene cevumeran phase 1).
- Genomic landscape. KRAS mutation in 88 to 94% (G12D about 40%, G12V about 32%, G12R about 16%, Q61 about 7%, G12C 1 to 2%), TP53 66 to 76%, CDKN2A loss 37 to 48%, SMAD4 loss 17 to 33%; the 6 to 12% of KRAS wild-type tumours carry the fusions and alternative drivers instead, and 4 to 10% of patients carry a germline susceptibility variant. Every figure and its cohort is in the molecular table; the full account is in the notes on the Data page.
- Transcriptional subtypes. Two survive every re-analysis, classical (GATA6-high) and basal-like or squamous (GATA6-low); in COMPASS basal-like tumours responded to first-line chemotherapy in 10% against 33% and lived 5.9 against 9.3 months, and a GATA6 in situ hybridisation stain calls the subtype with sensitivity 89% and specificity 83%.
- Precursors. More than 99% of the smallest PanIN-1 lesions already carry KRAS, CDKN2A, GNAS or BRAF mutations, IPMNs carry GNAS R201 in 66%, and the classical KRAS-CDKN2A-TP53-SMAD4 ladder is only part of the story: two-thirds of genomes show punctuated rearrangements that knock out several drivers at once.
- Stroma and immunity. The desmoplastic stroma limits perfusion but removing it is harmful (depletion made tumours more aggressive in mice; hyaluronidase failed in phase 3), T cells are excluded by CXCL12 from FAP-positive fibroblasts, and every checkpoint trial outside mismatch repair deficiency has failed.
- Monitoring. CA 19-9 has pooled sensitivity 79% and specificity 82%, rises with cholestasis and cannot be made by the roughly 10% of patients who are Lewis-negative; ctDNA predicts recurrence about three months before imaging, but most assays read only KRAS codons 12, 13 and 61 and no approval uses it.
- Early detection, research only. CAPS surveillance of high-risk individuals shifted 57.9% of detected cancers to stage I (median survival 9.8 against 1.5 years); blood tests are not ready (the methylation test reads 16.8% sensitivity at stage I) and new-onset diabetes is the strongest clinical enrichment.
- Testing, in practice. Germline panel testing at diagnosis for every patient, tumour sequencing with RNA for fusions where KRAS reads wild-type, mismatch repair immunohistochemistry, allele-level KRAS reporting because the alleles differ in prognosis and in which inhibitor applies, and GATA6 or a subtype classifier where a trial requires it.

## Open problems

- Resistance to RAS(ON) inhibitors: secondary RAS mutations, RTK bypass, and adaptive feedback are already described; combination strategies are unproven in phase 3.
- Half of patients are too frail for FOLFIRINOX-class regimens; RAS inhibitors may change this but toxicity (rash, stomatitis) is not trivial.
- No population screening; MCED sensitivity for stage I PDAC is low and PPV in average-risk adults is poor.
- Immune exclusion: every checkpoint inhibitor trial has failed outside MSI-H disease; vaccines must overcome a cold microenvironment.
- The dense stroma blocks drug delivery, yet stripping it out made tumours more aggressive in mice and hyaluronidase failed in phase 3 (HALO-301); reprogramming rather than depleting the stroma is unproven in patients.
- Access: RAS inhibitors and TTFields will be expensive; global disparities will widen.
- Emergency presentation: 45 percent of English cases (2019) and 60.9 percent of US Veterans Affairs cases (2026) are diagnosed as emergencies, with more advanced stage and higher mortality; the symptom-based referral rules (NG12) catch a minority.
- Enzyme replacement reaches a minority: only 21.7 percent of 4,554 UK patients in primary care records received pancreatic enzyme replacement therapy, and supplies were disrupted in 2024 (NG85 note), although it is a NICE recommendation for every unresectable patient.
- The 1 mm margin rule is not used everywhere, so R0 and R1 rates and their survival differences are not comparable between series or trials (Strobel 2017).
- Surveillance of mutation-negative familial kindreds found no cancers in the Dutch programme and few in EUROPAC, while carriers of CDKN2A and other genes have substantial yields; who to watch, and when to stop, is unresolved.
- Neither the new-onset diabetes score (3.6 percent prevalence among high scorers) nor carrier surveillance (7 of 9 CAPS5 cancers at stage I) has been tested prospectively at population scale, and CA 19-9 cannot be read in the Lewis-negative tenth of patients; four in five patients still present with disease that cannot be removed.
- Two perioperative trials (PREOPANC-3, Alliance A021806) are the only ones comparing chemotherapy before and after surgery with the current adjuvant standard; until they read out, neoadjuvant treatment for clearly resectable disease rests on secondary endpoints.
- Enzyme replacement reached 21.7 percent of UK patients in primary care data and cachexia has a mechanism-based drug in phase 2 but no phase 3; both determine whether combination chemotherapy is delivered, and both sit outside the trials that set the standards.
- Whether chemotherapy should be given before surgery for clearly resectable tumours is still unanswered after NORPACT-1, PREOPANC-2, SWOG S1505 and NEONAX; Alliance A021806 (primary completion December 2028) and PREOPANC-3 are the only trials comparing perioperative chemotherapy with the current adjuvant standard, and until they read out neoadjuvant treatment for clearly resectable disease rests on secondary endpoints.
- Radiotherapy has improved local control (LAP07) and R0 rates (CONKO-007) without lengthening life, and stereotactic radiotherapy and irreversible electroporation were equivalent in CROSSFIRE; no trial has shown that local ablation after chemotherapy extends survival in locally advanced disease.
- Daraxonrasib is approved in the United States only after first-line chemotherapy; RASolute 303 (first line, six UK sites) and RASolute 304 (adjuvant, six UK sites) will show whether it belongs earlier, and no European regulator or NICE decision existed on 24 September 2026.
- In England the newest options (NALIRIFOX, olaparib maintenance, daraxonrasib, zenocutuzumab, tumour treating fields) have no NICE recommendation (the olaparib and NALIRIFOX appraisals, TA750 and TA1052, were terminated when the companies made no submission; the rest have not been appraised) and liposomal irinotecan after gemcitabine is not recommended, so the funded pathway is FOLFIRINOX, gemcitabine combinations and gemcitabine plus capecitabine after surgery.
- Supportive treatments that most patients need, enzyme replacement, coeliac plexus block, stents and cachexia drugs, rest on small or observational studies; the one randomised trial of enzyme replacement was negative on its primary endpoint, cachexia has a mechanism-based drug (ponsegromab) in phase 2 but no phase 3, and both sit outside the trials that set the standards even though they decide whether combination chemotherapy is delivered.
- Homologous recombination deficiency in pancreatic cancer is wider than germline BRCA (somatic, PALB2 and signature-defined cases all respond to platinum) yet the only PARP inhibitor label is germline BRCA after platinum, and no genomic instability score has a pancreatic threshold.
- Transcriptional subtype predicts chemotherapy response retrospectively and a GATA6 stain can call it, but no prospective subtype-directed trial has changed a guideline and basal-like patients still receive the regimen they resist.
- Mutant KRAS allele and copy number change prognosis and drug choice, but routine reporting is often 'KRAS mutant' without the allele, and plasma assays that read only codons 12, 13 and 61 miss the wild-type minority in which the actionable fusions live.
- CA 19-9 cannot be produced by about a tenth of patients, whose outlook is as poor as the highest-marker group, so a normal marker is a false reassurance that no guideline yet corrects with Lewis genotyping.

## Notes

- Is pancreatic cancer the same as pancreatic ductal adenocarcinoma? Almost always: about 80 percent of pancreatic cancers are ductal adenocarcinomas (Cancer Research UK types page), and this record describes that disease. The rarer types (acinar cell carcinoma, the cystic tumours and the carcinomas that arise in them, solid pseudopapillary neoplasm, pancreatoblastoma) and the neuroendocrine tumours of the islets each have a page linked from this one and behave differently.
- How common is it? 531,318 new cases and 490,786 deaths a year worldwide (GLOBOCAN 2024), 11,479 cases and about 10,200 deaths a year in the UK, where it is the 10th commonest cancer but the 5th commonest cause of cancer death (Cancer Research UK), and 67,530 cases and 52,740 deaths projected in the United States for 2026, where it is the third leading cause of cancer death (SEER). The UK lifetime risk is about 1 in 55 to 1 in 59.
- Is it getting more common? Yes. UK incidence rates are up 21 percent since the early 1990s and 7 percent in the last decade, and the count is projected to reach about 16,000 a year by 2038 to 2040 (Cancer Research UK); incidence rose in 14 of 48 countries for men and 17 for women over a decade (Huang 2021); and in the United States it is projected to be the second leading cause of cancer death by 2040 (Rahib 2021). Ageing populations, obesity and diabetes are the usual explanations; mortality rates have not fallen because treatment gains have been small until recently.
- What raises the risk? Age above all (median 71 in the United States). Smoking doubles the risk (2.2 times for current smokers, back to normal 20 years after quitting) and causes 22 percent of UK cases; obesity carries about 1.5 times the risk and causes 12 percent; type 2 diabetes about 1.8 to 1.9 times; chronic pancreatitis about 8 times at five years; a first-degree relative with the disease 1.6 to 1.8 times; alcohol at 3 or more units a day 15 to 19 percent more (Bosetti 2012; Genkinger 2011; Huxley 2005; Ben 2011; Kirkegard 2017; Cancer Research UK). About 5.5 percent of patients carry an inherited variant in ATM, BRCA2, BRCA1, CDKN2A, TP53 or MLH1, most without a family history (Hu 2018; Shindo 2017).
- I have just been told I have diabetes. Should I worry? For most people, no: about 1 in 100 adults who develop diabetes after 50 is diagnosed with pancreatic cancer within three years (Chari 2005). But new diabetes with weight loss rather than weight gain, or diabetes that suddenly becomes hard to control, is a recognised warning sign: NICE NG12 lists new-onset diabetes with weight loss at 60 or over as a reason for an urgent CT, and research scores such as ENDPAC use weight change, glucose change and age to pick out the small group who need a scan (Sharma 2018).
- Why is it found so late? The early tumour causes no symptoms; when symptoms come they are vague (back pain, indigestion, weight loss) unless the tumour blocks the bile duct and causes jaundice, which is why head tumours are found earlier than body and tail tumours. In England in 2019, 45 percent of cases were diagnosed after an emergency presentation and only 22 percent through an urgent suspected cancer referral; only about a quarter are stage I or II at diagnosis (Cancer Research UK). In the SYMPTOM study no first symptom distinguished people who turned out to have cancer from those who did not (Walter 2016).
- Which tests will I have? A pancreatic protocol CT first (before any stent if you are jaundiced), then PET-CT and or endoscopic ultrasound with a needle sample if the diagnosis is unclear, blood tests including CA 19-9, and, if surgery is possible, sometimes MRI of the liver or a keyhole look inside the abdomen (NICE NG85 1.1 and 1.3). A biopsy is often not needed before surgery when the scan is clear (Cancer Research UK). Everyone should be offered a genetic (germline) test.
- What do resectable, borderline resectable and locally advanced mean? They describe how the tumour sits against the arteries and veins behind the pancreas on the CT scan, and they decide whether surgery comes first, after chemotherapy, or not at all: resectable means no arterial contact and limited venous contact; borderline resectable means arterial contact of less than 180 degrees or venous involvement the surgeon can reconstruct (or a very high CA 19-9, or uncertain spread, or poor fitness); locally advanced means the tumour encases an artery or blocks a vein beyond repair (Isaji 2018; NCCN). The stage number (1 to 4) is a separate description of size, nodes and spread.
- What does an R1 margin on my pathology report mean? In the UK, cancer cells within 1 mm of the cut edge of the removed tissue, even if not touching it (Royal College of Pathologists; Campbell 2009). Reported this way, most head-of-pancreas resections are R1 (76 to 85 percent in the studies that introduced the rule) because the tumour spreads along nerves and vessels behind the gland; it does not mean the operation failed, and adjuvant chemotherapy is given whatever the margin. Direct involvement of a margin carries a worse outlook than involvement within 1 mm (Ghaneh 2019).
- Should my relatives be screened? There is no NHS screening programme for the general population and none is recommended (UK National Screening Committee; the US task force advises against it). Surveillance with yearly MRI/MRCP or endoscopic ultrasound is offered to people with hereditary pancreatitis and a PRSS1 mutation, to carriers of BRCA1, BRCA2, PALB2 or CDKN2A who have an affected first-degree relative, and to Peutz-Jeghers syndrome, and considered for two or more affected first-degree relatives across two generations or Lynch syndrome with an affected relative (NICE NG85 1.1.15 to 1.1.17). In the CAPS programmes 77.8 percent of cancers found under surveillance were stage I and five-year survival was 73.3 percent (Dbouk 2022). Ask the team for a referral to genetics; the trial record for PRECEDE and the EUROPAC registry are linked from this page.
- Why have I been given enzyme capsules? Most pancreatic cancers block the duct that carries digestive enzymes, so fat is not absorbed and weight falls. NICE offers enteric-coated pancreatin to everyone with unresectable disease and considers it before and after surgery (NG85 1.6); in UK primary care records only 21.7 percent of patients received it, and those who did lived longer in a matched comparison (Roberts 2019). Fish oils are not recommended for weight loss (NG85 1.6.3).
- What is the outlook? Averages hide a wide range. Across everyone in the United States 13.7 percent are alive at five years; for the 15 percent found while confined to the pancreas it is 43.6 percent, and resected patients who complete modern adjuvant chemotherapy do better still (the treatment rows carry those trial figures); for distant disease it is 3.4 percent (SEER). In the UK about 25 percent survive one year and about 5 percent ten years (Cancer Research UK). These figures predate the 2026 RAS inhibitor results and are population averages, not a personal prognosis.
- The science in detail, 1 of 7 (the molecular layer; the headline is on the overview). Genomic landscape. KRAS mutation in 88 to 94% (G12D about 40%, G12V about 32%, G12R about 16%, Q61 about 7%, G12C 1 to 2%), TP53 66 to 76%, CDKN2A loss 37 to 48% with CDKN2B and often MTAP, SMAD4 loss 17 to 33%, RNF43 5 to 8%, ARID1A 5 to 9%, KDM6A 3 to 4%, GNAS R201 2 to 4%, MYC amplification 4 to 13%. The 6 to 12% of KRAS wild-type tumours carry the fusions and alternative drivers instead: BRAF mutation 13% and fusion 6.6% of them, FGFR2 5.2%, ALK 2.6%, NRG1 1.3%, RET 1.3%, with MSI-high 4.7% against 0.7%. Germline: BRCA2 1.4 to 2%, ATM 1.2 to 2.3%, BRCA1 0.4 to 1%, PALB2 0.2 to 0.6%, any susceptibility gene 4 to 10% and no family history in most carriers. Homologous recombination deficiency by gene mutation 11 to 19%; mismatch repair deficiency 1 to 2%; TMB 10 or more, 1 to 2%. Every figure and cohort is in the molecular table; the cBioPortal rows were computed on TCGA, QCMG, ICGC, UTSW, CPTAC and the two 2024 MSK cohorts.
- The science in detail, 2 of 7 (the molecular layer; the headline is on the overview). Transcriptional subtypes. Two survive every re-analysis: classical (GATA6-high) and basal-like or squamous (GATA6-low). In COMPASS, basal-like was 20% of 195 advanced patients, with response to first-line chemotherapy 10% against 33%, progression on modified FOLFIRINOX 60% against 15% and median overall survival 5.9 against 9.3 months; a GATA6 in situ hybridisation stain calls the subtype with sensitivity 89% and specificity 83%. Collisson's three, Bailey's four (squamous, progenitor, immunogenic, ADEX) and Puleo's five map onto the same axis; the exocrine-like and ADEX classes were acinar contamination. Subtype is a continuum set by mutant KRAS and GATA6 copy number, about 12% of tumours are hybrids with intermediate survival, and squamous histology is the tissue form of the basal-like signature, often as a subclone.
- The science in detail, 3 of 7 (the molecular layer; the headline is on the overview). Precursors. More than 99% of the smallest PanIN-1 lesions already carry KRAS, CDKN2A, GNAS or BRAF mutations; grading is now two-tier (Baltimore consensus 2015). IPMNs carry GNAS R201 in 66% and RNF43 in most, mucinous cystic neoplasms RNF43 without GNAS, and both are direct precursors, with SMAD4 and TGFBR2 loss marking the invasive step and about three years between high-grade dysplasia and cancer. A cancer beside a cyst is related in 51% of cases and independent in 18%. The classical KRAS-CDKN2A-TP53-SMAD4 ladder is only part of the story: two-thirds of genomes show punctuated, mitotic-error rearrangements that can knock out several drivers at once, and precursor cells travel along the ducts.
- The science in detail, 4 of 7 (the molecular layer; the headline is on the overview). Stroma and immunity. The desmoplastic stroma limits perfusion, but removing it is harmful: depleting myofibroblasts or hedgehog signalling gave more aggressive tumours in mice, and hyaluronidase raised the response rate without changing survival in phase 3. Fibroblasts exist as myofibroblastic, inflammatory and antigen-presenting states, and tissue organises into reactive (immune-hot) and deserted (chemoprotective) neighbourhoods. T cells are excluded by CXCL12 from FAP-positive fibroblasts, and MHC class I is degraded by autophagy. Every checkpoint trial outside mismatch repair deficiency has failed: ipilimumab 0 of 27, anti-PD-L1 0 of 14, durvalumab with or without tremelimumab 3.1% and 0% of 65. The exceptions point the way: long-term survivors have both many high-quality neoantigens and abundant CD8 T cells, and those clones are edited out at metastasis.
- The science in detail, 5 of 7 (the molecular layer; the headline is on the overview). Monitoring. CA 19-9 has pooled sensitivity 79% and specificity 82%, rises with cholestasis, and cannot be made at all by the roughly 10% of patients who are Lewis-negative (FUT3-null), whose median level is 2.4 against 496 U/mL and whose survival matches the worst marker group; a value of 7 U/mL or below identifies them with 95% positive predictive value. Baseline level is prognostic but a 50% fall on treatment is not a valid surrogate for survival. ctDNA is found in 43 to 62% of localised disease before surgery and 37 to 49% after it, predicts recurrence with 90% sensitivity about three months before imaging, and grades risk by allele fraction; most assays read only KRAS codons 12, 13 and 61, and no approval uses it.
- The science in detail, 6 of 7 (the molecular layer; the headline is on the overview). Early detection, research only. CAPS surveillance of high-risk individuals shifted 57.9% of detected cancers to stage I with median overall survival 9.8 against 1.5 years; the consensus starts at 50 or ten years before the youngest affected relative with annual endoscopic ultrasound and MRI. PRECEDE is building the international cohort and biomarker validation under a PROBE design. Blood tests are not ready: CA 19-9 turns up about two years before diagnosis, multi-analyte panels reach 64% sensitivity in resectable disease at 99.5% specificity, and the methylation test reads 16.8% sensitivity at stage I. New-onset diabetes is the strongest clinical enrichment, with about 1% of people over 50 diagnosed within three years and the ENDPAC score giving a 4.4-fold enrichment.
- The science in detail, 7 of 7 (the molecular layer; the headline is on the overview). Testing, in practice. Germline panel testing at diagnosis for every patient (BRCA1, BRCA2, PALB2, ATM, CDKN2A, TP53 and the mismatch repair genes), tumour sequencing with RNA for fusions where KRAS reads wild-type, mismatch repair immunohistochemistry especially for medullary and colloid tumours, allele-level KRAS reporting because the alleles differ in prognosis and in which inhibitor applies, and GATA6 or a subtype classifier where a trial requires it. Homologous recombination scores, ctDNA and TROP2-style expression readouts have no pancreatic label.
- Frequencies marked cBioPortal were computed from the public API on 24 September 2026 on the sequenced sample lists of paad_tcga_pan_can_atlas_2018 (184 samples), paad_qcmg_uq_2016 (383 sequenced), paad_icgc (99), paad_utsw_2015 (109), paad_cptac_2021 (140), pdac_msk_2024 (2,336) and pancreas_msk_2024 (395), as sample-level counts of non-synonymous mutation, high-level amplification, deep deletion or structural variant; they are not the papers' own percentages, which are quoted alongside.
- KRAS allele shares are counts of mutation records over all KRAS mutation records in a study, so a tumour with two KRAS mutations counts twice; the MSK study's own KRAS_VARIANT attribute gives the same ordering. The TCGA deposit reads KRAS in 65% because it keeps the low-cellularity and non-ductal samples the 2017 paper excluded; purified or microdissected cohorts read 92 to 96%.
- Panel and exome figures are not interchangeable: copy-number amplification calls run lower on the MSK panel than on TCGA or UTSW arrays and exomes, and the panel TMB median (about 3 per megabase) is three times the exome median.

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- Pancreatic Cancer UK: managing diabetes if you have pancreatic cancer (type 3c diabetes): https://www.pancreaticcancer.org.uk/information-and-support/managing-symptoms-and-side-effects/diabetes-with-pancreatic-cancer/
- Pancreatic Cancer UK: managing pancreatic cancer pain: https://www.pancreaticcancer.org.uk/information-and-support/managing-symptoms-and-side-effects/managing-pancreatic-cancer-pain/
- Pancreatic Cancer UK: treating jaundice if you have pancreatic cancer: https://www.pancreaticcancer.org.uk/information-and-support/managing-symptoms-and-side-effects/managing-jaundice-if-you-have-pancreatic-cancer/
- Pancreatic Cancer UK: dealing with the emotional impact of pancreatic cancer: https://www.pancreaticcancer.org.uk/information-and-support/dealing-with-pancreatic-cancer/dealing-with-the-emotional-impact-of-pancreatic-cancer/
- Pancreatic Cancer UK: work and money: https://www.pancreaticcancer.org.uk/information-and-support/dealing-with-pancreatic-cancer/daily-life-with-pancreatic-cancer/work-and-money/
- Pancreatic Cancer UK: information for families and friends: https://www.pancreaticcancer.org.uk/information-and-support/support-for-you/information-for-family-members/
- Pancreatic Cancer UK: family history of pancreatic cancer: https://www.pancreaticcancer.org.uk/information-and-support/family-history-of-pancreatic-cancer/
- Pancreatic Cancer UK: current developments in pancreatic cancer treatment: https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/current-developments-in-pancreatic-cancer-treatment/
- Macmillan: managing symptoms of pancreatic cancer: https://www.macmillan.org.uk/cancer-information-and-support/pancreatic-cancer/controlling-symptoms-of-pancreatic-cancer
- Macmillan: chemotherapy for pancreatic cancer: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/chemotherapy-for-pancreatic-cancer
- Macmillan: types of surgery for pancreatic cancer: https://www.macmillan.org.uk/cancer-information-and-support/pancreatic-cancer/types-of-surgery-for-pancreatic-cancer
- Macmillan: questions to ask your healthcare team: https://www.macmillan.org.uk/cancer-information-and-support/treatment/your-treatment-options/questions-to-ask-your-healthcare-team
- Macmillan: advanced cancer: https://www.macmillan.org.uk/cancer-information-and-support/treatment/if-you-have-an-advanced-cancer
- Macmillan: olaparib: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/olaparib
- Macmillan: BRCA1 and BRCA2 genes: https://www.macmillan.org.uk/cancer-information-and-support/worried-about-cancer/causes-and-risk-factors/brca-gene
- Cancer Research UK: treatment options for pancreatic cancer: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/treatment-decisions
- Cancer Research UK: surgery for pancreatic cancer: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/surgery
- Cancer Research UK: chemotherapy for pancreatic cancer: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/chemotherapy
- Cancer Research UK: radiotherapy for pancreatic cancer: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/about-radiotherapy
- Cancer Research UK: controlling symptoms of advanced pancreatic cancer: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/controlling-symptoms
- Cancer Research UK: follow up after treatment for pancreatic cancer: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/follow-up-appointment
- Cancer Research UK: your diet and pancreatic cancer: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/living-with/diet
- Cancer Research UK: coping and support when you have pancreatic cancer: https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/living-with/coping
- ESMO: pancreatic cancer, a guide for patients: https://www.esmo.org/for-patients/patient-guides/pancreatic-cancer
- Marie Curie: what are palliative care and end of life care?: https://www.mariecurie.org.uk/information/getting-care/palliative-care
- Conroy et al., FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer, PRODIGE 4/ACCORD 11 (NEJM 2011): https://doi.org/10.1056/NEJMoa1011923
- Von Hoff et al., increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine, MPACT (NEJM 2013): https://doi.org/10.1056/NEJMoa1304369
- Wainberg et al., NALIRIFOX versus nab-paclitaxel and gemcitabine in treatment-naive metastatic pancreatic cancer, NAPOLI 3 (Lancet 2023): https://doi.org/10.1016/S0140-6736(23)01366-1
- Conroy et al., FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer, PRODIGE 24/CCTG PA6 (NEJM 2018): https://doi.org/10.1056/NEJMoa1809775
- Neoptolemos et al., adjuvant gemcitabine and capecitabine versus gemcitabine alone, ESPAC-4 (Lancet 2017): https://doi.org/10.1016/S0140-6736(16)32409-6
- Golan et al., maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer, POLO (NEJM 2019): https://doi.org/10.1056/NEJMoa1903387
- Versteijne et al., neoadjuvant chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer, PREOPANC long-term results (JCO 2022): https://doi.org/10.1200/JCO.21.02233
- Wyse et al., randomised double-blind trial of early EUS-guided coeliac plexus neurolysis to prevent pain progression in pancreatic cancer (JCO 2011): https://doi.org/10.1200/JCO.2010.32.2750
- Roberts et al., enzyme replacement improves survival among patients with pancreatic cancer, population-based study (Pancreatology 2019): https://doi.org/10.1016/j.pan.2018.10.010
- Phillips et al., consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines (BMJ Open Gastroenterology 2021): https://doi.org/10.1136/bmjgast-2021-000643
- Scholten et al., new-onset diabetes after pancreatoduodenectomy, systematic review and meta-analysis (Surgery 2018): https://doi.org/10.1016/j.surg.2018.01.024
- Roeland et al., management of cancer cachexia, ASCO guideline (JCO 2020): https://doi.org/10.1200/JCO.20.00611
- NHS: clinical trials: https://www.nhs.uk/tests-and-treatments/clinical-trials/
- NHS: genetic and genomic testing: https://www.nhs.uk/tests-and-treatments/genetic-and-genomic-testing/
- Macmillan: sepsis: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/sepsis
- Macmillan: looking after someone with cancer: https://www.macmillan.org.uk/cancer-information-and-support/supporting-someone/looking-after-someone-with-cancer

## Connected records

- roadmaps: [Early detection roadmap: organ screening → blood tests for many cancers](https://onco.cc/roadmaps/early-detection-roadmap/), [KRAS roadmap: undruggable → G12C → pan-RAS](https://onco.cc/roadmaps/kras-roadmap/), [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- collections: [NHS Jewish BRCA Testing Programme](https://onco.cc/collections/nhs-jewish-brca-testing/), [PanCAN Know Your Tumor](https://onco.cc/collections/pancan-know-your-tumor/), [Pancreatic Cancer Action Network (PanCAN)](https://onco.cc/collections/pancan/), [UK specialist HPB cancer centres](https://onco.cc/collections/uk-hpb-specialist-centres/)
- ideas: [A billion-dollar prize for the first durable cure of a lethal metastatic cancer](https://onco.cc/ideas/idea-fund-cure-prize/), [A blood test for the pre-metastatic niche](https://onco.cc/ideas/idea-bio2-premetastatic-niche-assay/), [A dietitian in every gastrointestinal and head and neck tumour board](https://onco.cc/ideas/idea-nl-dietitian-in-every-mdt/), [A fast-track pathway from suspicion to treatment for pancreatic cancer in the NHS, measured from first scan to first treatment](https://onco.cc/ideas/idea-pdac-uk-fast-track-diagnosis-to-treatment-pathway/), [A guaranteed purchase prize for the first drug against a named hard target](https://onco.cc/ideas/idea-bio1-undruggable-market-commitment/), [A permanent neutral non-profit sponsor for multi-company platform trials](https://onco.cc/ideas/idea-fund-neutral-platform-sponsor/), [A perpetual platform trial in every major cancer, funded as infrastructure](https://onco.cc/ideas/idea-tr2-perpetual-platforms/), [A ring-fenced metastasis programme with metastasis-specific endpoints](https://onco.cc/ideas/idea-fund-metastasis-moonshot/), [A standing platform trial for every major cancer, funded as infrastructure](https://onco.cc/ideas/idea-tr1-standing-platform-per-cancer/), [A trial of GLP-1 weight-loss drugs with cancer as the primary outcome](https://onco.cc/ideas/idea-prev-glp1-cancer-prevention-rct/), [AI that spots pancreatic cancer on scans taken a year before diagnosis](https://onco.cc/ideas/idea-prev-pancreas-ai-prediagnostic-ct/), [Anchor a TGF-beta trap in the tumour stroma so it cannot act everywhere](https://onco.cc/ideas/idea-bio2-tumour-anchored-tgfbeta-trap/), [Automatic germline testing for every cancer type where it changes care](https://onco.cc/ideas/idea-prev-reflex-germline-testing/), [Automatic palliative care referral triggered by diagnosis, not by decline](https://onco.cc/ideas/idea-acc-automatic-early-palliative-triggers/), [Block the complement signal that recruits tumour-protecting cells](https://onco.cc/ideas/idea-bio2-complement-c5ar-blockade/), [Blood-based pancreatic cancer detection in new-onset diabetes](https://onco.cc/ideas/idea-mced-new-onset-diabetes/), [Break the neutrophil DNA nets that catch tumour cells after surgery](https://onco.cc/ideas/idea-bio2-net-blockade-perioperative/), [Burden-weighted portfolio targets for every major cancer funder](https://onco.cc/ideas/idea-fund-burden-weighted-portfolio/), [Can MYC be drugged directly, and will patients tolerate it?](https://onco.cc/ideas/idea-drugging-myc/), [Catch wasting early with a smart scale and a step counter](https://onco.cc/ideas/idea-bio2-remote-weight-step-monitoring/), [Chemotherapy before surgery for every resectable pancreatic cancer, settled by the two perioperative trials rather than assumed](https://onco.cc/ideas/idea-pdac-neoadjuvant-chemotherapy-for-all-resectable-disease/), [Clear the suppressive neutrophils out of pancreatic tumours first](https://onco.cc/ideas/idea-bio2-cxcr2-neutrophil-blockade/), [Combine the new anti-wasting antibody with exercise and protein](https://onco.cc/ideas/idea-bio2-gdf15-plus-exercise/), [Competing sponsors share one control arm in the same indication](https://onco.cc/ideas/idea-tr1-shared-control-arms-across-sponsors/), [Confirm low-dose olanzapine for appetite and weight in advanced cancer worldwide](https://onco.cc/ideas/idea-reg-olanzapine-cachexia-global-confirmation/), [Covalent chemistry for the RAS mutations that still have no drug](https://onco.cc/ideas/idea-bio1-pan-ras-covalent-g12d/), [Coverage-with-evidence registries for MR-guided and adaptive radiotherapy](https://onco.cc/ideas/idea-fund-adaptive-radiotherapy-evidence/), [Cure-focused prizes: pay for verified long-term cures, not for drugs](https://onco.cc/ideas/idea-moon-cure-prizes/), [Cut the nerve supply to tumours with old drugs](https://onco.cc/ideas/idea-nerve-tumour-blockade/), [De-acidify the tumour so T cells can work in it](https://onco.cc/ideas/idea-bio2-lactate-acid-axis/), [Dedicated cohorts for patients with performance status 2 in first-line trials](https://onco.cc/ideas/idea-tr1-ecog-2-dedicated-cohorts/), [Embed cachexia treatment in chemotherapy trials: weight, muscle and treatment delivery as co-primary endpoints](https://onco.cc/ideas/idea-pdac-cachexia-trials-embedded-in-chemotherapy-trials/), [Engineered bacteria that live in tumours and manufacture drugs there](https://onco.cc/ideas/idea-bio2-engineered-bacteria-payloads/), [Every routine CT scan checked by AI for early cancer signs, with a tracked follow-up pathway](https://onco.cc/ideas/idea-prev-opportunistic-ct-ai-registry/), [FAP theranostics as a pan-cancer stromal strategy](https://onco.cc/ideas/idea-fap-theranostics-pancancer/), [FAPI PET as the workup for MCED positives](https://onco.cc/ideas/idea-mced-plus-fapi/), [Four weeks of training and nutrition before major cancer surgery, as standard](https://onco.cc/ideas/idea-bio2-prehabilitation-standard/), [Get the one approved appetite drug licensed beyond a single country](https://onco.cc/ideas/idea-bio2-anamorelin-access/), [Glucose monitor data as an early pancreatic cancer signal](https://onco.cc/ideas/idea-prev-cgm-glycaemic-drift-pancreas/), [Grow each trial patient's tumour as organoids to decide which platform arm opens next](https://onco.cc/ideas/idea-tr2-organoid-coclinical-arms/), [In vivo CAR-T against solid-tumour antigens](https://onco.cc/ideas/idea-in-vivo-car-solid/), [Link bariatric and GLP-1 registries to cancer registries in every country that has both](https://onco.cc/ideas/idea-nl-bariatric-cancer-registry-linkage/), [Losartan to loosen the stroma of pancreatic cancer before chemotherapy: a phase 3](https://onco.cc/ideas/idea-reg-losartan-pancreatic-stroma/), [Make bespoke mouse cancer models in weeks with in vivo gene editing](https://onco.cc/ideas/idea-bio1-somatic-crispr-gemms/), [Make every cold tumour hot: a coordinated programme to reprogramme immune-excluded tumours](https://onco.cc/ideas/idea-moon-cold-to-hot-programme/), [Match therapy to the type of scar-forming cell in the tumour](https://onco.cc/ideas/idea-bio2-caf-subtype-assignment/), [mRNA-delivered MYC decoy proteins instead of MYC inhibitors](https://onco.cc/ideas/idea-bio1-omomyc-mrna/), [New diabetes after 50 plus weight loss triggers a pancreatic cancer check](https://onco.cc/ideas/idea-prev-new-onset-diabetes-pancreas-pathway/), [Off-the-shelf KRAS vaccines after pancreatic cancer surgery](https://onco.cc/ideas/idea-shared-kras-vaccine-adjuvant/), [Pancreatic enzyme replacement by default: prescribe at diagnosis, audit the rate, and run the trial that settles survival](https://onco.cc/ideas/idea-pdac-enzyme-replacement-prescribing-by-default/), [Partial lottery funding for good proposals in under-funded cancers](https://onco.cc/ideas/idea-fund-neglected-cancer-lottery/), [Personalised cancer vaccines at commodity cost through fully automated manufacturing](https://onco.cc/ideas/idea-moon-neoantigen-vaccines-at-scale/), [Personalised vaccines given only when the blood test turns positive](https://onco.cc/ideas/idea-bio2-mrd-triggered-neoantigen-vaccine/), [Public risk-adjusted outcome reporting for cancer surgery to drive centralisation](https://onco.cc/ideas/idea-fund-surgical-outcomes-public-reporting/), [Raise the share of UK patients who receive any active treatment, and publish it by trust](https://onco.cc/ideas/idea-pdac-uk-active-treatment-rate-audit-and-target/), [Rapid diagnostic centres for people with vague but worrying symptoms](https://onco.cc/ideas/idea-acc-rapid-diagnostic-centres-vague-symptoms/), [RAS inhibitor combinations and sequence: pan-RAS plus G12D-selective, plus chemotherapy, and what to give after progression](https://onco.cc/ideas/idea-pdac-ras-inhibitor-combinations-and-sequencing/), [RAS(ON) inhibitors to convert unresectable pancreatic cancer to resectable](https://onco.cc/ideas/idea-ras-inhibitor-neoadjuvant-pdac/), [Reprogramme suppressive macrophages instead of trying to delete them](https://onco.cc/ideas/idea-bio2-trem2-myeloid-reprogramming/), [Reprogramme the stroma rather than remove it: second-generation stromal trials with a stromal biomarker and a survival endpoint](https://onco.cc/ideas/idea-pdac-stromal-reprogramming-not-depletion/), [Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers](https://onco.cc/ideas/idea-pdac-new-onset-diabetes-risk-score-pathway/), [Select cachexia trial patients by the hormone driving their wasting](https://onco.cc/ideas/idea-bio2-gdf15-stratified-enrolment/), [Shared concurrent control arms across sponsors' trials in the same setting](https://onco.cc/ideas/idea-tr2-shared-control-network/), [Soften the tissue that new metastases need in order to grow](https://onco.cc/ideas/idea-bio2-matrix-stiffness-prevention/), [Stop watching stable low-risk pancreatic cysts after five years](https://onco.cc/ideas/idea-prev-ipmn-surveillance-stop-rule/), [Surveillance for every germline carrier found by universal testing, inside a registry rather than a research exception](https://onco.cc/ideas/idea-pdac-surveillance-for-every-germline-carrier/), [Test DPYD, UGT1A1 and TPMT/NUDT15 before the first dose, everywhere](https://onco.cc/ideas/idea-tr1-pre-emptive-pharmacogenomic-testing/), [Treat cachexia as a disease: GDF-15 blockade plus anabolic and nutrition bundles](https://onco.cc/ideas/idea-moon-cachexia-as-treatable-disease/), [Treat cachexia before it starts](https://onco.cc/ideas/idea-cachexia-gdf15-prevention/), [Zebrafish avatars for a drug answer within a week](https://onco.cc/ideas/idea-bio1-zebrafish-avatars/)
- cancers: [Adenosquamous carcinoma of the pancreas](https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/), [Ampullary cancer (ampulla of Vater)](https://onco.cc/cancers/ampullary/), [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [BRCA or PALB2-mutant pancreatic ductal adenocarcinoma](https://onco.cc/cancers/brca-palb2-pdac/), [Colloid (mucinous non-cystic) carcinoma of the pancreas](https://onco.cc/cancers/pancreatic-colloid-carcinoma/), [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma)](https://onco.cc/cancers/ipmn-associated-carcinoma/), [KRAS G12C-mutant pancreatic ductal adenocarcinoma](https://onco.cc/cancers/kras-g12c-pdac/), [KRAS wild-type pancreatic ductal adenocarcinoma](https://onco.cc/cancers/kras-wild-type-pdac/), [Locally advanced unresectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/locally-advanced-pdac/), [Metastatic pancreatic ductal adenocarcinoma](https://onco.cc/cancers/metastatic-pdac/), [Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma](https://onco.cc/cancers/msi-high-pdac/), [Mucinous cystic neoplasm of the pancreas with associated invasive carcinoma (MCN-associated carcinoma)](https://onco.cc/cancers/mcn-associated-carcinoma/), [Pancreatic acinar cell carcinoma](https://onco.cc/cancers/pancreatic-acinar-cell-carcinoma/), [Pancreatic neuroendocrine tumours](https://onco.cc/cancers/pancreatic-net/), [Pancreatoblastoma](https://onco.cc/cancers/pancreatoblastoma/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/), [Solid pseudopapillary neoplasm of the pancreas](https://onco.cc/cancers/solid-pseudopapillary-neoplasm/), [Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells](https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/)
- biomarkers: [ALK fusion (ALK-positive)](https://onco.cc/biomarkers/alk-fusion/), [Claudin 18.2 expression (>= 75% of tumour cells, moderate to strong)](https://onco.cc/biomarkers/cldn18-2-expression/), [ctDNA MRD positivity (molecular residual disease after curative treatment)](https://onco.cc/biomarkers/ctdna-mrd-positive/), [dMMR (mismatch repair deficiency by IHC)](https://onco.cc/biomarkers/dmmr-ihc/), [Germline BRCA1/2 pathogenic variant (gBRCAm)](https://onco.cc/biomarkers/brca-germline/), [HRD-positive (genomic instability score)](https://onco.cc/biomarkers/hrd-positive/), [KRAS G12C](https://onco.cc/biomarkers/kras-g12c/), [KRAS G12D (and other non-G12C KRAS mutations)](https://onco.cc/biomarkers/kras-g12d/), [MSI-high (microsatellite instability by PCR or sequencing)](https://onco.cc/biomarkers/msi-high/), [NRG1 gene fusion](https://onco.cc/biomarkers/nrg1-fusion/), [NTRK1/2/3 gene fusion](https://onco.cc/biomarkers/ntrk-fusion/), [TMB-high (tumour mutational burden >= 10 mutations per megabase)](https://onco.cc/biomarkers/tmb-high/), [Tumour (somatic or germline) BRCA1/2 mutation and HRR gene alterations](https://onco.cc/biomarkers/brca-somatic/)
- technologies: [Asking people how they are, every week, as a treatment in its own right](https://onco.cc/technologies/rejuv-measure-epro-as-treatment/), [Bacterial vector cancer vaccines](https://onco.cc/technologies/bacterial-vector-vaccines/), [Bariatric surgery and cancer incidence](https://onco.cc/technologies/bariatric-surgery-cancer-incidence/), [Biliary stenting and drainage](https://onco.cc/technologies/biliary-stenting-drainage/), [Bispecific antibodies](https://onco.cc/technologies/bispecific-antibody/), [Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine](https://onco.cc/technologies/cachexia-appetite-pharmacotherapy/), [Cachexia-directed therapy (GDF-15 blockade)](https://onco.cc/technologies/cachexia-therapy/), [Cancer neuroscience: cutting the nerve supply](https://onco.cc/technologies/nerve-tumour-denervation/), [Cancer pain management](https://onco.cc/technologies/pain-management/), [Cancer-associated thrombosis prevention and treatment](https://onco.cc/technologies/cancer-associated-thrombosis/), [CAR-T against stroma: fibroblasts and myeloid cells](https://onco.cc/technologies/stroma-directed-car/), [CAR-T cell therapy](https://onco.cc/technologies/car-t/), [Carbon-ion synchrotrons and facilities](https://onco.cc/technologies/carbon-ion-synchrotrons/), [Carbon-ion therapy](https://onco.cc/technologies/carbon-ion/), [CD40 agonist antibodies](https://onco.cc/technologies/cd40-agonists/), [Cell-free DNA methylation tests](https://onco.cc/technologies/cfdna-methylation-testing/), [Cognitive behavioural therapy for fatigue and distress](https://onco.cc/technologies/cbt-fatigue-distress/), [CT (computed tomography)](https://onco.cc/technologies/ct/), [CT body composition and sarcopenia measurement](https://onco.cc/technologies/ct-body-composition-sarcopenia/), [CyberKnife robotic radiosurgery](https://onco.cc/technologies/cyberknife/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Depression during and after cancer: the interview-based prevalence, and the care model that works](https://onco.cc/technologies/rejuv-mind-depression-after-cancer/), [DNA methylation profiling](https://onco.cc/technologies/methylation-profiling/), [DPYD genotyping and DPD phenotyping before fluoropyrimidines](https://onco.cc/technologies/dpyd-genotyping/), [Dual-energy and spectral CT](https://onco.cc/technologies/dual-energy-spectral-ct/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Elastography and contrast-enhanced ultrasound](https://onco.cc/technologies/ultrasound-elastography-ceus/), [Electrochemotherapy devices (Cliniporator)](https://onco.cc/technologies/electrochemotherapy-devices/), [Endoscopic ultrasound and EBUS systems](https://onco.cc/technologies/endoscopic-ultrasound-systems/), [Engineered bacteria as living cancer drugs](https://onco.cc/technologies/engineered-bacteria-therapy/), [Engineered exosomes as drug carriers](https://onco.cc/technologies/exosome-therapeutics/), [Enhanced recovery (ERAS) and perioperative nutrition](https://onco.cc/technologies/eras-perioperative-nutrition/), [Enteral and parenteral nutrition support](https://onco.cc/technologies/enteral-parenteral-nutrition/), [Exercise during chemotherapy and radiotherapy](https://onco.cc/technologies/exercise-during-chemotherapy/), [FAPI PET](https://onco.cc/technologies/fapi-pet/), [Fish oil (EPA) for cancer weight loss](https://onco.cc/technologies/omega3-epa-cachexia/), [Focused ultrasound & histotripsy](https://onco.cc/technologies/hifu-histotripsy/), [G8 geriatric screening tool](https://onco.cc/technologies/g8-geriatric-screening/), [Genetically engineered mouse models](https://onco.cc/technologies/genetically-engineered-mouse-models/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Gerson therapy, coffee enemas and 'detox' regimens](https://onco.cc/technologies/gerson-therapy-detox-regimens/), [GLP-1 receptor agonists and obesity-related cancer risk](https://onco.cc/technologies/glp1-agonists-cancer-risk/), [High-dose intravenous vitamin C](https://onco.cc/technologies/high-dose-vitamin-c/), [High-risk pancreatic surveillance (CAPS / PRECEDE)](https://onco.cc/technologies/pancreatic-surveillance/), [HIPEC perfusion pumps and PIPAC nebulisers](https://onco.cc/technologies/hipec-pipac-devices/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [HRD & BRCA testing](https://onco.cc/technologies/hrd-testing/), [HRD genomic scar scores (GIS, LOH, HRDetect)](https://onco.cc/technologies/hrd-genomic-scar-scores/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [Hypoxia-activated prodrugs](https://onco.cc/technologies/hypoxia-activated-therapy/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Immunonutrition before cancer surgery](https://onco.cc/technologies/immunonutrition-perioperative/), [Intraoperative radiotherapy (IORT)](https://onco.cc/technologies/intraoperative-radiotherapy/), [Irreversible electroporation (NanoKnife)](https://onco.cc/technologies/irreversible-electroporation/), [KRAS & RAS inhibitors](https://onco.cc/technologies/kras-inhibitors/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Measuring muscle and fat on scans the patient already had](https://onco.cc/technologies/rejuv-measure-body-composition/), [Mistletoe extracts (Iscador, Helixor)](https://onco.cc/technologies/mistletoe-extracts/), [MR-guided adaptive radiotherapy](https://onco.cc/technologies/mr-linac/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [MRI](https://onco.cc/technologies/mri/), [mRNA and lipid nanoparticle manufacturing](https://onco.cc/technologies/mrna-lnp-manufacturing/), [MSI and mismatch-repair testing](https://onco.cc/technologies/msi-mmr-testing/), [Multi-cancer early detection (MCED)](https://onco.cc/technologies/mced/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/), [Muscle and strength after treatment: sarcopenia, cachexia and what rebuilds](https://onco.cc/technologies/muscle-recovery-after-cancer-treatment/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Off-the-shelf cancer vaccines](https://onco.cc/technologies/shared-antigen-vaccine/), [Oncology nutrition assessment and medical nutrition therapy](https://onco.cc/technologies/nutrition-screening-mnt/), [Palliative radiotherapy](https://onco.cc/technologies/palliative-radiotherapy/), [PARP inhibitors](https://onco.cc/technologies/parp-inhibitor/), [Patient-derived organoids](https://onco.cc/technologies/organoids/), [PDAC organoid pharmacotyping](https://onco.cc/technologies/pdac-organoid-pharmacotyping/), [Peer support and support groups](https://onco.cc/technologies/peer-support-groups/), [Personalised neoantigen (mRNA) vaccines](https://onco.cc/technologies/neoantigen-mrna-vaccine/), [PET/CT](https://onco.cc/technologies/pet-ct/), [Photon-counting CT](https://onco.cc/technologies/photon-counting-ct/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [Proteomics & phosphoproteomics](https://onco.cc/technologies/proteomics/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Red and processed meat reduction](https://onco.cc/technologies/red-processed-meat-reduction/), [Resistance training and protein for cachexia and sarcopenia](https://onco.cc/technologies/resistance-training-cachexia/), [Respiratory gating and tumour tracking systems (RPM, ABC, Calypso, Synchrony)](https://onco.cc/technologies/respiratory-gating-tumour-tracking-systems/), [Respiratory motion management (4D-CT, gating, breath-hold, tracking)](https://onco.cc/technologies/respiratory-motion-management/), [RNA sequencing & expression profiling](https://onco.cc/technologies/rna-seq/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Screening for distress: what the thermometer can and cannot do](https://onco.cc/technologies/rejuv-mind-distress-screening/), [Serum tumour markers: proper use and misuse](https://onco.cc/technologies/serum-tumour-markers/), [Single-cell & spatial profiling](https://onco.cc/technologies/single-cell-spatial/), [Sleeping tablets after cancer: what they do and what they do not](https://onco.cc/technologies/rejuv-mind-sleeping-tablets-after-cancer/), [Solid stress and tumour mechanobiology models](https://onco.cc/technologies/tumour-mechanics-models/), [Spatial transcriptomics](https://onco.cc/technologies/spatial-transcriptomics/), [Surgical robots: da Vinci, Hugo, Versius and single-port systems](https://onco.cc/technologies/surgical-robot-platforms/), [Targeting the tumour's own microbes](https://onco.cc/technologies/tumour-microbiome-targeting/), [Targeting tumour mechanics and pressure](https://onco.cc/technologies/mechanobiology-therapy/), [The carer's own recovery: what is known about the person who is not the patient](https://onco.cc/technologies/rejuv-life-carers/), [Tumour mutational burden testing](https://onco.cc/technologies/tmb-testing/), [Tumour treating fields (TTFields)](https://onco.cc/technologies/ttfields/), [UGT1A1 genotyping before irinotecan](https://onco.cc/technologies/ugt1a1-genotyping/), [Ultra-processed food and sugar-sweetened drinks](https://onco.cc/technologies/ultra-processed-food-ssb/), [Ultrasound](https://onco.cc/technologies/ultrasound/), [Walking, gripping and standing up: the tests that take five minutes](https://onco.cc/technologies/rejuv-measure-functional-tests/), [What a prehabilitation programme actually contains, and how long it needs](https://onco.cc/technologies/rejuv-rehab-prehabilitation-programme/), [What the randomised trials of prehabilitation found, operation by operation](https://onco.cc/technologies/rejuv-rehab-prehabilitation-evidence/), [Whole-exome & whole-genome sequencing](https://onco.cc/technologies/wes-wgs/)
- terms: [Adenocarcinoma](https://onco.cc/terms/adenocarcinoma/), [Biliary drainage routes: ERCP stent, percutaneous (PTC) and EUS-guided](https://onco.cc/terms/biliary-drainage-routes/), [Biliary stent problems: blockage and infection](https://onco.cc/terms/biliary-stent-problems/), [CA 19-9](https://onco.cc/terms/ca19-9/), [Cancer cachexia](https://onco.cc/terms/cachexia/), [Cancer Drugs Fund (England)](https://onco.cc/terms/cancer-drugs-fund/), [Cancer-related fatigue (tiredness)](https://onco.cc/terms/cancer-related-fatigue/), [CAPS: the Cancer of the Pancreas Screening consortium and its surveillance studies (CAPS1 to CAPS5)](https://onco.cc/terms/caps-consortium-pancreatic-screening/), [Carers: what you can do and UK carer support (pancreatic cancer)](https://onco.cc/terms/carers-pancreatic-cancer-uk/), [CCGA: the Circulating Cell-free Genome Atlas behind the Galleri methylation test](https://onco.cc/terms/ccga-study/), [Cell-free DNA (cfDNA)](https://onco.cc/terms/cfdna/), [Central venous access (port, PICC line)](https://onco.cc/terms/central-venous-access/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Cholangitis: infection of a blocked bile duct](https://onco.cc/terms/acute-cholangitis/), [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Classical versus basal-like (squamous) subtypes of pancreatic cancer, and GATA6](https://onco.cc/terms/classical-vs-basal-like/), [Clinical benefit response (the gemcitabine trial endpoint)](https://onco.cc/terms/clinical-benefit-response/), [Coeliac plexus block for pancreatic cancer pain](https://onco.cc/terms/coeliac-plexus-block/), [COMPASS: real-time sequencing of advanced pancreatic cancer for treatment selection](https://onco.cc/terms/compass-study-pancreatic/), [Copy number alteration (CNA)](https://onco.cc/terms/copy-number-variation-term/), [Desmoplasia (tumour stroma)](https://onco.cc/terms/desmoplasia/), [DETECT-A: a blood test plus PET-CT to screen 10,006 women with no symptoms](https://onco.cc/terms/detect-a-study/), [Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen)](https://onco.cc/terms/distal-pancreatectomy/), [Downstaging and conversion therapy](https://onco.cc/terms/downstaging/), [Driver mutation](https://onco.cc/terms/driver-mutation/), [Duodenal stenting and gastrojejunostomy for malignant gastric outlet obstruction](https://onco.cc/terms/duodenal-stenting-gastric-outlet/), [Eating after a Whipple operation: slow stomach emptying, dumping and bowel changes](https://onco.cc/terms/eating-after-whipple/), [Emergency presentation (route to diagnosis)](https://onco.cc/terms/emergency-presentation/), [Emotional support and helplines (UK)](https://onco.cc/terms/emotional-support-cancer-uk/), [Endoscopy (EGD, EUS, ERCP)](https://onco.cc/terms/endoscopy/), [Enzyme](https://onco.cc/terms/enzyme/), [Event-free / disease-free survival (EFS, DFS, iDFS, RFS)](https://onco.cc/terms/efs/), [Familial pancreatic cancer and inherited risk (who qualifies for surveillance)](https://onco.cc/terms/familial-pancreatic-cancer/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Fibroblast subtypes in the pancreatic cancer stroma (myCAF, iCAF and apCAF)](https://onco.cc/terms/caf-subtypes-pancreatic/), [Fiducial markers](https://onco.cc/terms/fiducial-markers/), [Financial toxicity](https://onco.cc/terms/financial-toxicity/), [FISH / ISH (in situ hybridisation)](https://onco.cc/terms/fish/), [FOLFOX, FOLFIRI, FOLFIRINOX and CAPOX](https://onco.cc/terms/folfox-family/), [Founder mutation (BRCA1 185delAG and 5382insC, BRCA2 6174delT)](https://onco.cc/terms/founder-mutation/), [GATA6 as the marker of classical versus basal-like pancreatic cancer](https://onco.cc/terms/gata6-classical-basal-marker/), [Gene fusion](https://onco.cc/terms/gene-fusion/), [Germline BRCA mutation (gBRCA)](https://onco.cc/terms/gbrca-mutation/), [Germline vs somatic mutations](https://onco.cc/terms/germline-vs-somatic/), [Grade](https://onco.cc/terms/tumour-grade/), [Hand-foot syndrome and hand-foot skin reaction](https://onco.cc/terms/hand-foot-syndrome/), [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [Hereditary cancer syndromes](https://onco.cc/terms/hereditary-cancer-syndromes/), [High-risk stigmata and worrisome features of pancreatic cysts (IPMN and MCN surgical criteria)](https://onco.cc/terms/pancreatic-cyst-high-risk-stigmata/), [Homologous recombination deficiency (HRD)](https://onco.cc/terms/hrd/), [Hot vs cold tumours](https://onco.cc/terms/cold-vs-hot/), [Immune exclusion](https://onco.cc/terms/immune-exclusion/), [Immunohistochemistry (IHC)](https://onco.cc/terms/ihc/), [KRAS allelic imbalance and mutant KRAS dosage in pancreatic cancer](https://onco.cc/terms/kras-allelic-imbalance/), [KRAS mutation subtypes (G12C, G12D, G12V)](https://onco.cc/terms/kras-mutation-subtypes/), [Laparoscopy (keyhole surgery)](https://onco.cc/terms/staging-laparoscopy/), [Lewis-negative (Lewis antigen-negative, CA 19-9 non-secretor) status](https://onco.cc/terms/lewis-negative/), [Living with FOLFIRINOX, NALIRIFOX and gemcitabine with nab-paclitaxel](https://onco.cc/terms/chemotherapy-side-effects-pancreatic/), [Living with jaundice and itching (biliary cancer)](https://onco.cc/terms/jaundice-and-itch-biliary/), [Locally advanced and locoregional disease](https://onco.cc/terms/locally-advanced/), [Lynch syndrome](https://onco.cc/terms/lynch-syndrome/), [Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)](https://onco.cc/terms/malnutrition-screening/), [Mechanical theory: stiffness, pressure and force as causes](https://onco.cc/terms/mechanical-theory-of-cancer/), [Metabolic syndrome and insulin resistance](https://onco.cc/terms/metabolic-syndrome/), [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Mucositis and stomatitis](https://onco.cc/terms/mucositis/), [Mutational signature](https://onco.cc/terms/mutational-signature/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Neoadjuvant therapy versus surgery first for resectable and borderline resectable pancreatic cancer](https://onco.cc/terms/neoadjuvant-versus-upfront-surgery-pancreatic/), [Neoantigen](https://onco.cc/terms/neoantigen/), [Neutropenia](https://onco.cc/terms/neutropenia/), [New-onset diabetes as a signal of pancreatic cancer (and the ENDPAC score)](https://onco.cc/terms/new-onset-diabetes-pancreatic-cancer/), [Next-generation sequencing (NGS)](https://onco.cc/terms/ngs/), [Nutrition impact symptoms](https://onco.cc/terms/nutrition-impact-symptoms/), [Obesity-related cancers (IARC list of 13)](https://onco.cc/terms/obesity-related-cancers/), [Obstructive jaundice and biliary obstruction](https://onco.cc/terms/obstructive-jaundice/), [Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia](https://onco.cc/terms/pancreatic-palliation-obstruction-pain-nutrition/), [Pancreas protocol CT (pancreatic protocol CT, dual-phase thin-slice CT with structured reporting)](https://onco.cc/terms/pancreas-protocol-ct/), [Pancreatic cancer drugs in England: NICE appraisals and the Cancer Drugs Fund (September 2026)](https://onco.cc/terms/pancreatic-cancer-uk-drug-access/), [Pancreatic cancer trials open today (registry snapshot and UK sites)](https://onco.cc/terms/pancreatic-trials-open-today/), [Pancreatic cancer: the failed and stopped programmes and why](https://onco.cc/terms/pancreatic-failed-programmes/), [Pancreatic enzyme replacement therapy (PERT, pancreatin, Creon) for pancreatic exocrine insufficiency: why and how to take it](https://onco.cc/terms/pancreatic-enzyme-replacement/), [Pancreatic intraepithelial neoplasia (PanIN), the microscopic precursor of pancreatic cancer](https://onco.cc/terms/panin/), [Performance status (ECOG, Karnofsky)](https://onco.cc/terms/performance-status/), [Perineural invasion (PNI)](https://onco.cc/terms/perineural-invasion/), [Peripheral neuropathy (chemotherapy-induced)](https://onco.cc/terms/peripheral-neuropathy/), [Peritoneum and peritoneal metastases](https://onco.cc/terms/peritoneum/), [Platinum-sensitive / platinum-resistant](https://onco.cc/terms/platinum-sensitivity/), [Positive predictive value (PPV)](https://onco.cc/terms/ppv/), [R0 and R1 margins in pancreatic cancer: the 1 mm rule and standardised specimen reporting](https://onco.cc/terms/r0-r1-margin-pancreatic/), [Resectability classes for pancreatic cancer (NCCN anatomical criteria and the 2017 international consensus)](https://onco.cc/terms/nccn-resectability-criteria-pancreatic/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Retroperitoneum](https://onco.cc/terms/retroperitoneum/), [Sarcopenia](https://onco.cc/terms/sarcopenia/), [Somatic mutations from exome and genome sequencing (WXS, WGS)](https://onco.cc/terms/somatic-mutations-wxs-wgs/), [Stage shift](https://onco.cc/terms/stage-shift/), [Stent or bypass for jaundice: the choice](https://onco.cc/terms/stent-or-bypass-for-jaundice/), [Stenting (biliary, oesophageal, airway)](https://onco.cc/terms/biliary-stent/), [Stroma-rich and desmoplastic tumours in molecular data](https://onco.cc/terms/desmoplastic-stroma-rich/), [Symptom control in advanced gallbladder cancer: pain, ascites and nutrition](https://onco.cc/terms/gallbladder-cancer-symptom-control/), [Synthetic lethality](https://onco.cc/terms/synthetic-lethality/), [TNM staging](https://onco.cc/terms/tnm-staging/), [Total neoadjuvant therapy (TNT, rectal cancer)](https://onco.cc/terms/total-neoadjuvant-therapy/), [Tumour marker](https://onco.cc/terms/tumour-marker/), [Tumour markers (CEA, LDH, chromogranin, thyroglobulin)](https://onco.cc/terms/tumour-markers/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/), [Tumour-agnostic (tissue-agnostic) approval](https://onco.cc/terms/tumour-agnostic/), [Tumour-informed versus tumour-naive ctDNA assays](https://onco.cc/terms/tumour-informed-assay/), [Type 3c diabetes with pancreatic cancer](https://onco.cc/terms/type-3c-diabetes-pancreatic-cancer/), [Variant of uncertain significance (VUS)](https://onco.cc/terms/vus/), [Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection)](https://onco.cc/terms/vascular-resection-pancreatic/), [Venous thromboembolism (VTE)](https://onco.cc/terms/vte/), [When to seek urgent help with pancreatic cancer (NHS 111 and 999)](https://onco.cc/terms/urgent-help-pancreatic-cancer/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/), [Whole-genome doubling (WGD)](https://onco.cc/terms/whole-genome-doubling/), [Wild-type (WT)](https://onco.cc/terms/wild-type/), [Work and money with pancreatic cancer (UK)](https://onco.cc/terms/work-and-money-pancreatic-cancer-uk/)
- targets: [ACVR1B](https://onco.cc/targets/acvr1b/), [ACVR2A](https://onco.cc/targets/acvr2a/), [Adenosine A2A receptor (ADORA2A)](https://onco.cc/targets/adora2a/), [ALK](https://onco.cc/targets/alk/), [ALPK1](https://onco.cc/targets/alpk1/), [ARHGAP5](https://onco.cc/targets/arhgap5/), [ARID1A](https://onco.cc/targets/arid1a/), [ATG12](https://onco.cc/targets/atg12/), [ATG7](https://onco.cc/targets/atg7/), [ATM](https://onco.cc/targets/atm/), [ATXN1L](https://onco.cc/targets/atxn1l/), [BCORL1](https://onco.cc/targets/bcorl1/), [BRAF](https://onco.cc/targets/braf/), [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [CD39 (ENTPD1)](https://onco.cc/targets/entpd1/), [CD40](https://onco.cc/targets/cd40/), [CD73 / adenosine axis](https://onco.cc/targets/cd73-adenosine/), [CDH10](https://onco.cc/targets/cdh10/), [CDKN2A](https://onco.cc/targets/cdkn2a/), [CDKN2B](https://onco.cc/targets/cdkn2b/), [CIC](https://onco.cc/targets/cic/), [CIP2A](https://onco.cc/targets/cip2a/), [Claudin 18.2](https://onco.cc/targets/cldn18-2/), [COL1A1](https://onco.cc/targets/col1a1/), [COL6A6](https://onco.cc/targets/col6a6/), [CSF1R](https://onco.cc/targets/csf1r/), [CTNNA2](https://onco.cc/targets/ctnna2/), [CTNND2](https://onco.cc/targets/ctnnd2/), [CUX1](https://onco.cc/targets/cux1/), [DAXX](https://onco.cc/targets/daxx/), [DCC](https://onco.cc/targets/dcc/), [DCLK1](https://onco.cc/targets/dclk1/), [DNA polymerase alpha (POLA1)](https://onco.cc/targets/pola1/), [DROSHA](https://onco.cc/targets/drosha/), [EpCAM](https://onco.cc/targets/epcam/), [ETV1](https://onco.cc/targets/etv1/), [ETV4](https://onco.cc/targets/etv4/), [ETV5](https://onco.cc/targets/etv5/), [FAK (PTK2)](https://onco.cc/targets/fak/), [FAM135B](https://onco.cc/targets/fam135b/), [FANCC](https://onco.cc/targets/fancc/), [FAP](https://onco.cc/targets/fap/), [FAT1](https://onco.cc/targets/fat1/), [FAT3](https://onco.cc/targets/fat3/), [FBLN2](https://onco.cc/targets/fbln2/), [FBXW7](https://onco.cc/targets/fbxw7/), [FCRL4](https://onco.cc/targets/fcrl4/), [FGFR2](https://onco.cc/targets/fgfr2/), [FMN2](https://onco.cc/targets/fmn2/), [GNAS](https://onco.cc/targets/gnas/), [GRIN2A](https://onco.cc/targets/grin2a/), [HER2](https://onco.cc/targets/her2/), [HER3](https://onco.cc/targets/her3/), [HSPB1](https://onco.cc/targets/hspb1/), [IGF2](https://onco.cc/targets/igf2/), [IRS4](https://onco.cc/targets/irs4/), [KDM5C](https://onco.cc/targets/kdm5c/), [KDM6A](https://onco.cc/targets/kdm6a/), [KMT2C](https://onco.cc/targets/kmt2c/), [KRAS](https://onco.cc/targets/kras/), [LATS1](https://onco.cc/targets/lats1/), [LPA](https://onco.cc/targets/lpa/), [LRP1B](https://onco.cc/targets/lrp1b/), [MAP2K4](https://onco.cc/targets/map2k4/), [MARK2](https://onco.cc/targets/mark2/), [Mesothelin](https://onco.cc/targets/mesothelin/), [MIR218-1](https://onco.cc/targets/mir218-1/), [Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2)](https://onco.cc/targets/mmr/), [MUC16 (CA-125)](https://onco.cc/targets/muc16/), [MYC](https://onco.cc/targets/myc-gene/), [NCOA1](https://onco.cc/targets/ncoa1/), [NFATC2](https://onco.cc/targets/nfatc2/), [NOTCH3](https://onco.cc/targets/notch3/), [NPRL2](https://onco.cc/targets/nprl2/), [NQO1](https://onco.cc/targets/nqo1/), [NR4A2](https://onco.cc/targets/nr4a2/), [NRG1](https://onco.cc/targets/nrg1/), [NTRK](https://onco.cc/targets/ntrk/), [PALB2](https://onco.cc/targets/palb2/), [PARP](https://onco.cc/targets/parp/), [PEG3](https://onco.cc/targets/peg3/), [POLD1](https://onco.cc/targets/pold1/), [PREX2](https://onco.cc/targets/prex2/), [PRMT5 (MTAP-deleted cancers)](https://onco.cc/targets/prmt5-mtap/), [PTPN13](https://onco.cc/targets/ptpn13/), [PTPN3](https://onco.cc/targets/ptpn3/), [PTPRD](https://onco.cc/targets/ptprd/), [PTPRT](https://onco.cc/targets/ptprt/), [RABL3](https://onco.cc/targets/rabl3/), [RBM10](https://onco.cc/targets/rbm10/), [Ribonucleotide reductase (RRM1)](https://onco.cc/targets/rrm1/), [RNF43](https://onco.cc/targets/rnf43/), [RRM2](https://onco.cc/targets/rrm2/), [SETD1B](https://onco.cc/targets/setd1b/), [SETD2](https://onco.cc/targets/setd2/), [SETDB1](https://onco.cc/targets/setdb1/), [SF3B1](https://onco.cc/targets/sf3b1/), [SHP2 (PTPN11)](https://onco.cc/targets/shp2/), [SIRT1](https://onco.cc/targets/sirt1/), [SLC29A1](https://onco.cc/targets/slc29a1/), [SMAD3](https://onco.cc/targets/smad3/), [SMAD4](https://onco.cc/targets/smad4/), [SMARCA4](https://onco.cc/targets/smarca4/), [STK11](https://onco.cc/targets/stk11/), [TGFBR2](https://onco.cc/targets/tgfbr2/), [Thymidylate synthase (TYMS)](https://onco.cc/targets/tyms/), [Tissue factor](https://onco.cc/targets/tissue-factor/), [TNC](https://onco.cc/targets/tnc/), [TP53](https://onco.cc/targets/tp53/), [TSC2](https://onco.cc/targets/tsc2/), [U2AF1](https://onco.cc/targets/u2af1/), [VHL](https://onco.cc/targets/vhl/), [VISTA](https://onco.cc/targets/vista/), [WT1](https://onco.cc/targets/wt1/), [ZNF521](https://onco.cc/targets/znf521/)
- drugs: [Adagrasib](https://onco.cc/drugs/adagrasib/), [Aldoxorubicin](https://onco.cc/drugs/aldoxorubicin/), [Algenpantucel-L](https://onco.cc/drugs/algenpantucel-l/), [Anetumab ravtansine](https://onco.cc/drugs/anetumab-ravtansine/), [Atebimetinib](https://onco.cc/drugs/atebimetinib/), [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Autogene cevumeran](https://onco.cc/drugs/autogene-cevumeran/), [AZD4360](https://onco.cc/drugs/azd4360/), [AZD5863](https://onco.cc/drugs/azd5863/), [BRACAnalysis CDx](https://onco.cc/drugs/bracanalysis-cdx/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Catumaxomab](https://onco.cc/drugs/catumaxomab/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Crizotinib](https://onco.cc/drugs/crizotinib/), [CT3001](https://onco.cc/drugs/ct3001/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Dabrafenib + trametinib](https://onco.cc/drugs/dabrafenib-trametinib/), [Daraxonrasib](https://onco.cc/drugs/daraxonrasib/), [Devimistat](https://onco.cc/drugs/devimistat/), [Dostarlimab](https://onco.cc/drugs/dostarlimab/), [E-EDV-D682](https://onco.cc/drugs/e-edv-d682/), [ELI-002 7P](https://onco.cc/drugs/eli-002-7p/), [Elironrasib](https://onco.cc/drugs/elironrasib/), [Elraglusib](https://onco.cc/drugs/elraglusib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [Erlotinib](https://onco.cc/drugs/erlotinib/), [Eryaspase](https://onco.cc/drugs/eryaspase/), [Evofosfamide](https://onco.cc/drugs/evofosfamide/), [FAP-2286 (177Lu / 68Ga)](https://onco.cc/drugs/fap-2286/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [FoundationOne CDx / Liquid CDx](https://onco.cc/drugs/foundationone-cdx/), [Galleri](https://onco.cc/drugs/galleri/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [GFH375](https://onco.cc/drugs/gfh375/), [Gotistobart](https://onco.cc/drugs/gotistobart/), [Guardant360 CDx](https://onco.cc/drugs/guardant360-cdx/), [IBI343](https://onco.cc/drugs/ibi343/), [Ibrutinib](https://onco.cc/drugs/ibrutinib/), [IN10018](https://onco.cc/drugs/in10018/), [INCB161734](https://onco.cc/drugs/incb161734/), [Irinotecan (and liposomal irinotecan)](https://onco.cc/drugs/irinotecan/), [Ivospemin](https://onco.cc/drugs/ivospemin/), [JK08](https://onco.cc/drugs/jk08/), [JMT203](https://onco.cc/drugs/jmt203/), [JYP0015](https://onco.cc/drugs/jyp0015/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Leucovorin (folinic acid)](https://onco.cc/drugs/leucovorin/), [Liposomal irinotecan](https://onco.cc/drugs/liposomal-irinotecan/), [LM-108](https://onco.cc/drugs/lm-108/), [LP-184](https://onco.cc/drugs/lp-184/), [Mavrostobart](https://onco.cc/drugs/mavrostobart/), [MI Cancer Seek](https://onco.cc/drugs/caris-mi-cancer-seek/), [Mitazalimab](https://onco.cc/drugs/mitazalimab/), [MRTX1133](https://onco.cc/drugs/mrtx1133/), [Nab-paclitaxel](https://onco.cc/drugs/nab-paclitaxel/), [NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/), [Napabucasin](https://onco.cc/drugs/napabucasin/), [Navlimetostat](https://onco.cc/drugs/navlimetostat/), [Nimotuzumab](https://onco.cc/drugs/nimotuzumab/), [NUV-1511](https://onco.cc/drugs/nuv-1511/), [Olaparib](https://onco.cc/drugs/olaparib/), [Olomorasib](https://onco.cc/drugs/olomorasib/), [Optune / Optune Pax (TTFields)](https://onco.cc/drugs/optune/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pamrevlumab](https://onco.cc/drugs/pamrevlumab/), [Pancrelipase (pancreatic enzyme replacement therapy)](https://onco.cc/drugs/pancrelipase/), [PBP1510](https://onco.cc/drugs/pbp1510/), [Pegilodecakin](https://onco.cc/drugs/pegilodecakin/), [Pegvorhyaluronidase alfa](https://onco.cc/drugs/pegvorhyaluronidase-alfa/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Ponsegromab](https://onco.cc/drugs/ponsegromab/), [QLS31905](https://onco.cc/drugs/qls31905/), [Quemliclustat](https://onco.cc/drugs/quemliclustat/), [Repotrectinib](https://onco.cc/drugs/repotrectinib/), [Rucaparib](https://onco.cc/drugs/rucaparib/), [Satricabtagene autoleucel](https://onco.cc/drugs/satricabtagene-autoleucel/), [Setidegrasib](https://onco.cc/drugs/setidegrasib/), [Signatera](https://onco.cc/drugs/signatera/), [Sitneprotafib](https://onco.cc/drugs/sitneprotafib/), [Sonesitatug vedotin](https://onco.cc/drugs/cmg901/), [Sotorasib](https://onco.cc/drugs/sotorasib/), [Spevatamig](https://onco.cc/drugs/spevatamig/), [Streptozocin](https://onco.cc/drugs/streptozocin/), [Tegafur, gimeracil and oteracil (S-1)](https://onco.cc/drugs/tegafur-gimeracil-oteracil/), [Tempus xT CDx](https://onco.cc/drugs/tempus-xt-cdx/), [TNG462](https://onco.cc/drugs/tng462/), [TQB2868](https://onco.cc/drugs/tqb2868/), [Trabedersen](https://onco.cc/drugs/trabedersen/), [TruSight Oncology Comprehensive](https://onco.cc/drugs/trusight-oncology-comprehensive/), [VB15010](https://onco.cc/drugs/vb15010/), [VENTANA MMR RxDx Panel](https://onco.cc/drugs/ventana-mmr-rxdx/), [VS-7375](https://onco.cc/drugs/vs-7375/), [XNW27011](https://onco.cc/drugs/xnw27011/), [Zalifrelimab](https://onco.cc/drugs/zalifrelimab/), [Zenocutuzumab](https://onco.cc/drugs/zenocutuzumab/), [Zoldonrasib](https://onco.cc/drugs/zoldonrasib/)
- companies: [A2 Biotherapeutics](https://onco.cc/companies/a2-biotherapeutics/), [AB Science](https://onco.cc/companies/ab-science/), [Actuate Therapeutics](https://onco.cc/companies/actuate-therapeutics/), [Adventris Pharmaceuticals](https://onco.cc/companies/adventris-pharmaceuticals/), [Alpha Tau Medical](https://onco.cc/companies/alpha-tau-medical/), [Amplia Therapeutics](https://onco.cc/companies/amplia-therapeutics/), [AngioDynamics](https://onco.cc/companies/angiodynamics/), [Anocca](https://onco.cc/companies/anocca/), [Arcus Biosciences](https://onco.cc/companies/arcus-biosciences/), [Artios Pharma](https://onco.cc/companies/artios-pharma/), [Ascentawits Pharmaceuticals](https://onco.cc/companies/ascentawits-pharmaceuticals/), [AstraZeneca](https://onco.cc/companies/astrazeneca/), [Australasian Gastro-Intestinal Trials Group](https://onco.cc/companies/agitg/), [BioLineRx](https://onco.cc/companies/biolinerx/), [BioNTech](https://onco.cc/companies/biontech/), [Bristol Myers Squibb](https://onco.cc/companies/bms/), [Capnomed (Reger Medizintechnik)](https://onco.cc/companies/capnomed/), [CARsgen Therapeutics](https://onco.cc/companies/carsgen/), [CEBIOTEX](https://onco.cc/companies/cebiotex/), [CivaTech Oncology](https://onco.cc/companies/civatech-oncology/), [ClearNote Health](https://onco.cc/companies/clearnote-health/), [Cornerstone Pharmaceuticals (formerly Rafael Pharmaceuticals)](https://onco.cc/companies/cornerstone-pharmaceuticals/), [Crinetics Pharmaceuticals](https://onco.cc/companies/crinetics-pharmaceuticals/), [Diakonos Oncology](https://onco.cc/companies/diakonos-oncology/), [Dutch Pancreatic Cancer Group](https://onco.cc/companies/dpcg/), [Elicio Therapeutics](https://onco.cc/companies/elicio-therapeutics/), [Evopoint Biosciences](https://onco.cc/companies/evopoint-biosciences/), [FibroGen](https://onco.cc/companies/fibrogen/), [Frontier Medicines](https://onco.cc/companies/frontier-medicines/), [Fujirebio](https://onco.cc/companies/fujirebio/), [GERCOR](https://onco.cc/companies/gercor/), [GI Innovation](https://onco.cc/companies/gi-innovation/), [Halozyme Therapeutics](https://onco.cc/companies/halozyme/), [IDEAYA Biosciences](https://onco.cc/companies/ideaya-biosciences/), [Immuneering](https://onco.cc/companies/immuneering/), [Insilico Medicine](https://onco.cc/companies/insilico-medicine/), [InxMed](https://onco.cc/companies/inxmed/), [Ipsen](https://onco.cc/companies/ipsen/), [Isarna Therapeutics](https://onco.cc/companies/isarna-therapeutics/), [Kumquat Biosciences](https://onco.cc/companies/kumquat-biosciences/), [Lisata Therapeutics](https://onco.cc/companies/lisata/), [Marker Therapeutics](https://onco.cc/companies/marker-therapeutics/), [MBrace Therapeutics](https://onco.cc/companies/mbrace-therapeutics/), [Medigene](https://onco.cc/companies/medigene/), [Merrimack Pharmaceuticals](https://onco.cc/companies/merrimack-pharmaceuticals/), [Molecular Partners](https://onco.cc/companies/molecular-partners/), [NewLink Genetics (now Lumos Pharma)](https://onco.cc/companies/newlink-genetics/), [Novocure](https://onco.cc/companies/novocure/), [Nuvation Bio](https://onco.cc/companies/nuvation-bio/), [Oncolytics Biotech](https://onco.cc/companies/oncolytics-biotech/), [Orion, Orion Pharma](https://onco.cc/companies/orion-orion-pharma/), [Phaxiam Therapeutics (formerly ERYtech Pharma)](https://onco.cc/companies/phaxiam/), [Qilu Pharmaceutical](https://onco.cc/companies/qilu-pharmaceutical/), [Quanta Therapeutics](https://onco.cc/companies/quanta-therapeutics/), [Revolution Medicines](https://onco.cc/companies/revolution-medicines/), [Shenzhen Ionova Life Sciences](https://onco.cc/companies/shenzhen-ionova-life-sciences/), [SOFIE Biosciences](https://onco.cc/companies/sofie-biosciences/), [Sorrento Therapeutics](https://onco.cc/companies/sorrento-therapeutics/), [TaiRx](https://onco.cc/companies/tairx/), [Takara Bio](https://onco.cc/companies/takara-bio/), [Tango Therapeutics](https://onco.cc/companies/tango-therapeutics/), [Threshold Pharmaceuticals](https://onco.cc/companies/threshold-pharmaceuticals/), [Valar Labs](https://onco.cc/companies/valar-labs/), [Verastem Oncology](https://onco.cc/companies/verastem/), [ViewRay (MRIdian)](https://onco.cc/companies/viewray/)
- institutions: [Aberdeen Royal Infirmary](https://onco.cc/institutions/aberdeen-royal-infirmary/), [Addenbrooke's Hospital, Cambridge University Hospitals](https://onco.cc/institutions/addenbrookes-cambridge/), [Amsterdam UMC / Cancer Center Amsterdam](https://onco.cc/institutions/amsterdam-umc/), [Barts Cancer Institute / Barts Health NHS Trust](https://onco.cc/institutions/barts-cancer-institute/), [Beatson West of Scotland Cancer Centre / CRUK Scotland Institute](https://onco.cc/institutions/beatson-glasgow/), [Belfast Health and Social Care Trust HPB service](https://onco.cc/institutions/belfast-trust-hpb/), [Bristol Haematology and Oncology Centre](https://onco.cc/institutions/bristol-haematology-oncology-centre/), [Castle Hill Hospital, Hull (Queen's Centre)](https://onco.cc/institutions/hull-castle-hill/), [Cedars-Sinai Cancer](https://onco.cc/institutions/cedars-sinai-cancer/), [Centro Nacional de Investigaciones Oncológicas (CNIO)](https://onco.cc/institutions/cnio/), [Champalimaud Foundation, Champalimaud Clinical Centre](https://onco.cc/institutions/champalimaud/), [Cold Spring Harbor Laboratory](https://onco.cc/institutions/cold-spring-harbor/), [Derriford Hospital, University Hospitals Plymouth](https://onco.cc/institutions/derriford-plymouth/), [Fred & Pamela Buffett Cancer Center](https://onco.cc/institutions/nebraska-buffett/), [Garvan Institute of Medical Research / Kinghorn Cancer Centre](https://onco.cc/institutions/garvan-institute/), [Glasgow Royal Infirmary](https://onco.cc/institutions/glasgow-royal-infirmary/), [Gunma University Heavy Ion Medical Center](https://onco.cc/institutions/gunma-heavy-ion-medical-center/), [Holden Comprehensive Cancer Center, University of Iowa](https://onco.cc/institutions/iowa-holden/), [Imperial College Healthcare NHS Trust / Imperial College London Cancer Research](https://onco.cc/institutions/imperial-cancer-centre/), [INCLIVA Biomedical Research Institute / Hospital Clínico Universitario de Valencia](https://onco.cc/institutions/incliva-valencia/), [Institut Paoli-Calmettes](https://onco.cc/institutions/institut-paoli-calmettes/), [IRCCS Ospedale San Raffaele](https://onco.cc/institutions/san-raffaele/), [King's College Hospital, London](https://onco.cc/institutions/kings-college-hospital-london/), [Laura and Isaac Perlmutter Cancer Center at NYU Langone Health](https://onco.cc/institutions/nyu-perlmutter/), [Leeds Cancer Centre, St James's University Hospital](https://onco.cc/institutions/leeds-cancer-centre/), [Leicester Cancer Research Centre / University Hospitals of Leicester](https://onco.cc/institutions/leicester-cancer-research-centre/), [Liverpool University Hospitals HPB centre (Aintree)](https://onco.cc/institutions/liverpool-hpb-centre/), [Lustgarten Foundation](https://onco.cc/institutions/lustgarten-foundation/), [Manchester Royal Infirmary HPB Unit](https://onco.cc/institutions/manchester-royal-infirmary/), [Mayo Clinic Comprehensive Cancer Center in Arizona](https://onco.cc/institutions/mayo-clinic-arizona/), [Mays Cancer Center at UT Health San Antonio](https://onco.cc/institutions/mays-cancer-center/), [Morriston Hospital, Swansea](https://onco.cc/institutions/morriston-swansea/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/), [NCT/UCC Dresden, University Hospital Carl Gustav Carus](https://onco.cc/institutions/nct-dresden/), [Newcastle Cancer Centre / Northern Centre for Cancer Care](https://onco.cc/institutions/newcastle-cancer-centre/), [Ninewells Hospital, Dundee](https://onco.cc/institutions/ninewells-dundee/), [Nottingham University Hospitals Cancer Centre (City Hospital)](https://onco.cc/institutions/nottingham-cancer-centre/), [O'Neal Comprehensive Cancer Center at UAB](https://onco.cc/institutions/oneal-uab/), [Ontario Institute for Cancer Research](https://onco.cc/institutions/oicr/), [Oxford Cancer (Oxford University Hospitals and University of Oxford)](https://onco.cc/institutions/oxford-cancer/), [Pancreatic Cancer Action](https://onco.cc/institutions/pancreatic-cancer-action/), [Pancreatic Cancer UK](https://onco.cc/institutions/pancreatic-cancer-uk/), [Peking Union Medical College Hospital](https://onco.cc/institutions/pumch/), [QST Hospital (National Institutes for Quantum Science and Technology)](https://onco.cc/institutions/qst-hospital/), [Raigmore Hospital, Inverness](https://onco.cc/institutions/raigmore-inverness/), [Royal Blackburn Hospital (East Lancashire HPB MDT)](https://onco.cc/institutions/royal-blackburn-elht/), [Royal Free Hospital, Royal Free London NHS Foundation Trust](https://onco.cc/institutions/royal-free-hospital/), [Royal Infirmary of Edinburgh](https://onco.cc/institutions/royal-infirmary-edinburgh/), [Royal Stoke University Hospital](https://onco.cc/institutions/royal-stoke-uhnm/), [Royal Surrey County Hospital, Guildford](https://onco.cc/institutions/royal-surrey-guildford/), [Ruijin Hospital, Shanghai Jiao Tong University](https://onco.cc/institutions/ruijin-hospital/), [Salk Institute Cancer Center](https://onco.cc/institutions/salk-institute/), [Sheba Medical Center](https://onco.cc/institutions/sheba/), [Stand Up To Cancer](https://onco.cc/institutions/stand-up-to-cancer/), [Tianjin Medical University Cancer Institute and Hospital](https://onco.cc/institutions/tmucih/), [Translational Genomics Research Institute (TGen)](https://onco.cc/institutions/tgen/), [TUM Klinikum rechts der Isar / CCC München](https://onco.cc/institutions/tum-munich/), [UMC Utrecht Cancer Center](https://onco.cc/institutions/umc-utrecht/), [University Cancer Center Mainz (UCT Mainz) / Universitätsmedizin Mainz](https://onco.cc/institutions/uct-mainz/), [University College London Hospitals / UCL Cancer Institute](https://onco.cc/institutions/uclh/), [University Hospital Coventry](https://onco.cc/institutions/uhcw-coventry/), [University Hospital of Wales, Cardiff](https://onco.cc/institutions/university-hospital-wales-cardiff/), [University Hospital Southampton / Centre for Cancer Immunology](https://onco.cc/institutions/southampton-cancer/), [University Hospitals Birmingham / University of Birmingham Cancer Research Centre](https://onco.cc/institutions/birmingham-cancer-centre/), [UZ Leuven / Leuven Cancer Institute](https://onco.cc/institutions/uz-leuven/), [Weston Park Cancer Centre, Sheffield Teaching Hospitals](https://onco.cc/institutions/weston-park-sheffield/), [Wolfson Wohl Cancer Research Centre, University of Glasgow](https://onco.cc/institutions/wolfson-wohl-cancer-research-centre/)
- pathways: [Antigen presentation & immune editing](https://onco.cc/pathways/antigen-presentation-immunoediting/), [Autophagy](https://onco.cc/pathways/autophagy/), [Cancer cachexia](https://onco.cc/pathways/cachexia-biology/), [Cancer neuroscience (nerve-tumour signalling)](https://onco.cc/pathways/cancer-neuroscience/), [Chromosomal instability & aneuploidy](https://onco.cc/pathways/chromosomal-instability/), [Clonal evolution & minimal residual disease](https://onco.cc/pathways/clonal-evolution/), [Cold tumours: immune deserts and exclusion](https://onco.cc/pathways/immune-desert-exclusion/), [DNA damage response & homologous recombination](https://onco.cc/pathways/ddr/), [Double-strand break repair: HR versus end joining](https://onco.cc/pathways/homologous-recombination-repair/), [Epigenetic reprogramming](https://onco.cc/pathways/epigenetic-reprogramming/), [Epithelial-mesenchymal transition & drug efflux](https://onco.cc/pathways/emt/), [Fibroblast activation, desmoplasia & matrix stiffness](https://onco.cc/pathways/caf-activation-desmoplasia/), [Glutamine addiction](https://onco.cc/pathways/glutamine-metabolism/), [Hedgehog signalling](https://onco.cc/pathways/hedgehog/), [Invasion: proteases, adhesion & the invasive front](https://onco.cc/pathways/invasion-ecm-degradation/), [Microbiome-tumour interactions](https://onco.cc/pathways/microbiome-tumour/), [Mismatch repair & microsatellite instability](https://onco.cc/pathways/mismatch-repair-msi/), [Mutagenesis & mutational signatures](https://onco.cc/pathways/mutagenesis-signatures/), [MYC](https://onco.cc/pathways/myc/), [p53 / RB / cell-cycle checkpoint](https://onco.cc/pathways/p53-cell-cycle/), [Pancreatic cancer (KEGG map)](https://onco.cc/pathways/pancreatic-cancer-signalling/), [PD-1 / PD-L1 immune checkpoint & T-cell activation](https://onco.cc/pathways/pd1-checkpoint/), [RAS / RAF / MEK / ERK (MAPK)](https://onco.cc/pathways/ras-mapk/), [Receptor tyrosine kinase activation](https://onco.cc/pathways/rtk-activation/), [SWI/SNF chromatin remodelling](https://onco.cc/pathways/swi-snf-chromatin/), [TGF-β signalling](https://onco.cc/pathways/tgf-beta/), [Tumour microenvironment (TME)](https://onco.cc/pathways/tumor-microenvironment/), [Wnt / β-catenin](https://onco.cc/pathways/wnt/)
- trials: [[18F]FPyQCP PET Imaging of Fibroblast Activation Protein in Selected Oncology Indications](https://onco.cc/trials/nct07432633/), [[68Ga]BED003 PET Imaging of Fibroblast Activation Protein in Selected Oncology Indications](https://onco.cc/trials/nct07702292/), [18F-Fibroblast Activation Protein Inhibitor ([18F]FAPI-74) PET Imaging for Cancer Detection](https://onco.cc/trials/nct06503146/), [64Cu-LNTH-1363S in Patients With Sarcoma or Gastrointestinal Tract Cancer](https://onco.cc/trials/nct06298916/), [A Clinical Study of MK-2870 Alone or With Other Treatments to Treat Gastrointestinal Cancers (MK-9999-02A)](https://onco.cc/trials/nct06428409/), [A Clinical Study on the First-line Treatment of Metastatic Pancreatic Cancer With TQB2916 Injection Combined With Gemcitabine Hydrochloride for Injection and Paclitaxel for Injection (Albumin-bound Type)](https://onco.cc/trials/nct06962267/), [A Clinical Trial Testing the Safety of Pumitamig (an Investigational Drug) and How Well it Works When Combined With Chemotherapy for People Who Have N](https://onco.cc/trials/nct07255404/), [A Clinical Trial to Evaluate EDV Nanocell Therapy With Gemcitabine and Nab-paclitaxel in Pancreatic Cancer](https://onco.cc/trials/nct07049055/), [A First-in-Human Trial of BLU-924 (SAR449336) in Advanced Solid Tumors Harboring KRAS Mutations](https://onco.cc/trials/nct07629960/), [A Multicenter Study of IBI343 Monotherapy Versus Placebo in Subjects With Previously Treated, Claudin (CLDN) 18.2-positive, Pancreatic Cancer(G-HOPE-002)](https://onco.cc/trials/g-hope-002/), [A Phase 1 Study to Evaluate Safety and Efficacy of XER-001 (Amifostine for Nasoduodenal Delivery) in Combination With Sterotactic Body Radiotherapy for Treatment in Patients With Locally Advanced Pancreatic Cancer.](https://onco.cc/trials/nct07157033/), [A Phase 1/2 Study of VS-7375 in Patients With KRAS G12D-Mutated Solid Tumors](https://onco.cc/trials/nct07020221/), [A Phase 2 Study of ABSK021 in Patients With Advanced Pancreatic Cancer](https://onco.cc/trials/nct06111274/), [A Phase 2 Study of VS-7375 in Patients With KRAS G12D-Mutated Pancreatic Cancer](https://onco.cc/trials/nct07644559/), [A Phase I/II Study of AST-001 in Subjects With Advanced Solid Tumors](https://onco.cc/trials/nct06245330/), [A Phase I/IIa Study of EF-009 in Patients With Pancreatic Cancer](https://onco.cc/trials/nct04381130/), [A Phase I/IIa Study of GKL-006 Injection in Patients With Advanced Pancreatic Cancer](https://onco.cc/trials/nct07777211/), [A Phase II Study Evaluating BMS-986504 in MTAP-deleted Pancreatic Cancer](https://onco.cc/trials/nct07283705/), [A Phase II Study Evaluating JAB-21822 Monotherapy in Adult Patients With Pancreatic Cancer and Other Solid Tumors Harboring the KRAS p.G12C Mutation.](https://onco.cc/trials/nct06008288/), [A Phase II/III Trial to Evaluate the Efficacy and Safety of Surufatinib Combined With Camrelizumab, Nab-paclitaxel, and Gemcitabine in Metastatic Pancreatic Cancer](https://onco.cc/trials/nct06361888/), [A Phase III Study of Ivonescimab + Chemo With/Without AK117 in Metastatic Pancreatic Cancer](https://onco.cc/trials/nct06953999/), [A Pivotal Study of Safety and Effectiveness of NanoKnife IRE for Stage 3 Pancreatic Cancer](https://onco.cc/trials/nct03899636/), [A Study Comparing Navlimetostat (BMS-986504) in Combination With Nab-paclitaxel and Gemcitabine Versus Placebo in Combination With Nab-paclitaxel and Gemcitabine in Participants With Untreated Metastatic Pancreatic Ductal Adenocarcinoma With Homozygous MTAP Deletion (MountainTAP-30)](https://onco.cc/trials/mountaintap-30/), [A Study Evaluating FMC-376 in Participants With KRAS G12C Mutated Solid Tumors](https://onco.cc/trials/nct06244771/), [A Study in Advanced or Metastatic Gastrointestinal Cancers Exploring Treatment Combinations With Pelareorep and Atezolizumab](https://onco.cc/trials/nct07280377/), [A Study of AK104 With Chemotherapy as First-line Treatment in Patients With Advanced Pancreatic Cancer](https://onco.cc/trials/nct05859750/), [A Study of AK130 in Combination With AK112 for the Treatment of Advanced Pancreatic Cancer](https://onco.cc/trials/nct07114315/), [A Study of ART0380 for the Treatment of Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct04657068/), [A Study of ASP546C in Adults With Gastroesophageal Cancer, Pancreatic Cancer or Other Solid Tumors](https://onco.cc/trials/nct07488676/), [A Study of DM002 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06751329/), [A Study of Evofosfamide in Combination with Zalifrelimab and Balstilimab](https://onco.cc/trials/nct06782555/), [A Study of GI-108, an Anti-CD73-IgG4 Fc-IL-2v Bispecific Fusion Protein, as Monotherapy in Patients With Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct07172802/), [A Study of JMT203 in Patients With Cancer Cachexia](https://onco.cc/trials/nct06868849/), [A Study of More Frequent Dosing of VCN-01 Combined With Standard Chemotherapy in Patients With Newly Diagnosed Metastatic Pancreatic Cancer](https://onco.cc/trials/nct07701486/), [A Study of MT-4561 in Patients With Various Advanced Solid Tumors](https://onco.cc/trials/nct06943521/), [A Study of Narmafotinib Given in Combination With Modified FOLFIRINOX in Patients With Metastatic Pancreatic Cancer](https://onco.cc/trials/nct07026279/), [A Study of Nuzefatide Pevedotin (BT5528) in Patients With Metastatic Pancreatic Ductal Adenocarcinoma (PDAC)](https://onco.cc/trials/nct07450859/), [A Study of OT-101 With mFOLFIRINOX in Patients With Advanced and Unresectable or Metastatic Pancreatic Cancer](https://onco.cc/trials/nct06079346/), [A Study of the Efficacy and Safety of Adjuvant Autogene Cevumeran Plus Atezolizumab and mFOLFIRINOX Versus mFOLFIRINOX Alone in Participants With Resected PDAC](https://onco.cc/trials/nct05968326/), [A Study of Zenocutuzumab (MCLA-128) in Patients With Solid Tumors Harboring an NRG1 Fusion (eNRGy)](https://onco.cc/trials/nct02912949/), [A Study of Zolbetuximab (IMAB362) in Adults With Pancreatic Cancer](https://onco.cc/trials/nct03816163/), [A Study to Assess Adverse Events and Change in Disease Activity With Treatment Combinations With Telisotuzumab Adizutecan in Adults Participants With Pancreatob](https://onco.cc/trials/nct07769502/), [A Study to Assess IPN01194 When Administered Alone in Adults With Advanced Solid Tumours](https://onco.cc/trials/nct06305247/), [A Study to Assess Safety, Tolerability and Imaging Characteristics of [68Ga]Ga-DPI-4452 and to Assess Safety, Tolerability, and Efficacy of [177Lu]Lu-DPI-4452 in Participants With Unresectable Locally Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct05706129/), [A Study to Compare QLS31905 and Chemotherapy With Placebo and Chemotherapy in Participants With Pancreatic Cancer](https://onco.cc/trials/nct07079228/), [A Study to Determine the Effect of CT3001 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06598007/), [A Study to Evaluate Chemotherapy With or Without INCB161734 in Previously Untreated, KRAS G12D-Mutated Metastatic Pancreatic Ductal Adenocarcinoma](https://onco.cc/trials/nct07522073/), [A Study to Evaluate the Effectiveness and Safety of Setidegrasib, Given With Either mFOLFIRINOX or NALIRIFOX Chemotherapies, in People With Pancreatic Cancer](https://onco.cc/trials/nct07409272/), [A Study to Evaluate the Safety and Efficacy of A2B530, a Logic-gated CAR T, in Participants With Solid Tumors That Express CEA and Have Lost HLA-A*02 Expression](https://onco.cc/trials/nct05736731/), [A Study to Evaluate the Safety and Efficacy of Mesothelin-Targeting Logic-gated CAR T, in Participants With Solid Tumors That Express MSLN and Have Lost HLA-A*02 Expression](https://onco.cc/trials/nct06051695/), [A Study to Evaluate the Safety, Tolerability, and Efficacy of BMS-986523 Alone and in Combination With Anti-Cancer Agents in Participants With Advance](https://onco.cc/trials/nct07223047/), [A Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Preliminary Antitumor Activity of INV-8989 in Patients With Advanced Solid Tumors Harboring KRAS G12D Mutations](https://onco.cc/trials/nct07610798/), [A Study to Investigate APL-5125 in Adults With Advanced Solid Tumors](https://onco.cc/trials/nct06399757/), [A Study to Learn About the Medicine Ponsegromab in Adults With Cancer of the Pancreas Which Has Spread and Caused Significant Body Weight Loss and Fatigue](https://onco.cc/trials/nct06989437/), [A Trial of AMXI-5001 for Treatment in Patients With Advanced Malignancies](https://onco.cc/trials/nct04503265/), [A Trial to Assess Efficacy, Safety, Pharmacokinetics of Octreotide Subcutaneous Injection in Patients With Gastroentero-pancreatic Neuroendocrine Tumor (GEP-NET)](https://onco.cc/trials/nct06505395/), [ACCENT: AMP945 in Combination With Nab-paclitaxel and Gemcitabine for Treatment of Pancreatic Cancer](https://onco.cc/trials/nct05355298/), [Acoustic Cluster Therapy (ACT) With Chemotherapy for the Treatment of Locally Advanced Pancreatic Cancer](https://onco.cc/trials/nct06850623/), [Actuate 1801 Part 3B (elraglusib)](https://onco.cc/trials/actuate-1801/), [Adapted Guided Stereotactic Body Radiotherapy Combined With Chemotherapy and Enhancement of Novel Drug Ivonescimab for Pancreatic Cancer (ASCEND)](https://onco.cc/trials/nct06844422/), [Administering Peripheral Blood Lymphocytes Transduced With a CD70-Binding Chimeric Antigen Receptor to People With CD70 Expressing Cancers](https://onco.cc/trials/nct02830724/), [Administering Peripheral Blood Lymphocytes Transduced With a Murine T-Cell Receptor Recognizing the G12V Variant of Mutated RAS in HLA-A*11:01 Patients](https://onco.cc/trials/nct03190941/), [AK112 and Cadonilimab Combined With Chemotherapy for 1L Treatment of Metastatic Pancreatic Cancer](https://onco.cc/trials/nct06646055/), [Alliance A021501](https://onco.cc/trials/alliance-a021501/), [Alliance A021806](https://onco.cc/trials/alliance-a021806/), [AMPLIFY-7P](https://onco.cc/trials/amplify-7p/), [An Exploratory Clinical Study of HRS-4642 in Combination With Immunotherapy and Chemotherapy for Pancreatic Cancer](https://onco.cc/trials/nct06938282/), [An Open-label Phase 3 Study of Lutetium (177Lu) Oxodotreotide Injection in Subjects With Advanced Gastrointestinal Pancreatic Neuroendocrine Tumors.](https://onco.cc/trials/nct05884255/), [An Open-label, Multicenter, Phase II Clinical Study to Evaluate HRS-7058 in Patients With Pancreatic Cancer](https://onco.cc/trials/nct07589569/), [ANO31905 in Combination With Chemotherapy for CLDN18.2-Positive Locally Advanced Unresectable or Metastatic Pancreatic Cancer](https://onco.cc/trials/nct07444541/), [APACT](https://onco.cc/trials/apact/), [Atebimetinib + GnP as a First Line Treatment in Patients With Metastatic Pancreatic Adenocarcinoma](https://onco.cc/trials/nct07562152/), [Autogene cevumeran phase 1 in resected pancreatic cancer (Memorial Sloan Kettering)](https://onco.cc/trials/autogene-cevumeran-phase-1/), [AVENGER 500](https://onco.cc/trials/avenger-500/), [AZD0901 in Participants With Advanced Solid Tumours Expressing Claudin18.2](https://onco.cc/trials/nct06219941/), [BEFAST Study, [68Ga]Ga-FAPI Total Body PET/CT for Better and Faster Imaging in Cancer](https://onco.cc/trials/nct07629609/), [Binimetinib in Patients With BRAF Fusion-positive Low-grade Glioma or Pancreatic Cancer (Perfume)](https://onco.cc/trials/nct06159478/), [CanStem111P](https://onco.cc/trials/canstem111p/), [Carcinoid Syndrome Efficacy Study Featuring an Oral Daily Paltusotine Regimen](https://onco.cc/trials/nct07087054/), [CD318-targeted CAR-T Cell Therapy in Patients With Pancreatic Cancer (ResCPa)](https://onco.cc/trials/nct07153289/), [CEB-01 in Locally Resectable Pancreatic Cancer](https://onco.cc/trials/nct06538857/), [Central-boost Ablative Radiation Therapy for Solid Tumors (CBART)](https://onco.cc/trials/nct06427460/), [Claudin18.2 CAR-T (CT041) in Patients With Gastric, Pancreatic Cancer, or Other Specified Digestive Cancers](https://onco.cc/trials/nct04404595/), [Clinical Study Evaluating the Safety, Tolerability, and Preliminary Efficacy of LM-108 ± Penpulimab+Chemotherapy in Advanced Solid Tumors - Cohort C](https://onco.cc/trials/nct06821503/), [Clinical Study of TQB2868 Injection Combined With Anlotinib Capsule and Chemotherapy in the First-line Treatment of Metastatic Pancreatic Neoplasms](https://onco.cc/trials/nct06767813/), [Clinical Study of Tumor Treating Fields Combined with Gemcitabine and Albumin-bound Paclitaxel in the First-line Treatment of Locally Advanced Pancreatic Cancer](https://onco.cc/trials/nct05653453/), [CodeBreaK 100 (pancreatic cancer cohort)](https://onco.cc/trials/codebreak-100/), [Combination Immunotherapy Plus Standard-of-Care Chemotherapy Versus Standard-of-Care Chemotherapy for the Treatment of Locally Advanced or Metastatic Pancreatic Cancer](https://onco.cc/trials/nct04390399/), [CONKO-001](https://onco.cc/trials/conko-001/), [CONKO-003 (OFF)](https://onco.cc/trials/conko-003/), [CONKO-005](https://onco.cc/trials/conko-005/), [CONKO-007](https://onco.cc/trials/conko-007/), [CROSSFIRE](https://onco.cc/trials/crossfire/), [Cutting Edge Imaging With PET-FAPI for Earlier Pancreatic Cancer Diagnosis (INDIGO-FAPI)](https://onco.cc/trials/nct06659705/), [DETERMINE Trial Treatment Arm 07: Dabrafenib in Combination With Trametinib in Adult, Paediatric and Teenage/Young Adult Patients With BRAF V600 Mutation-Positi](https://onco.cc/trials/nct07440290/), [Dose Escalation/Expansion Study of Mavrostobart (PT199), an Anti-CD73 mAb, Administered Alone and in Combination With a PD-1 Inhibitor or Chemotherapy](https://onco.cc/trials/nct05431270/), [Dual-Target CAR-NK Cells Targeting Mesothelin (MSLN) and MUC1 in Advanced Pancreatic Ductal Adenocarcinoma](https://onco.cc/trials/nct07627711/), [Dual-Targeting CAR-NK Cells Targeting Mesothelin (MSLN) and MUC1 in Advanced Pancreatic Ductal Adenocarcinoma](https://onco.cc/trials/nct07480928/), [Early Phase Study of KESONOTIDE™in Participants With Solid Tumours](https://onco.cc/trials/nct06926075/), [ECLIPSE (GVAX pancreas and CRS-207)](https://onco.cc/trials/eclipse/), [Efficacy and Safety Study of Tisotumab Vedotin for Patients With Solid Tumors](https://onco.cc/trials/nct03485209/), [ESPAC-1](https://onco.cc/trials/espac-1/), [ESPAC-3](https://onco.cc/trials/espac-3/), [ESPAC-4](https://onco.cc/trials/espac-4/), [ESPAC-5](https://onco.cc/trials/espac-5/), [EUROPAC](https://onco.cc/trials/europac/), [EUS-RFA PANCARDINAL-1 Trial](https://onco.cc/trials/nct04990609/), [Evaluation of PET Probe [68Ga]CBP8 in the Detection of Radiation Induced Tissue Injury](https://onco.cc/trials/nct04485286/), [Evaluation of Safety and Efficacy in BEY1107 in Monotherapy Gemcitabine Combination in Patient with Pancreatic Cancer](https://onco.cc/trials/nct03579836/), [Feasibility of the LUM Imaging System for Detection of Gastrointestinal Cancers](https://onco.cc/trials/nct02584244/), [First in Human Phase1/2a Clinical Trial of Anti-PAUF Monoclonal Antibody PBP1510 in Patients With Pancreatic Cancer](https://onco.cc/trials/nct05141149/), [FOLFIRINOX Versus OncoSil™ in Addition to FOLFIRINOX in Patients With Locally Advanced Pancreatic Adenocarcinoma](https://onco.cc/trials/nct05466799/), [Gemcitabine and Celecoxib Combination Therapy in Treating Patients With R0 Resection Pancreatic Cancer](https://onco.cc/trials/nct03498326/), [Glufosfamide Versus 5-FU in Second Line Metastatic Pancreatic Cancer](https://onco.cc/trials/nct01954992/), [HALO 109-301](https://onco.cc/trials/halo-301/), [HRS 4642 Injection Combined With AG Versus Placebo Combined With AG Therapy in First-Line Advanced or Metastatic Pancreatic Cancer](https://onco.cc/trials/nct07232875/), [HRS-4642 Combination With Other Antitumor Therapies in Patients With Solid Tumors](https://onco.cc/trials/nct07296341/), [IBI343 in Combination Therapy for Advanced Malignant Solid Tumors](https://onco.cc/trials/nct07483554/), [IMPRESS (algenpantucel-L)](https://onco.cc/trials/impress-trial/), [IN10018+ Standard Chemotherapy (+KN046) in Subjects With Advanced Pancreatic Cancer](https://onco.cc/trials/nct05827796/), [Initial Feasibility Study to Treat Borderline Resectable Pancreatic Cancer With a Planar LDR Source](https://onco.cc/trials/nct02843945/), [Intra-arterial Gemcitabine vs. IV Gemcitabine and Nab-Paclitaxel Following Radiotherapy for LAPC](https://onco.cc/trials/nct03257033/), [Irinotecan Hydrochloride Liposome Injection (II)in Combination With Oxaliplatin, 5-FU/LV Versus AG for First-line Treatment of Metastatic Pancreatic Cancer](https://onco.cc/trials/nct07238283/), [Ivonescimab(AK112/SMT112) in Combination With Stereotactic Body Radiation Therapy and Chemotherapy in Patients With Pancreatic Cancer](https://onco.cc/trials/nct06491472/), [JASPAC 01](https://onco.cc/trials/jaspac-01/), [KEYNOTE-158](https://onco.cc/trials/keynote-158/), [LAP07](https://onco.cc/trials/lap07/), [LAPIS](https://onco.cc/trials/lapis-trial/), [Lead-212 PSV359 Therapy for Patients With Solid Tumors](https://onco.cc/trials/nct06710756/), [Low-dose olanzapine for cancer anorexia (Tata Memorial)](https://onco.cc/trials/olanzapine-appetite-tmh/), [MPACT](https://onco.cc/trials/mpact/), [Multicenter Validation Trial of [18F]AlF-FAPI-74 for PET Imaging of Cancer-associated Fibroblasts Through Fibroblast Activation Protein Inhibitors (FAPI) in Dif](https://onco.cc/trials/nct06782412/), [Namodenoson Treatment of Advanced Pancreatic Cancer](https://onco.cc/trials/nct06387342/), [NAPOLI 3](https://onco.cc/trials/napoli-3/), [NAPOLI-1](https://onco.cc/trials/napoli-1/), [NEOLAP](https://onco.cc/trials/neolap/), [NEONAX](https://onco.cc/trials/neonax/), [NHS-Galleri](https://onco.cc/trials/nhs-galleri/), [NORPACT-1](https://onco.cc/trials/norpact-1/), [NOTABLE (nimotuzumab, KRAS wild-type pancreatic cancer)](https://onco.cc/trials/notable-trial/), [Pancreatic Cancer Diagnosis With FAPI-PET Imaging](https://onco.cc/trials/nct07098598/), [PANFIRE-2](https://onco.cc/trials/panfire-2/), [PANOPTIMOX-PRODIGE 35](https://onco.cc/trials/panoptimox-prodige-35/), [PANOVA-3](https://onco.cc/trials/panova-3/), [Phase 1/2 Dose Finding, Safety and PK Study in Advanced Refractory Solid Tumors](https://onco.cc/trials/nct07145255/), [Phase 1/2 Study of BHB810 in Advanced Gastric and GEJ Adenocarcinoma](https://onco.cc/trials/nct07529808/), [Phase 1/2 Study of MRTX849 in Patients With Cancer Having a KRAS G12C Mutation KRYSTAL-1](https://onco.cc/trials/nct03785249/), [Phase 1/2a Study to Assess the Safety, Tolerability, Pharmacokinetics, and Preliminary Efficacy of WEF-001 as Monotherapy in Advanced KRAS-Mutant Solid Tumours.](https://onco.cc/trials/nct07148128/), [Phase 2 Futibatinib in Combination With PD-1 Antibody Based Standard of Care in Solid Tumors](https://onco.cc/trials/nct05945823/), [Phase I Study of Autologous CD8+ and CD4+ Engineered T Cell Receptor T Cells in Subjects With Advanced or Metastatic Solid Tumor](https://onco.cc/trials/nct06105021/), [Phase I/II Clinical Study to Evaluate VB15010 Tablets in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06819215/), [Phase I/II Study: Allogeneic NK-cell Therapy With Chemotherapy for Post-Surgery PDA or Cholangiocarcinoma Patients](https://onco.cc/trials/nct06730009/), [Phase III Study to Compare GFH375 and Chemotherapy in Patients With KRAS G12D-Mutant Metastatic Pancreatic Cancer](https://onco.cc/trials/nct07262567/), [POLO](https://onco.cc/trials/polo/), [Polymeric Micellar Paclitaxel for Metastatic Pancreatic Cancer](https://onco.cc/trials/nct06752811/), [Ponsegromab phase 2 in cancer cachexia](https://onco.cc/trials/ponsegromab-phase-2/), [PRECEDE](https://onco.cc/trials/precede/), [Precision Promise](https://onco.cc/trials/precision-promise/), [Precision-Panc](https://onco.cc/trials/precision-panc/), [PREOPANC-1](https://onco.cc/trials/preopanc/), [PREOPANC-2](https://onco.cc/trials/preopanc-2/), [PREOPANC-3](https://onco.cc/trials/preopanc-3/), [PRIMUS 001](https://onco.cc/trials/primus-001/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [PRODIGE 4 / ACCORD 11](https://onco.cc/trials/prodige-4-accord-11/), [Psilocybin-Assisted Psychotherapy in Cancer Patients With Adjustment Disorder](https://onco.cc/trials/nct07072728/), [RASolute 302](https://onco.cc/trials/rasolute-302/), [Recombinant Human IL-21-expressing Oncolytic Vaccinia Virus Injection (hV01) in Advanced Pancreatic Cancer](https://onco.cc/trials/nct07006077/), [Relacorilant With Nab-Paclitaxel and Gemcitabine in Patients With Metastatic Pancreatic Adenocarcinoma](https://onco.cc/trials/nct07259317/), [Repurposing Riluzole for Cancer-Related Cognitive Impairment: A Pilot Trial](https://onco.cc/trials/nct06580002/), [RESOLVE](https://onco.cc/trials/resolve/), [Romiplostim N01 Plus ATRA for Persistent Isolated Chemotherapy-Induced Thrombocytopenia After Complete Remission of Gastrointestinal Solid Tumors](https://onco.cc/trials/nct07586813/), [Safety and Efficacy of Immuncell-LC With Gemcitabine in Resectable Pancreatic Cancer](https://onco.cc/trials/nct04969731/), [Safety and Efficacy of Mitazalimab in Combination With Chemotherapy in Pancreatic Cancer Patients](https://onco.cc/trials/nct04888312/), [Safety and Efficacy Study of NUV-1511 in Adult Patients With Advanced Solid Tumors](https://onco.cc/trials/nct06334432/), [Safety and Performance of a Novel Infusion Catheter System for Peri/Intratumoral Gemcitabine Delivery in Patients With Pancreatic Cancer](https://onco.cc/trials/nct07575191/), [Saltikva for Metastatic Pancreatic Cancer](https://onco.cc/trials/nct04589234/), [SCALOP](https://onco.cc/trials/scalop/), [SCALOP-2](https://onco.cc/trials/scalop-2/), [SEQUOIA](https://onco.cc/trials/sequoia/), [Sirolimus for Injection (Albumin Bound) Combined With Octreotide Long-acting Injection in Patients With Metastatic Gastroenteropancreatic Neuroendocrine Tumors](https://onco.cc/trials/nct07165886/), [SL-28 for Advanced Solid Tumours](https://onco.cc/trials/nct07341737/), [Spevatamig (PT886) as Monotherapy or in Combination With Chemo and/or ICI, for the Treatment of Patients With Advanced Gastric, Gastroesophageal Junct](https://onco.cc/trials/nct05482893/), [STARPAC2](https://onco.cc/trials/starpac2/), [Study for AZD4360 in Participants With Advanced Solid Tumours](https://onco.cc/trials/nct06921928/), [Study of [212Pb]Pb-DOTAM-MAM279 ([212Pb]Pb-MP0712) in Patients With Small Cell Lung Cancer and Other DLL3 Expressing Solid Tumors](https://onco.cc/trials/nct07278479/), [Study of Anti-CEACAM5 ADC M9140 in Participants With Advanced Solid Tumors (PROCEADE PanTumor)](https://onco.cc/trials/nct06710132/), [Study of AZD5863 in Adult Participants With Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct06005493/), [Study of CM4620 to Reduce the Severity of Pancreatitis Due to Asparaginase](https://onco.cc/trials/nct04195347/), [Study of Combined SGT-53 Plus Gemcitabine/Nab-Paclitaxel for Metastatic Pancreatic Cancer](https://onco.cc/trials/nct02340117/), [Study of CP-383 in Patients With Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct07030257/), [Study of CVM-1118 for Patients With Advanced Neuroendocrine Tumors](https://onco.cc/trials/nct03600233/), [Study of Daraxonrasib (RMC-6236) in Patients With Resected Pancreatic Ductal Adenocarcinoma (PDAC)](https://onco.cc/trials/nct07252232/), [Study of Daraxonrasib and Daraxonrasib + GnP as First-line Treatment in Patients With Metastatic Pancreatic Adenocarcinoma](https://onco.cc/trials/nct07491445/), [Study of Elironrasib and Daraxonrasib as Monotherapies and Combination Therapy in Participants With Advanced KRAS G12C Mutant Solid Tumors](https://onco.cc/trials/nct06128551/), [Study of JAB-23E73 in Combination With Chemotherapy in Participants With Metastatic PDAC Harboring KRAS Gene Alterations](https://onco.cc/trials/nct07640295/), [Study of JYP0015 in Patients With Advanced Solid Tumors Harboring Specific Mutations in RAS](https://onco.cc/trials/nct06895031/), [Study of LP-184 in Patients With Advanced Solid Tumors](https://onco.cc/trials/nct05933265/), [Study of LY3537982 in Cancer Patients With a Specific Genetic Mutation (KRAS G12C)](https://onco.cc/trials/nct04956640/), [Study of MRTX1133 in Patients With Advanced Solid Tumors Harboring a KRAS G12D Mutation](https://onco.cc/trials/nct05737706/), [Study of Nab-Paclitaxel and Gemcitabine With or Without SBP-101 in Pancreatic Cancer](https://onco.cc/trials/nct05254171/), [Study of Quemliclustat and Chemotherapy Versus Placebo and Chemotherapy in Patients With Metastatic Pancreatic Ductal Adenocarcinoma](https://onco.cc/trials/nct06608927/), [Study of RAS(ON) Inhibitors in Patients With Gastrointestinal Solid Tumors](https://onco.cc/trials/nct06445062/), [Study of RMC-6236 in Patients With Advanced Solid Tumors Harboring Specific Mutations in RAS](https://onco.cc/trials/nct05379985/), [Study of RMC-9805 in Participants With KRAS G12D-Mutant Solid Tumors](https://onco.cc/trials/nct06040541/), [Study of XNW28012 in Subjects With Advanced Solid Tumors Who Failed Standard Treatments](https://onco.cc/trials/nct06799637/), [Study of XNW28012 in Subjects With Metastatic Pancreatic Cancer Who Received Prior Systemic Therapy](https://onco.cc/trials/nct07823049/), [Study of Zoldonrasib (RMC-9805) Plus Daraxonrasib (RMC-6236) Versus Gemcitabine and Nab-Paclitaxel as First-Line Treatment in Metastatic KRAS G12D-Mut](https://onco.cc/trials/nct07805954/), [Study of Zoldonrasib + Chemo of Investigator's Choice vs Placebo + Chemo of Investigator's Choice as First-line Treatment in Metastatic KRAS G12D-muta](https://onco.cc/trials/nct07621718/), [Study to Assess GTAEXS617 in Participants With Advanced Solid Tumors](https://onco.cc/trials/nct05985655/), [Study to Assess the Safety, Tolerability of JPI-547 in Combination With Modified FOLFIRINOX or Gemcitabine-nab-paclitaxel in Patients With Locally Adv](https://onco.cc/trials/nct05257993/), [Study to Evaluate the Diagnostic Performance of GEH300079 (68Ga) Injection PET/CT for Detection of PC in Patients With Colorectal, Gastric, Ovarian, o](https://onco.cc/trials/nct07219238/), [Study to Evaluate the Efficacy and Safety of [177Lu]Lu-DOTA-TATE in Patients With Grade 1 and Grade 2 Advanced GEP-NET](https://onco.cc/trials/nct06784752/), [Study to Evaluate the Efficacy and Safety of Lutathera in Patients With Grade 2 and Grade 3 Advanced GEP-NET](https://onco.cc/trials/nct03972488/), [Study to Evaluate the Safety and Efficacy of Treatment With NLM-001 and Standard Chemotherapy Plus Zalifrelimab in Patients With Advanced Pancreatic C](https://onco.cc/trials/nct04827953/), [Study to Evaluate the Safety, Tolerability & Efficacy of TNG462 in Combination in PDAC & NSCLC Patients](https://onco.cc/trials/nct06922591/), [SWOG S1505](https://onco.cc/trials/swog-s1505/), [Targeted Alpha-Particle Therapy for Advanced Somatostatin Receptor Type 2 (SSTR2) Positive Tumors](https://onco.cc/trials/nct05636618/), [The Cancer Connected Access and Remote Expertise Beyond Walls Program to Provide In-Home Cancer Treatment and Improve Treatment Satisfaction in Cancer Patients](https://onco.cc/trials/nct07285044/), [The Cancer of the Pancreas Screening-5 CAPS5)Study](https://onco.cc/trials/nct02000089/), [The Effect of Kinisoquin™ on Thromboembolic Events in Patients With Metastatic or Locally Advanced Pancreatic Cancer](https://onco.cc/trials/nct06861088/), [The KN510713 Study in Combination With mFOLFIRINOX](https://onco.cc/trials/nct07114861/), [tislelizUMaB in canceR Patients With molEcuLar residuaL Disease](https://onco.cc/trials/nct06332274/), [TRYbeCA-1](https://onco.cc/trials/trybeca-1/)
- people: [Albert C. Koong](https://onco.cc/people/albert-koong/), [Andrew Biankin](https://onco.cc/people/andrew-biankin/), [Andrew J. Aguirre](https://onco.cc/people/andrew-aguirre/), [Anirban Maitra](https://onco.cc/people/anirban-maitra/), [Bert Vogelstein](https://onco.cc/people/bert-vogelstein/), [Bill Greenhalf](https://onco.cc/people/bill-greenhalf/), [Chris Halloran](https://onco.cc/people/chris-halloran/), [Costas A. Lyssiotis](https://onco.cc/people/costas-lyssiotis/), [Daniel D. Von Hoff](https://onco.cc/people/daniel-von-hoff/), [Daniel Palmer](https://onco.cc/people/daniel-palmer/), [David A. Tuveson](https://onco.cc/people/david-tuveson/), [Diane M. Simeone](https://onco.cc/people/diane-simeone/), [Do-Youn Oh](https://onco.cc/people/oh-do-youn/), [Dung T. Le](https://onco.cc/people/dung-le/), [Eileen M. O'Reilly](https://onco.cc/people/eileen-oreilly/), [Elizabeth M. Jaffee](https://onco.cc/people/elizabeth-jaffee/), [Eric Van Cutsem](https://onco.cc/people/eric-van-cutsem/), [Francisco Berrospi Espinoza](https://onco.cc/people/francisco-berrospi-espinoza/), [Frank McCormick](https://onco.cc/people/frank-mccormick/), [Giampaolo Tortora](https://onco.cc/people/giampaolo-tortora/), [Hedy L. Kindler](https://onco.cc/people/hedy-kindler/), [Jürgen Weitz](https://onco.cc/people/jurgen-weitz/), [Kevan M. Shokat](https://onco.cc/people/kevan-shokat/), [Leonor Beleza](https://onco.cc/people/leonor-beleza/), [Lin Shen](https://onco.cc/people/shen-lin/), [Linda Tantawi](https://onco.cc/people/linda-tantawi/), [Marc G. Besselink](https://onco.cc/people/marc-besselink/), [Marc Lustgarten](https://onco.cc/people/marc-lustgarten/), [Matthew Vander Heiden](https://onco.cc/people/matthew-vander-heiden/), [Owen Sansom](https://onco.cc/people/owen-sansom/), [Paula Ghaneh](https://onco.cc/people/paula-ghaneh/), [Peter J. O'Dwyer](https://onco.cc/people/peter-odwyer/), [Peter W. T. Pisters](https://onco.cc/people/peter-pisters/), [Philip D. Greenberg](https://onco.cc/people/philip-greenberg/), [Rachel Michaelson-Cohen](https://onco.cc/people/rachel-michaelson-cohen/), [Raffit Hassan](https://onco.cc/people/raffit-hassan/), [Randy Pausch](https://onco.cc/people/randy-pausch/), [Richard Schulick](https://onco.cc/people/richard-schulick/), [Robert H. Vonderheide](https://onco.cc/people/robert-vonderheide/), [Selwyn M. Vickers](https://onco.cc/people/selwyn-vickers/), [Senthil K. Muthuswamy](https://onco.cc/people/senthil-muthuswamy/), [Susan M. Domchek](https://onco.cc/people/susan-domchek/), [Talia Golan](https://onco.cc/people/talia-golan/), [Tanios Bekaii-Saab](https://onco.cc/people/tanios-bekaii-saab/), [Teresa Cotta-Dias](https://onco.cc/people/teresa-cotta-dias/), [Theodore S. Hong](https://onco.cc/people/theodore-hong/), [Theodore S. Lawrence](https://onco.cc/people/theodore-lawrence/), [Thierry Conroy](https://onco.cc/people/thierry-conroy/), [Tobias Janowitz](https://onco.cc/people/tobias-janowitz/), [Uğur Şahin](https://onco.cc/people/ugur-sahin/), [Vinod P. Balachandran](https://onco.cc/people/vinod-balachandran/), [Volker Heinemann](https://onco.cc/people/volker-heinemann/), [Zev A. Wainberg](https://onco.cc/people/zev-wainberg/)
- key papers: [A combination of molecular markers and clinical features improve the classification of pancreatic cysts](https://onco.cc/key-papers/paper-springer-pancreatic-cyst-molecular-classification-gastroenterology-2015/), [A new CA19-9 cutoff value identifies Lewis antigen status and refines prognostic stratification in PDAC](https://onco.cc/key-papers/paper-yeh-ca19-9-lewis-negative-fut3-cutoff-ccr-2026/), [A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer](https://onco.cc/key-papers/paper-espac-1-chemoradiotherapy-chemotherapy-resected-pancreatic-nejm-2004/), [A renewed model of pancreatic cancer evolution based on genomic rearrangement patterns](https://onco.cc/key-papers/paper-notta-punctuated-evolution-pancreatic-nature-2016/), [A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas](https://onco.cc/key-papers/paper-basturk-baltimore-consensus-precursor-lesions-ajsp-2015/), [A unifying paradigm for transcriptional heterogeneity and squamous features in pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-hayashi-squamous-basal-like-pancreatic-nat-cancer-2020/), [Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial](https://onco.cc/key-papers/paper-conko-001-adjuvant-gemcitabine-observation-jama-2007/), [Allemani 2018: CONCORD-3, global surveillance of cancer survival 2000 to 2014](https://onco.cc/key-papers/paper-allemani-concord-3-lancet-2018/), [Alliance A021501: preoperative modified FOLFIRINOX with or without hypofractionated radiotherapy for borderline resectable pancreatic cancer](https://onco.cc/key-papers/paper-alliance-a021501-mfolfirinox-radiotherapy-borderline-resectable-jama-oncol-2022/), [Association Between Inherited Germline Mutations in Cancer Predisposition Genes and Risk of Pancreatic Cancer](https://onco.cc/key-papers/paper-hu-germline-mutations-pancreatic-cancer-risk-jama-2018/), [Association of alterations in main driver genes with outcomes of patients with resected pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-qian-driver-genes-outcomes-resected-pancreatic-jama-oncol-2018/), [Association of distinct mutational signatures with correlates of increased immune activity in pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-connor-mutational-signatures-immune-pancreatic-jama-oncol-2017/), [Autophagy promotes immune evasion of pancreatic cancer by degrading MHC-I](https://onco.cc/key-papers/paper-yamamoto-nature/), [Bien 2011: pancreatoblastoma, a report from the European cooperative study group for paediatric rare tumours (EXPeRT)](https://onco.cc/key-papers/paper-bien-pancreatoblastoma-expert-european-cooperative-ejc-2011/), [Burris 1997: gemcitabine becomes the first standard treatment for advanced pancreatic cancer](https://onco.cc/key-papers/paper-burris-gemcitabine-pancreatic-jco-1997/), [CA 19-9 tumour-marker response to chemotherapy in patients with advanced pancreatic cancer enrolled in a randomised controlled trial](https://onco.cc/key-papers/paper-hess-ca19-9-response-chemotherapy-lancet-oncol-2008/), [Calle 2003: overweight, obesity and death from cancer in 900,000 US adults](https://onco.cc/key-papers/paper-calle-obesity-cancer-mortality-nejm-2003/), [Challenges and opportunities for pancreatic cancer immunotherapy](https://onco.cc/key-papers/paper-bear-pancreatic-immunotherapy-review-cancer-cell-2020/), [Chmielecki 2014: comprehensive genomic profiling of pancreatic acinar cell carcinomas identifies recurrent RAF fusions and frequent inactivation of DNA repair genes](https://onco.cc/key-papers/paper-chmielecki-acinar-cell-carcinoma-raf-fusions-dna-repair-cancer-discov-2014/), [Circulating nucleic acids are associated with outcomes of patients with pancreatic cancer](https://onco.cc/key-papers/paper-bernard-ctdna-exodna-pancreatic-gastroenterology-2019/), [Circulating tumor DNA as a clinical test in resected pancreatic cancer](https://onco.cc/key-papers/paper-groot-kras-ctdna-clinical-test-resected-pancreatic-ccr-2019/), [Circulating tumor DNA as a potential marker of adjuvant chemotherapy benefit following surgery for localized pancreatic cancer](https://onco.cc/key-papers/paper-lee-ctdna-adjuvant-benefit-localized-pancreatic-ann-oncol-2019/), [Clinical implications of genomic alterations in the tumour and circulation of pancreatic cancer patients](https://onco.cc/key-papers/paper-sausen-ctdna-pancreatic-resection-nat-commun-2015/), [Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set](https://onco.cc/key-papers/paper-klein-ccga3-mced-validation-ann-oncol-2021/), [CodeBreaK 100: sotorasib in KRAS p.G12C-mutated advanced pancreatic cancer](https://onco.cc/key-papers/paper-codebreak-100-sotorasib-kras-g12c-pancreatic-nejm-2023/), [Combined circulating tumor DNA and protein biomarker-based liquid biopsy for the earlier detection of pancreatic cancers](https://onco.cc/key-papers/paper-cohen-ctdna-protein-liquid-biopsy-pancreatic-pnas-2017/), [Comprehensive characterisation of pancreatic ductal adenocarcinoma with microsatellite instability: histology, molecular pathology and clinical implications](https://onco.cc/key-papers/paper-luchini-msi-dmmr-pancreatic-systematic-review-gut-2021/), [Concurrent inhibition of oncogenic and wild-type RAS-GTP for cancer therapy](https://onco.cc/key-papers/paper-holderfield-ras-on-multi-selective-inhibitor-nature-2024/), [CONKO-001: adjuvant gemcitabine and long-term outcomes after resected pancreatic cancer](https://onco.cc/key-papers/paper-conko-001-adjuvant-gemcitabine-long-term-oettle-jama-2013/), [Conroy 2011: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer (PRODIGE 4/ACCORD 11)](https://onco.cc/key-papers/paper-conroy-folfirinox-pancreatic-nejm-2011/), [Core signaling pathways in human pancreatic cancers revealed by global genomic analyses](https://onco.cc/key-papers/paper-jones-pancreatic-core-pathways-science-2008/), [Cross-species single-cell analysis of pancreatic ductal adenocarcinoma reveals antigen-presenting cancer-associated fibroblasts](https://onco.cc/key-papers/paper-elyada-antigen-presenting-cafs-single-cell-cancer-discov-2019/), [Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer](https://onco.cc/key-papers/paper-daraxonrasib-pancreatic-n-engl-j-med-2026/), [Deleterious germline mutations in patients with apparently sporadic pancreatic adenocarcinoma](https://onco.cc/key-papers/paper-shindo-germline-sporadic-pancreatic-jco-2017/), [Depletion of carcinoma-associated fibroblasts and fibrosis induces immunosuppression and accelerates pancreas cancer with reduced survival](https://onco.cc/key-papers/paper-ozdemir-caf-depletion-accelerates-pancreatic-cancer-cancer-cell-2014/), [DETECT-A: a blood test plus PET-CT found treatable cancers in 10,000 women with no symptoms](https://onco.cc/key-papers/paper-detect-a-science-2020/), [Detection and localization of surgically resectable cancers with a multi-analyte blood test](https://onco.cc/key-papers/paper-cohen-cancerseek-multi-analyte-blood-test-science-2018/), [Dhebri 2004: diagnosis, treatment and outcome of pancreatoblastoma](https://onco.cc/key-papers/paper-dhebri-pancreatoblastoma-diagnosis-treatment-outcome-pancreatology-2004/), [Distant metastasis occurs late during the genetic evolution of pancreatic cancer](https://onco.cc/key-papers/paper-yachida-metastasis-late-genetic-evolution-pancreatic-nature-2010/), [Distinct populations of inflammatory fibroblasts and myofibroblasts in pancreatic cancer](https://onco.cc/key-papers/paper-ohlund-caf-subtypes-mycaf-icaf-jem-2017/), [DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer](https://onco.cc/key-papers/paper-iacobuzio-donahue-dpc4-failure-pattern-autopsy-jco-2009/), [Durvalumab with or without tremelimumab for patients with metastatic pancreatic ductal adenocarcinoma: a phase 2 randomized clinical trial](https://onco.cc/key-papers/paper-oreilly-durvalumab-tremelimumab-pancreatic-jama-oncol-2019/), [Efficacy and safety of trastuzumab deruxtecan in patients with HER2-expressing biliary tract or pancreatic tumors: a subgroup analysis of DESTINY-PanTumor02](https://onco.cc/key-papers/paper-oh-destiny-pantumor02-biliary-pancreatic-esmo-open-2026/), [eNRGy: efficacy of zenocutuzumab in NRG1 fusion-positive cancer](https://onco.cc/key-papers/paper-enrgy-zenocutuzumab-nrg1-fusion-positive-cancer-nejm-2025/), [Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study](https://onco.cc/key-papers/paper-roberts-pert-survival-pancreatic-cancer-pancreatology-2019/), [ESPAC-3: adjuvant fluorouracil plus folinic acid versus gemcitabine after pancreatic cancer resection](https://onco.cc/key-papers/paper-espac-3-fluorouracil-vs-gemcitabine-adjuvant-neoptolemos-jama-2010/), [ESPAC-4: adjuvant gemcitabine plus capecitabine versus gemcitabine alone after resection of pancreatic cancer](https://onco.cc/key-papers/paper-espac-4-gemcitabine-capecitabine-adjuvant-pancreatic-lancet-2017/), [ESPAC5: immediate surgery versus short-course neoadjuvant chemotherapy or chemoradiotherapy for borderline resectable pancreatic cancer](https://onco.cc/key-papers/paper-espac-5-neoadjuvant-borderline-resectable-pancreatic-lancet-gastro-hep-2023/), [Estimated Projection of US Cancer Incidence and Death to 2040](https://onco.cc/key-papers/paper-rahib-projection-us-cancer-2040-jama-netw-open-2021/), [European evidence-based guidelines on pancreatic cystic neoplasms (2018)](https://onco.cc/key-papers/paper-european-evidence-based-guidelines-pancreatic-cystic-neoplasms-gut-2018/), [Fifty years of the British Doctors Study: smokers lose ten years of life, quitting gives most of it back](https://onco.cc/key-papers/paper-doll-peto-50-year-doctors-bmj-2004/), [Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial](https://onco.cc/key-papers/paper-prodige-24-five-year-outcomes-jama-oncol-2022/), [GATA6 expression distinguishes classical and basal-like subtypes in advanced pancreatic cancer](https://onco.cc/key-papers/paper-okane-gata6-basal-like-compass-ccr-2020/), [Genomic analyses identify molecular subtypes of pancreatic cancer](https://onco.cc/key-papers/paper-bailey-molecular-subtypes-pancreatic-nature-2016/), [Genomic characterization of malignant progression in neoplastic pancreatic cysts](https://onco.cc/key-papers/paper-noe-cyst-malignant-progression-genomics-nat-commun-2020/), [Genomic methods identify homologous recombination deficiency in pancreas adenocarcinoma and optimize treatment selection](https://onco.cc/key-papers/paper-park-hrd-pancreatic-platinum-ccr-2020/), [Genomics-driven precision medicine for advanced pancreatic cancer: early results from the COMPASS trial](https://onco.cc/key-papers/paper-aung-compass-early-results-ccr-2018/), [Germline cancer susceptibility gene variants, somatic second hits, and survival outcomes in patients with resected pancreatic cancer](https://onco.cc/key-papers/paper-yurgelun-germline-second-hits-resected-pancreatic-genet-med-2019/), [Heining 2018: NRG1 fusions in KRAS wild-type pancreatic cancer](https://onco.cc/key-papers/paper-heining-nrg1-fusions-kras-wild-type-pancreatic-cancer-discov-2018/), [Hu 2018: evaluating mismatch repair deficiency in pancreatic adenocarcinoma, challenges and recommendations](https://onco.cc/key-papers/paper-hu-mismatch-repair-deficiency-pancreatic-adenocarcinoma-ccr-2018/), [IARC verdict: excess body fat causes 13 cancers](https://onco.cc/key-papers/paper-body-fatness-iarc-nejm-2016/), [Identification of targetable ALK rearrangements in pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-singhi-alk-rearrangements-pancreatic-jnccn-2017/), [Identification of unique neoantigen qualities in long-term survivors of pancreatic cancer](https://onco.cc/key-papers/paper-balachandran-neoantigen-quality-long-term-survivors-nature-2017/), [Inhibition of hedgehog signaling enhances delivery of chemotherapy in a mouse model of pancreatic cancer](https://onco.cc/key-papers/paper-olive-hedgehog-stroma-gemcitabine-delivery-science-2009/), [Integrated genomic characterization of pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-tcga-pancreatic-integrated-characterisation-cancer-cell-2017/), [International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas (2024)](https://onco.cc/key-papers/paper-kyoto-2024-evidence-based-guidelines-ipmn-pancreatology-2024/), [IPMNs with co-occurring invasive cancers: neighbours but not always relatives](https://onco.cc/key-papers/paper-felsenstein-ipmn-cooccurring-cancer-relatedness-gut-2018/), [Jones 2019: NRG1 gene fusions are recurrent, clinically actionable rearrangements in KRAS wild-type pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-jones-nrg1-fusions-recurrent-actionable-kras-wild-type-pdac-ccr-2019/), [KEYNOTE-158: pembrolizumab in non-colorectal high microsatellite instability or mismatch repair-deficient cancer](https://onco.cc/key-papers/paper-keynote-158-pembrolizumab-msi-high-noncolorectal-jco-2020/), [Klimstra 1992: acinar cell carcinoma of the pancreas, a clinicopathologic study of 28 cases](https://onco.cc/key-papers/paper-klimstra-acinar-cell-carcinoma-pancreas-28-cases-ajsp-1992/), [Klimstra 1995: pancreatoblastoma, a clinicopathologic study and review of the literature](https://onco.cc/key-papers/paper-klimstra-pancreatoblastoma-clinicopathologic-study-ajsp-1995/), [KRAS G12D mutation subtype is a prognostic factor for advanced pancreatic adenocarcinoma](https://onco.cc/key-papers/paper-bournet-kras-g12d-prognosis-pancreatic-ctg-2016/), [KRYSTAL-1: adagrasib in advanced solid tumours harbouring a KRAS G12C mutation, including pancreatic cancer](https://onco.cc/key-papers/paper-krystal-1-adagrasib-kras-g12c-solid-tumours-jco-2023/), [La Rosa 2012: clinicopathologic study of 62 acinar cell carcinomas of the pancreas](https://onco.cc/key-papers/paper-la-rosa-acinar-cell-carcinoma-62-cases-ajsp-2012/), [LAP07: chemoradiotherapy versus continued chemotherapy for locally advanced pancreatic cancer controlled after four months of gemcitabine](https://onco.cc/key-papers/paper-lap07-chemoradiotherapy-locally-advanced-pancreatic-jama-2016/), [Le 2017: mismatch-repair deficiency predicts response to PD-1 blockade across twelve tumour types, leading to the first tissue-agnostic drug approval](https://onco.cc/key-papers/paper-le-mmr-deficiency-science-2017/), [Lead-Time Trajectory of CA19-9 as an Anchor Marker for Pancreatic Cancer Early Detection](https://onco.cc/key-papers/paper-fahrmann-ca19-9-lead-time-gastroenterology-2021/), [Limited heterogeneity of known driver gene mutations among the metastases of individual patients with pancreatic cancer](https://onco.cc/key-papers/paper-makohon-moore-metastases-driver-homogeneity-nat-genet-2017/), [Loss of KDM6A activates super-enhancers to induce gender-specific squamous-like pancreatic cancer and confers sensitivity to BET inhibitors](https://onco.cc/key-papers/paper-andricovich-kdm6a-squamous-pancreatic-cancer-cell-2018/), [Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium](https://onco.cc/key-papers/paper-caps-consortium-surveillance-recommendations-gut-2020/), [Metastatic Pancreatic Cancer: ASCO Guideline Update](https://onco.cc/key-papers/paper-asco-metastatic-pancreatic-cancer-guideline-update-jco-2020/), [Model to Determine Risk of Pancreatic Cancer in Patients With New-Onset Diabetes](https://onco.cc/key-papers/paper-sharma-endpac-model-new-onset-diabetes-gastroenterology-2018/), [Molecular characterization of KRAS wild-type tumors in patients with pancreatic adenocarcinoma](https://onco.cc/key-papers/paper-philip-kras-wild-type-pancreatic-ccr-2022/), [Most human carcinomas of the exocrine pancreas contain mutant c-K-ras genes](https://onco.cc/key-papers/paper-almoguera-kras-codon-12-pancreatic-cell-1988/), [MPACT (Von Hoff 2013): nab-paclitaxel plus gemcitabine for metastatic pancreatic cancer](https://onco.cc/key-papers/paper-mpact-nab-paclitaxel-gemcitabine-nejm-2013/), [Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial](https://onco.cc/key-papers/paper-napoli-1-nanoliposomal-irinotecan-lancet-2016/), [NAPOLI-3: NALIRIFOX versus gemcitabine plus nab-paclitaxel as first treatment for metastatic pancreatic cancer](https://onco.cc/key-papers/paper-napoli-3-lancet-2023/), [Neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy in resectable and borderline resectable pancreatic cancer (PREOPANC-2): a multicentre, open-label, phase 3 randomised trial](https://onco.cc/key-papers/paper-preopanc-2-neoadjuvant-folfirinox-vs-chemoradiotherapy-lancet-oncol-2025/), [NORPACT-1: neoadjuvant FOLFIRINOX versus upfront surgery for resectable pancreatic head cancer](https://onco.cc/key-papers/paper-norpact-1-neoadjuvant-folfirinox-labori-lancet-gastroenterol-hepatol-2024/), [O'Reilly 2020: gemcitabine and cisplatin with or without veliparib in pancreatic cancer with a germline BRCA or PALB2 mutation](https://onco.cc/key-papers/paper-oreilly-gemcitabine-cisplatin-veliparib-gbrca-palb2-pancreatic-jco-2020/), [Ostrem and Shokat: the hidden pocket that made KRAS G12C druggable](https://onco.cc/key-papers/paper-ostrem-kras-g12c-nature-2013/), [Overall survival and clinical characteristics of pancreatic cancer in BRCA mutation carriers](https://onco.cc/key-papers/paper-golan-brca-pancreatic-platinum-survival-bjc-2014/), [Overall survival in patients with pancreatic cancer receiving matched therapies following molecular profiling: a retrospective analysis of the Know Your Tumor registry trial](https://onco.cc/key-papers/paper-pishvaian-lancet-oncol/), [Pancreatic Adenocarcinoma, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology](https://onco.cc/key-papers/paper-nccn-pancreatic-adenocarcinoma-v2-2021-jnccn-2021/), [Pancreatic cancer](https://onco.cc/key-papers/paper-hidalgo-pancreatic-cancer-review-nejm-2010/), [Pancreatic cancer early detection biomarkers for high-risk individuals: insights from the PRECEDE consortium](https://onco.cc/key-papers/paper-worthington-precede-early-detection-biomarkers-ijc-2026/), [Pancreatic cancer genomes reveal aberrations in axon guidance pathway genes](https://onco.cc/key-papers/paper-biankin-pancreatic-exomes-axon-guidance-nature-2012/), [Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up](https://onco.cc/key-papers/paper-esmo-pancreatic-cancer-guideline-ann-oncol-2023/), [Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions](https://onco.cc/key-papers/paper-hruban-panin-nomenclature-ajsp-2001/), [Pathways of progression from intraductal papillary mucinous neoplasm to pancreatic ductal adenocarcinoma based on molecular features](https://onco.cc/key-papers/paper-omori-ipmn-progression-pathways-gastroenterology-2019/), [Performance of a multi-cancer early detection test in the randomized controlled NHS-Galleri trial](https://onco.cc/key-papers/paper-nhs-galleri-performance-nat-med-2026/), [Phase 2 trial of single agent ipilimumab (anti-CTLA-4) for locally advanced or metastatic pancreatic adenocarcinoma](https://onco.cc/key-papers/paper-royal-ipilimumab-pancreatic-j-immunother-2010/), [Phase II study of maintenance rucaparib in patients with platinum-sensitive advanced pancreatic cancer and a pathogenic germline or somatic variant in BRCA1, BRCA2, or PALB2](https://onco.cc/key-papers/paper-reiss-rucaparib-maintenance-brca-palb2-pancreatic-jco-2021/), [Phase II trial of cetuximab, gemcitabine, and oxaliplatin followed by chemoradiation with cetuximab for locally advanced (T4) pancreatic adenocarcinoma: correlation of Smad4(Dpc4) immunostaining with pattern of disease progression](https://onco.cc/key-papers/paper-crane-smad4-progression-pattern-locally-advanced-jco-2011/), [Plasma circulating tumor DNA in pancreatic cancer patients is a prognostic marker](https://onco.cc/key-papers/paper-pietrasz-ctdna-prognostic-pancreatic-ccr-2017/), [POLO final overall survival: maintenance olaparib versus placebo in germline BRCA-mutated metastatic pancreatic cancer](https://onco.cc/key-papers/paper-polo-overall-survival-olaparib-gbrca-pancreatic-jco-2022/), [POLO: maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer](https://onco.cc/key-papers/paper-polo-olaparib-maintenance-gbrca-pancreatic-nejm-2019/), [Ponsegromab for the Treatment of Cancer Cachexia](https://onco.cc/key-papers/paper-groarke-ponsegromab-cancer-cachexia-nejm-2024/), [Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update](https://onco.cc/key-papers/paper-asco-potentially-curable-pancreatic-guideline-update-jco-2019/), [Precancerous neoplastic cells can move through the pancreatic ductal system](https://onco.cc/key-papers/paper-makohon-moore-precursor-cells-ductal-system-nature-2018/), [PREOPANC long-term results: neoadjuvant gemcitabine-based chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer](https://onco.cc/key-papers/paper-preopanc-neoadjuvant-chemoradiotherapy-long-term-jco-2022/), [Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial](https://onco.cc/key-papers/paper-preopanc-preoperative-chemoradiotherapy-jco-2020/), [Presence of somatic mutations in most early-stage pancreatic intraepithelial neoplasia](https://onco.cc/key-papers/paper-kanda-panin-1-somatic-mutations-gastroenterology-2012/), [Preservation of the pylorus in pancreaticoduodenectomy](https://onco.cc/key-papers/paper-traverso-longmire-pylorus-preservation-pancreaticoduodenectomy-sgo-1978/), [Probability of pancreatic cancer following diabetes: a population-based study](https://onco.cc/key-papers/paper-chari-pancreatic-cancer-following-diabetes-gastroenterology-2005/), [PRODIGE 24/CCTG PA6: adjuvant modified FOLFIRINOX versus gemcitabine after resection of pancreatic cancer](https://onco.cc/key-papers/paper-prodige-24-adjuvant-mfolfirinox-pancreatic-nejm-2018/), [Prospective evaluation of germline alterations in patients with exocrine pancreatic neoplasms](https://onco.cc/key-papers/paper-lowery-prospective-germline-exocrine-pancreatic-jnci-2018/), [Purity Independent Subtyping of Tumors (PurIST), a clinically robust, single-sample classifier for tumor subtyping in pancreatic cancer](https://onco.cc/key-papers/paper-rashid-purist-pancreatic-subtype-classifier-ccr-2020/), [Rahib 2014: projecting US cancer incidence and deaths to 2030](https://onco.cc/key-papers/paper-rahib-projecting-cancer-deaths-2030-cancerres-2014/), [Randomized Phase III Trial of Pegvorhyaluronidase Alfa With Nab-Paclitaxel Plus Gemcitabine for Patients With Hyaluronan-High Metastatic Pancreatic Adenocarcinoma](https://onco.cc/key-papers/paper-halo-301-pegvorhyaluronidase-jco-2020/), [Real-time genomic characterization of advanced pancreatic cancer to enable precision medicine](https://onco.cc/key-papers/paper-aguirre-real-time-genomic-characterisation-pancreatic-cancer-discov-2018/), [Real-time targeted genome profile analysis of pancreatic ductal adenocarcinomas identifies genetic alterations that might be targeted with existing drugs or used as biomarkers](https://onco.cc/key-papers/paper-singhi-targeted-genome-profiling-3594-pdac-gastroenterology-2019/), [Recommendations for a more organized and effective approach to the early detection of pancreatic cancer from the PRECEDE (Pancreatic Cancer Early Detection) consortium](https://onco.cc/key-papers/paper-gonda-precede-consortium-recommendations-gastroenterology-2021/), [Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development](https://onco.cc/key-papers/paper-wu-gnas-ipmn-sci-transl-med-2011/), [Relationship of carbohydrate antigen 19-9 and Lewis antigens in pancreatic cancer](https://onco.cc/key-papers/paper-tempero-ca19-9-lewis-antigens-cancer-res-1987/), [Revised international consensus Fukuoka guidelines for the management of IPMN of the pancreas (2017)](https://onco.cc/key-papers/paper-fukuoka-2017-consensus-guidelines-ipmn-pancreatology-2017/), [Risk of Neoplastic Progression in Individuals at High Risk for Pancreatic Cancer Undergoing Long-term Surveillance](https://onco.cc/key-papers/paper-canto-caps-long-term-surveillance-gastroenterology-2018/), [RNA neoantigen vaccines prime long-lived CD8+ T cells in pancreatic cancer](https://onco.cc/key-papers/paper-sethna-rna-neoantigen-vaccine-long-lived-t-cells-nature-2025/), [Rojas 2023: a personalised mRNA vaccine trained T cells against each patient's pancreatic cancer, and those who responded stayed cancer-free longer](https://onco.cc/key-papers/paper-rojas-mrna-neoantigen-vaccine-pancreatic-nature-2023/), [Safety and activity of anti-PD-L1 antibody in patients with advanced cancer](https://onco.cc/key-papers/paper-brahmer-anti-pd-l1-phase-1-nejm-2012/), [Siegel 2024: Cancer statistics, 2024, the American Cancer Society's annual US report](https://onco.cc/key-papers/paper-siegel-cancer-statistics-2024-cacancer-2024/), [Spatially confined sub-tumor microenvironments in pancreatic cancer](https://onco.cc/key-papers/paper-grunwald-subtme-pancreatic-cell-2021/), [Stratification of pancreatic ductal adenocarcinomas based on tumor and microenvironment features](https://onco.cc/key-papers/paper-puleo-pancreatic-tumour-microenvironment-subtypes-gastroenterology-2018/), [Stromal elements act to restrain, rather than support, pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-rhim-stroma-restrains-pancreatic-cancer-cell-2014/), [Subtype-discordant pancreatic ductal adenocarcinoma tumors show intermediate clinical and molecular characteristics](https://onco.cc/key-papers/paper-topham-subtype-discordant-pancreatic-ccr-2021/), [Subtypes of pancreatic ductal adenocarcinoma and their differing responses to therapy](https://onco.cc/key-papers/paper-collisson-pancreatic-subtypes-nat-med-2011/), [Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer](https://onco.cc/key-papers/paper-goonetilleke-ca19-9-systematic-review-ejso-2007/), [Targeting CXCL12 from FAP-expressing carcinoma-associated fibroblasts synergizes with anti-PD-L1 immunotherapy in pancreatic cancer](https://onco.cc/key-papers/paper-feig-cxcl12-fap-cafs-t-cell-exclusion-pnas-2013/), [The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival](https://onco.cc/key-papers/paper-dbouk-caps5-stage-survival-jco-2022/), [The tumour microenvironment in pancreatic cancer: clinical challenges and opportunities](https://onco.cc/key-papers/paper-ho-pancreatic-tumour-microenvironment-review-nrco-2020/), [Transcription phenotypes of pancreatic cancer are driven by genomic events during tumor evolution](https://onco.cc/key-papers/paper-chan-seng-yue-pancreatic-transcription-phenotypes-nat-genet-2020/), [Treatment of carcinoma of the ampulla of Vater](https://onco.cc/key-papers/paper-whipple-carcinoma-ampulla-of-vater-ann-surg-1935/), [Tumor Treating Fields With Gemcitabine and Nab-Paclitaxel for Locally Advanced Pancreatic Adenocarcinoma: Randomized, Open-Label, Pivotal Phase III PANOVA-3 Study](https://onco.cc/key-papers/paper-panova-3-ttfields-locally-advanced-pancreatic-jco-2025/), [Tumour response to TRK inhibition in a patient with pancreatic adenocarcinoma harbouring an NTRK gene fusion](https://onco.cc/key-papers/paper-oreilly-hechtman-ntrk-fusion-pancreatic-larotrectinib-ann-oncol-2019/), [Virtual microdissection identifies distinct tumor- and stroma-specific subtypes of pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-moffitt-virtual-microdissection-subtypes-nat-genet-2015/), [Whole genome sequencing defines the genetic heterogeneity of familial pancreatic cancer](https://onco.cc/key-papers/paper-roberts-familial-pancreatic-whole-genome-cancer-discov-2016/), [Whole genomes redefine the mutational landscape of pancreatic cancer](https://onco.cc/key-papers/paper-waddell-whole-genomes-pancreatic-nature-2015/), [Whole-exome sequencing of neoplastic cysts of the pancreas reveals recurrent mutations in components of ubiquitin-dependent pathways](https://onco.cc/key-papers/paper-wu-pancreatic-cyst-exomes-rnf43-pnas-2011/), [Whole-exome sequencing of pancreatic cancer defines genetic diversity and therapeutic targets](https://onco.cc/key-papers/paper-witkiewicz-pancreatic-exomes-utsw-nat-commun-2015/), [Wisnoski 2008: 672 patients with acinar cell carcinoma of the pancreas, a population-based comparison to pancreatic adenocarcinoma](https://onco.cc/key-papers/paper-wisnoski-acinar-cell-carcinoma-672-patients-seer-surgery-2008/)
- journals: [Clinical colorectal cancer](https://onco.cc/journals/clinical-colorectal-cancer/), [Gastroenterology](https://onco.cc/journals/gastroenterology/), [Gut](https://onco.cc/journals/gut/), [Journal of gastrointestinal cancer](https://onco.cc/journals/journal-of-gastrointestinal-cancer/)
- pairings: [G12D-selective + pan-RAS(ON) inhibitor (zoldonrasib + daraxonrasib)](https://onco.cc/pairings/g12d-plus-pan-ras/), [Personalised neoantigen vaccine + PD-1 blockade](https://onco.cc/pairings/vaccine-plus-pd1/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Cold tumours and the immunosuppressive microenvironment](https://onco.cc/bottlenecks/b-tme-immunosuppression/), [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/), [Lab models that fail to predict what happens in patients](https://onco.cc/bottlenecks/b-preclinical-models/), [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/), [The undruggable drivers](https://onco.cc/bottlenecks/b-undruggable-targets/), [Tumour heterogeneity and clonal evolution](https://onco.cc/bottlenecks/b-tumor-heterogeneity/)

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