{"entity":{"id":"metastatic-pdac","kind":"cancer","name":"Metastatic pancreatic ductal adenocarcinoma","aka":["Metastatic pancreatic cancer","Stage IV pancreatic adenocarcinoma","Advanced pancreatic cancer","mPDAC"],"tldr":"Metastatic pancreatic cancer has spread beyond the pancreas, usually to the liver, and is treated with chemotherapy rather than surgery. Three combination regimens lengthen life, a minority of patients qualify for targeted drugs chosen by tumour or inherited mutations, and in 2026 the pan-RAS inhibitor daraxonrasib became the first drug against the KRAS mutation that drives almost every case.","summary":"Metastatic pancreatic ductal adenocarcinoma is diagnosed by CT with biopsy of the primary or a metastasis, usually under endoscopic ultrasound or CT guidance. Nearly every tumour carries a KRAS mutation (G12D, G12V and G12R most often, G12C in a small minority) alongside TP53, CDKN2A and SMAD4 loss, and every patient should have germline testing and tumour sequencing at diagnosis, because roughly one in ten has an actionable finding: a germline BRCA or PALB2 variant, mismatch repair deficiency, or, in KRAS wild-type tumours, a gene fusion or BRAF alteration. Supportive care runs in parallel: biliary stenting, pancreatic enzyme replacement, nutrition, pain control and treatment of thrombosis.\n\nGemcitabine became the standard in 1997 by improving symptoms and survival modestly over fluorouracil. Two combinations then beat it: FOLFIRINOX in PRODIGE 4/ACCORD 11 (2011) for fit patients, and gemcitabine plus nab-paclitaxel in MPACT (2013) for a broader group. NAPOLI 3 (2023) showed that NALIRIFOX, which replaces irinotecan with its liposomal form, beats gemcitabine plus nab-paclitaxel, and it was approved in 2024. Choice between them turns on fitness, neuropathy, biliary drainage and patient preference. Olaparib maintenance after platinum chemotherapy is approved for germline BRCA carriers (POLO), pembrolizumab for mismatch repair deficient tumours, zenocutuzumab for NRG1 fusions, and NTRK, BRAF and other targeted drugs for the rare tumours that carry them. Second-line chemotherapy switches backbone: liposomal irinotecan with fluorouracil after gemcitabine (NAPOLI-1), gemcitabine-based treatment after FOLFIRINOX.\n\nThe field changed in 2026 when RASolute 302 showed that daraxonrasib, an inhibitor of the active form of all RAS proteins, lengthened survival over chemotherapy after first-line treatment; it is now approved and is being tested first line with and without chemotherapy and in the adjuvant setting. G12D-selective inhibitors (zoldonrasib, MRTX1133 and others) are in phase 3 first line, G12C inhibitors are used off label or in trials for the small G12C group, and shared KRAS vaccines, personalised mRNA vaccines, claudin 18.2 and mesothelin-directed antibodies, antibody-drug conjugates and CAR-T cells are in trials. Immune checkpoint inhibitors alone do not work outside mismatch repair deficient disease, and the search for combinations that make this immunologically cold tumour respond continues.","asOf":"2026-09-18","wikipedia":"https://en.wikipedia.org/wiki/Pancreatic_cancer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Pancreatic_cancer"},{"label":"NCCN Guidelines: Pancreatic Adenocarcinoma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455"}],"tags":["subtype-page","gastrointestinal"],"related":["locally-advanced-pdac","kras-g12c-pdac","kras-wild-type-pdac","brca-palb2-pdac","msi-high-pdac","resectable-pdac","kras-roadmap"],"cancers":[],"sections":[],"technologies":["cytotoxic-chemotherapy","kras-inhibitors","parp-inhibitor","checkpoint-inhibitor","neoantigen-mrna-vaccine","shared-antigen-vaccine","car-t","adc","bispecific-antibody","cgp","liquid-biopsy","biliary-stenting-drainage"],"targets":["kras","brca","cldn18-2","mesothelin","her3","ntrk","pd1","fap"],"drugs":["folfirinox","nalirifox","gemcitabine-nab-paclitaxel","gemcitabine","irinotecan","fluorouracil","olaparib","pembrolizumab","zenocutuzumab","daraxonrasib","zoldonrasib","mrtx1133","eli-002-7p","autogene-cevumeran","ibi343","cmg901","satricabtagene-autoleucel","fap-2286","devimistat","pamrevlumab","eryaspase","algenpantucel-l"],"companies":["ipsen","revolution-medicines","astrazeneca","merck","bms","biontech","elicio-therapeutics","innovent","astellas","carsgen"],"institutions":[],"pathways":["pancreatic-cancer-signalling","ras-mapk","immune-desert-exclusion","cachexia-biology"],"terms":["kras-mutation-subtypes","ca19-9","metastasis","peritoneal-metastasis","gbrca-mutation","msi","gene-fusion","resistance","cachexia","obstructive-jaundice","platinum-sensitivity"],"trials":["napoli-3","polo","rasolute-302","nct07491445","nct07805954","nct07621718","nct07522073","g-hope-002","nct04404595","nct06051695","nct07562152","nct06608927","mountaintap-30","precision-promise","avenger-500","lapis-trial","trybeca-1","impress-trial","notable-trial"],"people":["daniel-von-hoff","thierry-conroy","zev-wainberg","eileen-oreilly","talia-golan","tanios-bekaii-saab","eric-van-cutsem","volker-heinemann","hedy-kindler","kevan-shokat","frank-mccormick"],"bottlenecks":[],"keyPapers":["paper-conroy-folfirinox-pancreatic-nejm-2011","paper-mpact-nab-paclitaxel-gemcitabine-nejm-2013","paper-napoli-3-lancet-2023","paper-burris-gemcitabine-pancreatic-jco-1997","paper-rahib-projecting-cancer-deaths-2030-cancerres-2014"],"journals":[],"dependsOn":[],"notes":[],"group":"gastrointestinal","burden":"About half of pancreatic cancers have already spread, most often to the liver and peritoneum, when they are found; this stage accounts for most of the disease's deaths and most of its trials.","subtypes":["Metastatic PDAC, fit for combination chemotherapy (FOLFIRINOX, NALIRIFOX or gemcitabine plus nab-paclitaxel)","Metastatic PDAC, unfit for combination chemotherapy (gemcitabine alone or best supportive care)","Metastatic PDAC with a KRAS G12D, G12V or G12R mutation (pan-RAS and G12D inhibitors)","Metastatic PDAC with an actionable non-KRAS finding (BRCA or PALB2, mismatch repair deficiency, NRG1 or NTRK fusion, BRAF)","Metastatic PDAC after first-line chemotherapy (daraxonrasib, switch of backbone)","Liver-dominant versus peritoneal-dominant metastatic PDAC"],"biomarkers":["KRAS mutation subtype by tissue or plasma sequencing (G12D, G12V, G12R, G12C; wild-type prompts fusion testing)","Germline BRCA1, BRCA2, PALB2 and ATM (platinum and PARP inhibitor choice)","Mismatch repair status by immunohistochemistry or sequencing (pembrolizumab)","NRG1, NTRK, ALK, ROS1, FGFR2 and RET fusions and BRAF alterations in KRAS wild-type tumours","CA 19-9 for response monitoring (uninformative in Lewis-negative patients)","Claudin 18.2 and mesothelin expression (trial eligibility)","Performance status, bilirubin and neuropathy (regimen choice)"],"standardOfCare":[{"setting":"First line, fit patients","approach":"Modified FOLFIRINOX or NALIRIFOX (NAPOLI 3); gemcitabine plus nab-paclitaxel as the alternative, chosen by fitness, biliary drainage and neuropathy.","refs":["folfirinox","nalirifox","napoli-3","gemcitabine-nab-paclitaxel"],"guideline":{"version":"NCCN Guidelines: Pancreatic Adenocarcinoma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455"}},{"setting":"First line, less fit patients","approach":"Gemcitabine plus nab-paclitaxel at reduced dose or gemcitabine alone; best supportive care when chemotherapy would do harm.","refs":["gemcitabine-nab-paclitaxel","gemcitabine","cachexia"],"guideline":{"version":"NCCN Guidelines: Pancreatic Adenocarcinoma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455"}},{"setting":"Maintenance and biomarker-directed therapy","approach":"Olaparib after at least sixteen weeks of platinum without progression in germline BRCA carriers (POLO); pembrolizumab for mismatch repair deficient tumours; zenocutuzumab for NRG1 fusions; NTRK and BRAF inhibitors where present.","refs":["olaparib","polo","pembrolizumab","zenocutuzumab","larotrectinib","dabrafenib-trametinib"],"guideline":{"version":"NCCN Guidelines: Pancreatic Adenocarcinoma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455"}},{"setting":"Second line","approach":"Daraxonrasib after first-line chemotherapy (RASolute 302); otherwise switch backbone, liposomal irinotecan with fluorouracil after gemcitabine or a gemcitabine-based regimen after FOLFIRINOX.","refs":["daraxonrasib","rasolute-302","irinotecan","fluorouracil","gemcitabine-nab-paclitaxel"],"guideline":{"version":"NCCN Guidelines: Pancreatic Adenocarcinoma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455"}},{"setting":"Supportive care throughout","approach":"Biliary stenting, pancreatic enzyme replacement, dietetic support, early palliative care, anticoagulation for thrombosis and coeliac plexus block for pain.","refs":["biliary-stenting-drainage","cachexia","obstructive-jaundice"],"guideline":{"version":"NCCN Guidelines: Pancreatic Adenocarcinoma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455"}},{"setting":"Clinical trials","approach":"First-line daraxonrasib with or without chemotherapy; G12D inhibitors with chemotherapy; KRAS vaccines; claudin 18.2 and mesothelin-directed antibodies and CAR-T; platform trials such as Precision Promise.","refs":["nct07491445","zoldonrasib","nct07805954","eli-002-7p","g-hope-002","nct04404595","precision-promise"],"guideline":{"version":"NCCN Guidelines: Pancreatic Adenocarcinoma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455"}}],"stateOfArt":["Three combination regimens lengthen life first line and NALIRIFOX is the newest (NAPOLI 3, approved 2024).","Daraxonrasib is the first RAS inhibitor to lengthen survival in pancreatic cancer (RASolute 302, 2026) and is approved after first-line chemotherapy.","Biomarker testing at diagnosis finds an actionable target in about one in ten patients.","G12D-selective inhibitors, KRAS vaccines and claudin 18.2 or mesothelin-directed cell and antibody therapies are in late trials."],"history":[{"year":1997,"title":"Gemcitabine approved after showing clinical benefit over fluorouracil (Burris)","refs":["gemcitabine","paper-burris-gemcitabine-pancreatic-jco-1997"]},{"year":2011,"title":"PRODIGE 4/ACCORD 11: FOLFIRINOX lengthens survival over gemcitabine in fit patients","refs":["folfirinox","thierry-conroy","paper-conroy-folfirinox-pancreatic-nejm-2011"]},{"year":2013,"title":"MPACT: gemcitabine plus nab-paclitaxel lengthens survival over gemcitabine","refs":["gemcitabine-nab-paclitaxel","daniel-von-hoff","paper-mpact-nab-paclitaxel-gemcitabine-nejm-2013"]},{"year":2019,"title":"POLO: olaparib maintenance delays progression in germline BRCA carriers","refs":["polo","olaparib","talia-golan"]},{"year":2023,"title":"NAPOLI 3: NALIRIFOX beats gemcitabine plus nab-paclitaxel first line","refs":["napoli-3","nalirifox","zev-wainberg","paper-napoli-3-lancet-2023"]},{"year":2024,"title":"Zenocutuzumab approved for NRG1 fusion-positive pancreatic cancer","refs":["zenocutuzumab"]},{"year":2026,"title":"RASolute 302: daraxonrasib lengthens survival after first-line chemotherapy, the first RAS inhibitor to do so","refs":["rasolute-302","daraxonrasib","revolution-medicines"]}],"pipeline":["nct07491445","zoldonrasib","nct07805954","nct07621718","nct07522073","mrtx1133","eli-002-7p","autogene-cevumeran","g-hope-002","ibi343","cmg901","nct04404595","satricabtagene-autoleucel","nct06051695","fap-2286","nct07562152","nct06608927","nct07259317","nct07450859","mountaintap-30","elraglusib","precision-promise","idea-bio1-pan-ras-covalent-g12d","idea-shared-kras-vaccine-adjuvant"],"openProblems":["Resistance to RAS inhibitors emerges within months and the best partner drugs are unknown.","Checkpoint inhibitors fail outside mismatch repair deficient disease because the tumour excludes T cells.","Most patients are too unwell for FOLFIRINOX-type regimens and trials under-represent them.","Cachexia and thrombosis kill many patients before the cancer itself is the limiting problem.","Late diagnosis: half of patients present with metastases and no screening test exists for the general population."],"parent":"pancreatic"},"route":"/cancers/metastatic-pdac/","neighbours":{"cancer":[{"id":"borderline-resectable-pdac","kind":"cancer","name":"Borderline resectable pancreatic ductal adenocarcinoma","route":"/cancers/borderline-resectable-pdac/"},{"id":"brca-palb2-pdac","kind":"cancer","name":"BRCA or PALB2-mutant pancreatic ductal adenocarcinoma","route":"/cancers/brca-palb2-pdac/"},{"id":"kras-g12c-pdac","kind":"cancer","name":"KRAS G12C-mutant pancreatic ductal adenocarcinoma","route":"/cancers/kras-g12c-pdac/"},{"id":"kras-wild-type-pdac","kind":"cancer","name":"KRAS wild-type pancreatic ductal adenocarcinoma","route":"/cancers/kras-wild-type-pdac/"},{"id":"locally-advanced-pdac","kind":"cancer","name":"Locally advanced unresectable pancreatic ductal adenocarcinoma","route":"/cancers/locally-advanced-pdac/"},{"id":"msi-high-pdac","kind":"cancer","name":"Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma","route":"/cancers/msi-high-pdac/"},{"id":"pancreatic-acinar-cell-carcinoma","kind":"cancer","name":"Pancreatic acinar cell carcinoma","route":"/cancers/pancreatic-acinar-cell-carcinoma/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"roadmap":[{"id":"kras-roadmap","kind":"roadmap","name":"KRAS roadmap: undruggable → G12C → pan-RAS","route":"/roadmaps/kras-roadmap/"},{"id":"pancreatic-roadmap","kind":"roadmap","name":"Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question","route":"/roadmaps/pancreatic-roadmap/"}],"technology":[{"id":"adc","kind":"technology","name":"Antibody-drug conjugate (ADC)","route":"/technologies/adc/"},{"id":"biliary-stenting-drainage","kind":"technology","name":"Biliary stenting and drainage","route":"/technologies/biliary-stenting-drainage/"},{"id":"bispecific-antibody","kind":"technology","name":"Bispecific antibodies","route":"/technologies/bispecific-antibody/"},{"id":"car-t","kind":"technology","name":"CAR-T cell therapy","route":"/technologies/car-t/"},{"id":"cgp","kind":"technology","name":"Comprehensive genomic profiling","route":"/technologies/cgp/"},{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"kras-inhibitors","kind":"technology","name":"KRAS & RAS inhibitors","route":"/technologies/kras-inhibitors/"},{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"shared-antigen-vaccine","kind":"technology","name":"Off-the-shelf cancer vaccines","route":"/technologies/shared-antigen-vaccine/"},{"id":"parp-inhibitor","kind":"technology","name":"PARP inhibitors","route":"/technologies/parp-inhibitor/"},{"id":"neoantigen-mrna-vaccine","kind":"technology","name":"Personalised neoantigen (mRNA) vaccines","route":"/technologies/neoantigen-mrna-vaccine/"}],"target":[{"id":"brca","kind":"target","name":"BRCA1 / BRCA2 (HRD)","route":"/targets/brca/"},{"id":"cldn18-2","kind":"target","name":"Claudin 18.2","route":"/targets/cldn18-2/"},{"id":"fap","kind":"target","name":"FAP","route":"/targets/fap/"},{"id":"her3","kind":"target","name":"HER3","route":"/targets/her3/"},{"id":"kras","kind":"target","name":"KRAS","route":"/targets/kras/"},{"id":"mesothelin","kind":"target","name":"Mesothelin","route":"/targets/mesothelin/"},{"id":"ntrk","kind":"target","name":"NTRK","route":"/targets/ntrk/"},{"id":"pd1","kind":"target","name":"PD-1","route":"/targets/pd1/"}],"drug":[{"id":"algenpantucel-l","kind":"drug","name":"Algenpantucel-L","route":"/drugs/algenpantucel-l/"},{"id":"autogene-cevumeran","kind":"drug","name":"Autogene cevumeran","route":"/drugs/autogene-cevumeran/"},{"id":"dabrafenib-trametinib","kind":"drug","name":"Dabrafenib + trametinib","route":"/drugs/dabrafenib-trametinib/"},{"id":"daraxonrasib","kind":"drug","name":"Daraxonrasib","route":"/drugs/daraxonrasib/"},{"id":"devimistat","kind":"drug","name":"Devimistat","route":"/drugs/devimistat/"},{"id":"eli-002-7p","kind":"drug","name":"ELI-002 7P","route":"/drugs/eli-002-7p/"},{"id":"elraglusib","kind":"drug","name":"Elraglusib","route":"/drugs/elraglusib/"},{"id":"eryaspase","kind":"drug","name":"Eryaspase","route":"/drugs/eryaspase/"},{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"},{"id":"fluorouracil","kind":"drug","name":"Fluorouracil (5-FU)","route":"/drugs/fluorouracil/"},{"id":"folfirinox","kind":"drug","name":"FOLFIRINOX / mFOLFIRINOX","route":"/drugs/folfirinox/"},{"id":"folfox","kind":"drug","name":"FOLFOX (5-FU, leucovorin, oxaliplatin)","route":"/drugs/folfox/"},{"id":"gemcitabine","kind":"drug","name":"Gemcitabine","route":"/drugs/gemcitabine/"},{"id":"gemcitabine-nab-paclitaxel","kind":"drug","name":"Gemcitabine + nab-paclitaxel","route":"/drugs/gemcitabine-nab-paclitaxel/"},{"id":"ibi343","kind":"drug","name":"IBI343","route":"/drugs/ibi343/"},{"id":"ibrutinib","kind":"drug","name":"Ibrutinib","route":"/drugs/ibrutinib/"},{"id":"irinotecan","kind":"drug","name":"Irinotecan (and liposomal irinotecan)","route":"/drugs/irinotecan/"},{"id":"larotrectinib","kind":"drug","name":"Larotrectinib","route":"/drugs/larotrectinib/"},{"id":"mrtx1133","kind":"drug","name":"MRTX1133","route":"/drugs/mrtx1133/"},{"id":"nalirifox","kind":"drug","name":"NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)","route":"/drugs/nalirifox/"},{"id":"napabucasin","kind":"drug","name":"Napabucasin","route":"/drugs/napabucasin/"},{"id":"olaparib","kind":"drug","name":"Olaparib","route":"/drugs/olaparib/"},{"id":"pamrevlumab","kind":"drug","name":"Pamrevlumab","route":"/drugs/pamrevlumab/"},{"id":"pancrelipase","kind":"drug","name":"Pancrelipase (pancreatic enzyme replacement therapy)","route":"/drugs/pancrelipase/"},{"id":"pegilodecakin","kind":"drug","name":"Pegilodecakin","route":"/drugs/pegilodecakin/"},{"id":"pegvorhyaluronidase-alfa","kind":"drug","name":"Pegvorhyaluronidase alfa","route":"/drugs/pegvorhyaluronidase-alfa/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"},{"id":"satricabtagene-autoleucel","kind":"drug","name":"Satricabtagene autoleucel","route":"/drugs/satricabtagene-autoleucel/"},{"id":"cmg901","kind":"drug","name":"Sonesitatug vedotin","route":"/drugs/cmg901/"},{"id":"tegafur-gimeracil-oteracil","kind":"drug","name":"Tegafur, gimeracil and oteracil (S-1)","route":"/drugs/tegafur-gimeracil-oteracil/"},{"id":"zenocutuzumab","kind":"drug","name":"Zenocutuzumab","route":"/drugs/zenocutuzumab/"},{"id":"zoldonrasib","kind":"drug","name":"Zoldonrasib","route":"/drugs/zoldonrasib/"}],"company":[{"id":"astellas","kind":"company","name":"Astellas","route":"/companies/astellas/"},{"id":"astrazeneca","kind":"company","name":"AstraZeneca","route":"/companies/astrazeneca/"},{"id":"biontech","kind":"company","name":"BioNTech","route":"/companies/biontech/"},{"id":"bms","kind":"company","name":"Bristol Myers Squibb","route":"/companies/bms/"},{"id":"carsgen","kind":"company","name":"CARsgen Therapeutics","route":"/companies/carsgen/"},{"id":"elicio-therapeutics","kind":"company","name":"Elicio Therapeutics","route":"/companies/elicio-therapeutics/"},{"id":"innovent","kind":"company","name":"Innovent Biologics","route":"/companies/innovent/"},{"id":"ipsen","kind":"company","name":"Ipsen","route":"/companies/ipsen/"},{"id":"merck","kind":"company","name":"Merck & Co. (MSD)","route":"/companies/merck/"},{"id":"revolution-medicines","kind":"company","name":"Revolution Medicines","route":"/companies/revolution-medicines/"}],"pathway":[{"id":"cachexia-biology","kind":"pathway","name":"Cancer cachexia","route":"/pathways/cachexia-biology/"},{"id":"immune-desert-exclusion","kind":"pathway","name":"Cold tumours: immune deserts and exclusion","route":"/pathways/immune-desert-exclusion/"},{"id":"pancreatic-cancer-signalling","kind":"pathway","name":"Pancreatic cancer (KEGG map)","route":"/pathways/pancreatic-cancer-signalling/"},{"id":"ras-mapk","kind":"pathway","name":"RAS / RAF / MEK / ERK (MAPK)","route":"/pathways/ras-mapk/"}],"term":[{"id":"ca19-9","kind":"term","name":"CA 19-9","route":"/terms/ca19-9/"},{"id":"cachexia","kind":"term","name":"Cancer cachexia","route":"/terms/cachexia/"},{"id":"classical-vs-basal-like","kind":"term","name":"Classical versus basal-like (squamous) subtypes of pancreatic cancer, and GATA6","route":"/terms/classical-vs-basal-like/"},{"id":"clinical-benefit-response","kind":"term","name":"Clinical benefit response (the gemcitabine trial endpoint)","route":"/terms/clinical-benefit-response/"},{"id":"compass-study-pancreatic","kind":"term","name":"COMPASS: real-time sequencing of advanced pancreatic cancer for treatment selection","route":"/terms/compass-study-pancreatic/"},{"id":"resistance","kind":"term","name":"Drug resistance (primary and acquired)","route":"/terms/resistance/"},{"id":"emergency-presentation","kind":"term","name":"Emergency presentation (route to diagnosis)","route":"/terms/emergency-presentation/"},{"id":"gata6-classical-basal-marker","kind":"term","name":"GATA6 as the marker of classical versus basal-like pancreatic cancer","route":"/terms/gata6-classical-basal-marker/"},{"id":"gene-fusion","kind":"term","name":"Gene fusion","route":"/terms/gene-fusion/"},{"id":"gbrca-mutation","kind":"term","name":"Germline BRCA mutation (gBRCA)","route":"/terms/gbrca-mutation/"},{"id":"kras-mutation-subtypes","kind":"term","name":"KRAS mutation subtypes (G12C, G12D, G12V)","route":"/terms/kras-mutation-subtypes/"},{"id":"lewis-negative","kind":"term","name":"Lewis-negative (Lewis antigen-negative, CA 19-9 non-secretor) status","route":"/terms/lewis-negative/"},{"id":"metastasis","kind":"term","name":"Metastasis","route":"/terms/metastasis/"},{"id":"msi","kind":"term","name":"Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)","route":"/terms/msi/"},{"id":"obstructive-jaundice","kind":"term","name":"Obstructive jaundice and biliary obstruction","route":"/terms/obstructive-jaundice/"},{"id":"pancreatic-palliation-obstruction-pain-nutrition","kind":"term","name":"Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia","route":"/terms/pancreatic-palliation-obstruction-pain-nutrition/"},{"id":"pancreatic-cancer-uk-drug-access","kind":"term","name":"Pancreatic cancer drugs in England: NICE appraisals and the Cancer Drugs Fund (September 2026)","route":"/terms/pancreatic-cancer-uk-drug-access/"},{"id":"pancreatic-trials-open-today","kind":"term","name":"Pancreatic cancer trials open today (registry snapshot and UK sites)","route":"/terms/pancreatic-trials-open-today/"},{"id":"pancreatic-failed-programmes","kind":"term","name":"Pancreatic cancer: the failed and stopped programmes and why","route":"/terms/pancreatic-failed-programmes/"},{"id":"pancreatic-enzyme-replacement","kind":"term","name":"Pancreatic enzyme replacement therapy (PERT, pancreatin, Creon) for pancreatic exocrine insufficiency: why and how to take it","route":"/terms/pancreatic-enzyme-replacement/"},{"id":"peritoneal-metastasis","kind":"term","name":"Peritoneal 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