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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.
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258 trials on record are attached to one of the types below rather than to Pancreatic ductal adenocarcinoma itself. They are grouped by the type that holds them, so someone still working out which type they have can see the whole field from here.
The 48 most recent of 150 papers; see them all →
A very low CA 19-9 is not reassurance: it marks the non-producer group whose outlook matches the highest-marker group, and it gives clinics a rule they can apply without genotyping.
One of the most cited trial reports Europe PMC returns for Daraxonrasib in Pancreatic ductal adenocarcinoma, so it is a natural first reading for anyone weighing the idea it is linked from. The record was linked automatically by title and abstract; read the abstract above and the paper itself before relying on any figure.
The IHC 3+ subgroup result is why the tumour-agnostic label is written at 3+ and not 2+, and why a gallbladder cancer with a strong HER2 stain now has two on-label choices (zanidatamab, trastuzumab deruxtecan) after chemotherapy. Lung toxicity again ran higher than in breast cancer.
The current honest statement of where early detection stands: no blood test is ready, and the research is about finding the threshold at which to operate.
For someone offered the test, these are the numbers that describe what a result means in an NHS population: about 1 in 100 tests came back positive each year, between 46 and 58 in 100 positives were cancer, and a negative result left about 1 in 100 with an undetected cancer within the year. The test found between a quarter and a third of all cancers diagnosed in a screening round, and about half to two thirds of the 12 cancer types it was designed to find. Whether finding them this way reduces late-stage diagnoses is the primary question, and this paper says only that the answer was no; the primary-endpoint paper had not appeared on Europe PMC by 23 September 2026.
Every KRAS wild-type pancreatic cancer should be tested for NRG1 fusions because a specific, approved antibody now exists; zenocutuzumab is the first targeted drug approved for a pancreatic cancer driver.
Together with NORPACT-1 this left the neoadjuvant question for resectable disease open: FOLFIRINOX before surgery is not proven superior to alternatives, and the comparison against upfront surgery with adjuvant modified FOLFIRINOX is what PREOPANC-3 and Alliance A021806 are running.
The strongest human evidence that a cancer vaccine can make durable T cells in a tumour with few mutations; the randomised phase 2 IMCODE003 (260 patients, primary completion listed for January 2031) is the test of whether that translates into fewer relapses.
Query for this cancer: (TITLE:"Pancreatic ductal adenocarcinoma" OR ABSTRACT:"Pancreatic ductal adenocarcinoma" OR TITLE:"Pancreatic cancer" OR ABSTRACT:"Pancreatic cancer" OR TITLE:"PDAC" OR ABSTRACT:"PDAC" OR TITLE:"Cancer of the pancreas" OR ABSTRACT:"Cancer of the pancreas" OR TITLE:"Exocrine pancreatic cancer" OR ABSTRACT:"Exocrine pancreatic cancer" OR TITLE:"Pancreatic adenocarcinoma" OR ABSTRACT:"Pancreatic adenocarcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Pancreatic ductal adenocarcinoma, not a curated reading list.
Surgery becomes the only curative option, a status it still holds.
Traverso and Longmire, two patients; their 1980 follow-up of 18 found every patient had exocrine insufficiency and needed enzyme replacement.
Within a decade shown to be mutated in ~90% of pancreatic cancers.
Tempero and colleagues, 20 patients: a normal marker never rules the cancer out.
Almoguera and Perucho, by polymerase chain reaction; the most uniform driver in any common cancer.
Clinical benefit response over 5-FU; the standard for 14 years.
Eight pathologists had used more than 70 terms for 35 duct lesions; the working group adopted pancreatic intraepithelial neoplasia grades 1 to 3, and precursor research became comparable.
289 patients; five-year survival 21 versus 8 percent with chemotherapy, 10 versus 20 percent with chemoradiotherapy.
Chari's Minnesota cohort of 2,122; observed-to-expected ratio 7.94.
Vessel contact on CT starts to decide who has surgery first and who has treatment first; the definition was revised yearly until the 2017 international consensus.
368 patients; 13.4 versus 6.9 months.
Twenty-four cancers carried an average of 63 alterations hitting twelve pathways in 67 to 100% of tumours.
Tumour within 1 mm of a margin is R1 (Royal College of Pathologists); standardised protocols raised the reported R1 rate to 76 to 85 percent of head resections.
A decade from the initiating mutation to the founder clone and five more years to metastatic ability: the quantitative case for early detection.
PRODIGE 4 / ACCORD 11 establishes combination chemotherapy for fit patients.
GNAS R201 in 66% of IPMNs and carried into the invasive cancer; Collisson's classical, quasi-mesenchymal and exocrine-like classes.
PanIN, IPMN and MCN move to a two-tier grading; 0.5 to 1 cm separates a large PanIN from an incipient IPMN.
Waddell's 100 genomes tie unstable genomes to BRCA-type defects and platinum response; Moffitt separates tumour from stroma and finds two tumour and two stromal subtypes; Witkiewicz's 109 microdissected exomes give the purified driver frequencies.
456 tumours, 32 genes, 10 pathways, squamous subtype worst. Liposomal irinotecan with fluorouracil: 6.1 versus 4.2 months after gemcitabine.
Notta's whole genomes show chromothripsis and polyploidy, not stepwise mutation, in two-thirds of tumours, knocking out several drivers at once; Bailey's four expression subtypes from the same year are on the evidence entry.
T1 to T3 by size (2 and 4 cm), N1 and N2 by one to three and four or more nodes; validated in 2,318 resections from three US centres and 8,960 SEER cases.
Survivors have both many high-quality neoantigens and abundant CD8 T cells, and lose those clones at metastasis; TCGA fixes the driver list and shows KRAS wild-type tumours carry other RAS-pathway drivers.
Median OS 54 months after resection.
Pancreatic protocol CT before biliary drainage, PET-CT for localised disease, enzyme replacement for unresectable disease, surveillance criteria for inherited risk.
Hu, 3,030 patients. Canto, 354 high-risk individuals over 16 years: 9 of 10 surveillance-detected cancers resectable. Sharma's ENDPAC score for new-onset diabetes.
NRG1 fusions found in every KRAS wild-type tumour of a young-adult series (Heining), later put at about 1% of all pancreatic cancers (Philip 2022); only 3 of 33 Johns Hopkins germline carriers had a family history (Shindo). The 5.5% carrier rate of Hu 2018 is on the evidence entry for the same year.
First biomarker-directed approval.
Adenosquamous, colloid and undifferentiated carcinomas and the IPMN- and MCN-associated carcinomas listed as variants of ductal adenocarcinoma; solid pseudopapillary neoplasm and acinar cell carcinoma stand apart.
Classical tumours respond to chemotherapy three times as often as basal-like; 3,594 profiled tumours give KRAS 88% and MSI or TMB-high 0.5%; a CLIA KRAS ctDNA assay predicts recurrence 84 days before imaging.
Goal: high-grade dysplasia and T1N0M0 cancer; EUS and MRI/MRCP yearly; ATM carriers with an affected relative now eligible.
Preoperative chemoradiotherapy: 16.0 versus 14.3 months, R0 71 versus 40 percent. Pegvorhyaluronidase: 11.2 versus 11.5 months. Germline and tumour testing for every treatment-eligible patient.
Core and biallelic repair-gene mutations predict first-line platinum benefit (hazard ratio 0.44); single-cell sequencing adds antigen-presenting fibroblasts to the myofibroblastic and inflammatory states.
Only 1-2% of pancreatic cancers carry G12C, but the door is open.
Reactive and deserted tissue states track immunity and chemoprotection; CA 19-9 rises two years before diagnosis, reaching 60% sensitivity only in the last six months.
1,461 high-risk people enrolled; across CAPS1 to 5 (1,731 people) 57.9 percent of the 19 surveillance-detected cancers were stage I, with five-year survival 73.3 percent and median overall survival 9.8 years against 1.5 years for cancers found outside surveillance.
Adjuvant modified FOLFIRINOX against gemcitabine: median overall survival 53.5 versus 35.5 months, five-year survival 43.2 versus 31.4 percent, hazard ratio 0.68.
Tumour treating fields with gemcitabine and nab-paclitaxel: 16.2 against 14.2 months in 571 patients with locally advanced disease.
Neoadjuvant FOLFIRINOX 21.9 versus 21.3 months against gemcitabine chemoradiotherapy. Sethna: responders' recurrence-free survival not reached at 3.2 years.
ASCO plenary and NEJM; FDA approval of daraxonrasib on 26 August 2026; Optune Pax approved; zoldonrasib combinations reported; AMPLIFY-7P vaccine misses.
FUT3-null patients, about 10%, have median CA 19-9 of 2.4 U/mL and the same short survival as patients above 200; a value of 7 or below identifies them without genotyping.