• Clinical benefit response (the gemcitabine trial endpoint): Clinical benefit response was the measure invented for the 1997 trial that got gemcitabine approved for pancreatic cancer: a patient counted as benefiting if pain, painkiller use, day-to-day function or weight improved for at least four weeks without any of the others getting worse.
• Metastasis: Cancer that has spread from where it started to distant parts of the body, travelling through the blood or lymph.
• Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia: Most people with pancreatic cancer need treatment for a blocked bile duct, pain, poor digestion or weight loss alongside chemotherapy: a metal stent placed by endoscopy for jaundice, a duodenal stent or bypass for a blocked bowel, an alcohol block of the nerves behind the pancreas for pain, enzyme capsules with every meal, and dietetic support.
• GATA6 as the marker of classical versus basal-like pancreatic cancer: GATA6 is the transcription factor that separates the two pancreatic cancer subtypes that survive every re-analysis: classical tumours express it, basal-like (squamous) tumours have lost it.
• COMPASS: real-time sequencing of advanced pancreatic cancer for treatment selection: COMPASS was the Canadian study that took a fresh biopsy from people about to start chemotherapy for advanced pancreatic cancer, sequenced the whole genome and RNA within the time of a treatment decision, and showed that the basal-like subtype predicts poor response to first-line chemotherapy.
• Lewis-negative (Lewis antigen-negative, CA 19-9 non-secretor) status: About one person in ten to twenty cannot make the sugar that the CA 19-9 blood test measures, because they lack a working copy of the Lewis blood-group gene.
• Pancreatic cancer: the failed and stopped programmes and why: Pancreatic cancer has a long list of phase 3 trials that added a new drug to standard chemotherapy and found nothing: a stroma-degrading enzyme, an interleukin-10, a stemness inhibitor, a BTK inhibitor, a metabolic inhibitor, an anti-fibrotic antibody, two vaccines and erlotinib in three settings.
• Classical versus basal-like (squamous) subtypes of pancreatic cancer, and GATA6: Gene expression divides pancreatic ductal adenocarcinoma into two main types: classical, the commoner, which keeps its pancreatic identity and responds better to chemotherapy, and basal-like or squamous, which has lost it and carries a worse outlook.
• Emergency presentation (route to diagnosis): An emergency presentation means a cancer was diagnosed after the person arrived as an emergency, through A&E or an urgent admission, rather than through a GP referral or screening.
• Pancreatic cancer trials open today (registry snapshot and UK sites): Every phase 2 or 3 interventional trial that was recruiting, about to open or still running for pancreatic cancer on ClinicalTrials.gov in September 2026, with the hospitals in the United Kingdom that take part named where the registry lists them.

Biomarker results to ask for: 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).

Scans and tests linked to this cancer: Comprehensive genomic profiling, Liquid biopsy (ctDNA), MRD / molecular residual disease testing, FAPI PET.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• First line, fit patients: Modified FOLFIRINOX or NALIRIFOX (NAPOLI 3); gemcitabine plus nab-paclitaxel as the alternative, chosen by fitness, biliary drainage and neuropathy. (FOLFIRINOX / mFOLFIRINOX, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), NAPOLI 3, Gemcitabine + nab-paclitaxel)
• First line, less fit patients: Gemcitabine plus nab-paclitaxel at reduced dose or gemcitabine alone; best supportive care when chemotherapy would do harm. (Gemcitabine + nab-paclitaxel, Gemcitabine, Cancer cachexia)
• Clinical trials: 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. (Study of Daraxonrasib and Daraxonrasib + GnP as First-line Treatment in Patients With Metastatic Pancreatic Adenocarcinoma, Zoldonrasib, Study of Zoldonrasib (RMC-9805) Plus Daraxonrasib (RMC-6236) Versus Gemcitabine and Nab-Paclitaxel as First-Line Treatment in Metastatic KRAS G12D-Mut, ELI-002 7P, A Multicenter Study of IBI343 Monotherapy Versus Placebo in Subjects With Previously Treated, Claudin (CLDN) 18.2-positive, Pancreatic Cancer(G-HOPE-002), Claudin18.2 CAR-T (CT041) in Patients With Gastric, Pancreatic Cancer, or Other Specified Digestive Cancers, Precision Promise)
• Second line: Daraxonrasib after first-line chemotherapy (RASolute 302); otherwise switch backbone, liposomal irinotecan with fluorouracil after gemcitabine or a gemcitabine-based regimen after FOLFIRINOX. (Daraxonrasib, RASolute 302, Irinotecan (and liposomal irinotecan), Fluorouracil (5-FU), Gemcitabine + nab-paclitaxel)
• Maintenance and biomarker-directed therapy: 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. (Olaparib, POLO, Pembrolizumab, Zenocutuzumab, Larotrectinib, Dabrafenib + trametinib)
• Supportive care throughout: Biliary stenting, pancreatic enzyme replacement, dietetic support, early palliative care, anticoagulation for thrombosis and coeliac plexus block for pain. (Biliary stenting and drainage, Cancer cachexia, Obstructive jaundice and biliary obstruction)

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.