# Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question

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

## TL;DR

Pancreatic cancer has had one operation since 1935 and a handful of chemotherapy drugs since 1997. This roadmap follows the evidence through FOLFIRINOX, chemotherapy before and after surgery, the first inherited-gene drug, the first drugs against the KRAS protein that drives nearly every tumour, personalised vaccines, and the surveillance and blood tests that might catch it earlier, to 2031.

## Summary

Pancreatic ductal adenocarcinoma is the cancer where progress has been slowest. Whipple's 1935 operation is still the only cure and about one patient in five presents in time for it; Traverso and Longmire's 1978 modification and the centralisation of surgery into high-volume centres made it safer without changing who can have it. The oncogene was found in 1988, when Almoguera and Perucho showed KRAS codon 12 mutations in 21 of 22 tumours, and the blood marker CA 19-9 was already known to be unreadable in the Lewis-negative tenth of patients (Tempero 1987). Gemcitabine (Burris 1997) then set a standard that lasted 14 years, while the European adjuvant trials (ESPAC-1 2004, CONKO-001 2007, ESPAC-3 2010) established that chemotherapy after surgery helped and chemoradiotherapy did not.

The second decade of the century brought combination chemotherapy: FOLFIRINOX (Conroy 2011) and gemcitabine with nab-paclitaxel (Von Hoff 2013) for metastatic disease, liposomal irinotecan second line (NAPOLI-1 2016), gemcitabine with capecitabine (ESPAC-4 2017) and then modified FOLFIRINOX (PRODIGE 24 2018, five-year update 2022: median survival 53.5 months) after surgery, and NALIRIFOX first line (NAPOLI 3 2023). The genomes (Waddell 2015, Bailey 2016) and the classical versus basal-like split (Moffitt 2015) gave the disease a molecular vocabulary; Hu 2018 found a germline fault in 5.5 percent of all patients regardless of family history, and POLO (2019) turned the BRCA subset into the first biomarker-directed approval, without a survival gain. Neoadjuvant treatment became standard for borderline resectable disease after PREOPANC (2020, 2022) but PREOPANC-2 (2025) and NORPACT-1 left the resectable question open, and the first attempt at the stroma failed (HALO-301 2020) after mouse work had warned that removing fibroblasts made tumours worse (Özdemir 2014).

The third decade is the KRAS decade. Ostrem and Shokat's 2013 pocket led to sotorasib in the 1 to 2 percent with G12C (CodeBreaK 100 2023); the RAS(ON) tri-complex chemistry (Holderfield 2024) produced daraxonrasib, which in RASolute 302 (2026) nearly doubled survival in previously treated metastatic disease and became the first RAS inhibitor approved for pancreatic cancer. Personalised mRNA vaccines made T cells that lasted years in responders (Rojas 2023, Sethna 2025), a wearable electric-field device added two months in locally advanced disease (PANOVA-3 2025), and surveillance of germline carriers shifted most detected cancers to stage I (Canto 2018, Dbouk 2022) while the new-onset diabetes score ENDPAC (Sharma 2018) offered a way to enrich the general population for a test. What comes next is on the registry: first-line and adjuvant RAS inhibitor trials, G12D-selective combinations, perioperative chemotherapy trials, the randomised vaccine trial and the 20,000-person PRECEDE surveillance cohort, with dates between 2026 and 2031.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-24
- Also known as: PDAC roadmap; Pancreatic ductal adenocarcinoma roadmap; Pancreatic cancer history; Pancreatic cancer evidence roadmap
- Tags: pancreatic; gi; roadmap

## Notes

- How this stays current: scripts/roadmap-watch.ts (npm run roadmap:watch) checks each trial here against ClinicalTrials.gov and searches Europe PMC for new papers on the acronyms since asOf. Anything it prints that this page does not say is an edit to make; then move asOf forward.
- Dates in 'What to watch' are quoted from the registry as read on 2026-09-24 and are not predictions; estimated completion dates move.
- The primary papers of Conroy 2011, MPACT, NAPOLI 3, PRODIGE 24 (2018), ESPAC-3, ESPAC-4, ESPAC-5, CONKO-001 (2013), LAP07, NORPACT-1, Alliance A021501, PREOPANC long-term, POLO (2019 and 2022), CodeBreaK 100, KRYSTAL-1, RASolute 302, Rojas 2023, Burris 1997 and Rahib 2014 already existed in the corpus and are linked from the steps; this deep dive adds the guideline, surgical, oncogene, genome, hereditary, surveillance, diabetes, stroma, vaccine follow-up, device and supportive care papers around them.
- UK and NHS specifics (referral routes, NICE NG85 positions, Cancer Drugs Fund status, audit indicators, surveillance access, trial access) are held on the UK and NHS page for pancreatic cancer, written by another file of the deep dive, and are not restated here.

## Sources

- NICE NG85: pancreatic cancer in adults, diagnosis and management (published 7 February 2018): https://www.nice.org.uk/guidance/ng85
- National Pancreatic Cancer Audit: State of the Nation Report 2026 (patients diagnosed 2022 to 2023 in England, 2023 to 2024 in Wales): https://www.natcan.org.uk/reports/npaca-state-of-the-nation-report-2026/
- National Pancreatic Cancer Audit: State of the Nation Report 2025: https://www.natcan.org.uk/reports/npaca-state-of-the-nation-report-2025/
- National Pancreatic Cancer Audit: State of the Nation Report 2024 (first report): https://www.natcan.org.uk/reports/npaca-state-of-the-nation-report-2024/
- Pancreatic Cancer UK: campaigning for change: https://www.pancreaticcancer.org.uk/about-us/what-we-do/we-campaign-for-change/
- ClinicalTrials.gov NCT04927780: https://clinicaltrials.gov/study/NCT04927780
- ClinicalTrials.gov NCT04340141: https://clinicaltrials.gov/study/NCT04340141

## Connected records

- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment](https://onco.cc/roadmaps/ctdna-tests/), [Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants](https://onco.cc/roadmaps/devices-roadmap/), [Early detection roadmap: organ screening → blood tests for many cancers](https://onco.cc/roadmaps/early-detection-roadmap/), [Immunotherapy roadmap: Coley's toxins → checkpoint inhibitors → engineered immunity](https://onco.cc/roadmaps/immunotherapy-roadmap/), [KRAS roadmap: undruggable → G12C → pan-RAS](https://onco.cc/roadmaps/kras-roadmap/), [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/), [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/), [Targeted therapy roadmap: imatinib → designed for resistance → the undruggable drivers fall](https://onco.cc/roadmaps/targeted-therapy-roadmap/)
- pairings: [G12D-selective + pan-RAS(ON) inhibitor (zoldonrasib + daraxonrasib)](https://onco.cc/pairings/g12d-plus-pan-ras/), [Germline BRCA test → adjuvant PARP inhibitor](https://onco.cc/pairings/germline-to-parp/)
- ideas: [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/), [Blood-based pancreatic cancer detection in new-onset diabetes](https://onco.cc/ideas/idea-mced-new-onset-diabetes/), [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/), [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/), [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/), [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/), [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 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/), [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/)
- collections: [NCCN Guidelines](https://onco.cc/collections/nccn/), [Pancreatic Cancer Action Network (PanCAN)](https://onco.cc/collections/pancan/)
- cancers: [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/), [Metastatic pancreatic ductal adenocarcinoma](https://onco.cc/cancers/metastatic-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Immunotherapy](https://onco.cc/fronts/immunotherapy/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/), [Surgery & Interventional](https://onco.cc/fronts/surgery/), [Targeted Therapy](https://onco.cc/fronts/targeted-therapy/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [High-risk pancreatic surveillance (CAPS / PRECEDE)](https://onco.cc/technologies/pancreatic-surveillance/), [KRAS & RAS inhibitors](https://onco.cc/technologies/kras-inhibitors/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Multi-cancer early detection (MCED)](https://onco.cc/technologies/mced/), [Off-the-shelf cancer vaccines](https://onco.cc/technologies/shared-antigen-vaccine/), [PARP inhibitors](https://onco.cc/technologies/parp-inhibitor/), [Personalised neoantigen (mRNA) vaccines](https://onco.cc/technologies/neoantigen-mrna-vaccine/), [RNA sequencing & expression profiling](https://onco.cc/technologies/rna-seq/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Tumour treating fields (TTFields)](https://onco.cc/technologies/ttfields/), [Whole-exome & whole-genome sequencing](https://onco.cc/technologies/wes-wgs/)
- targets: [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/), [FAP](https://onco.cc/targets/fap/), [KRAS](https://onco.cc/targets/kras/), [PARP](https://onco.cc/targets/parp/)
- drugs: [Adagrasib](https://onco.cc/drugs/adagrasib/), [Autogene cevumeran](https://onco.cc/drugs/autogene-cevumeran/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Daraxonrasib](https://onco.cc/drugs/daraxonrasib/), [ELI-002 7P](https://onco.cc/drugs/eli-002-7p/), [Elironrasib](https://onco.cc/drugs/elironrasib/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Galleri](https://onco.cc/drugs/galleri/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [Liposomal irinotecan](https://onco.cc/drugs/liposomal-irinotecan/), [MRTX1133](https://onco.cc/drugs/mrtx1133/), [NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/), [Olaparib](https://onco.cc/drugs/olaparib/), [Optune / Optune Pax (TTFields)](https://onco.cc/drugs/optune/), [Ponsegromab](https://onco.cc/drugs/ponsegromab/), [Sotorasib](https://onco.cc/drugs/sotorasib/), [Zenocutuzumab](https://onco.cc/drugs/zenocutuzumab/), [Zoldonrasib](https://onco.cc/drugs/zoldonrasib/)
- companies: [Amgen](https://onco.cc/companies/amgen/), [AstraZeneca](https://onco.cc/companies/astrazeneca/), [BioNTech](https://onco.cc/companies/biontech/), [Bristol Myers Squibb](https://onco.cc/companies/bms/), [Elicio Therapeutics](https://onco.cc/companies/elicio-therapeutics/), [Ipsen](https://onco.cc/companies/ipsen/), [Novocure](https://onco.cc/companies/novocure/), [Revolution Medicines](https://onco.cc/companies/revolution-medicines/), [UNICANCER](https://onco.cc/companies/unicancer/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [Cancer Research UK](https://onco.cc/institutions/cruk/), [Erasmus MC Cancer Institute](https://onco.cc/institutions/erasmus-mc/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Garvan Institute of Medical Research / Kinghorn Cancer Centre](https://onco.cc/institutions/garvan-institute/), [Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center](https://onco.cc/institutions/johns-hopkins/), [Mayo Clinic](https://onco.cc/institutions/mayo-clinic/), [Memorial Sloan Kettering Cancer Center](https://onco.cc/institutions/mskcc/), [UNC Lineberger Comprehensive Cancer Center](https://onco.cc/institutions/unc-lineberger/)
- pathways: [DNA damage response & homologous recombination](https://onco.cc/pathways/ddr/), [RAS / RAF / MEK / ERK (MAPK)](https://onco.cc/pathways/ras-mapk/)
- terms: [CA 19-9](https://onco.cc/terms/ca19-9/), [Cancer-associated fibroblasts (CAFs)](https://onco.cc/terms/cancer-associated-fibroblasts/), [Desmoplasia (tumour stroma)](https://onco.cc/terms/desmoplasia/), [Germline BRCA mutation (gBRCA)](https://onco.cc/terms/gbrca-mutation/), [Germline vs somatic mutations](https://onco.cc/terms/germline-vs-somatic/), [KRAS mutation subtypes (G12C, G12D, G12V)](https://onco.cc/terms/kras-mutation-subtypes/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Neoantigen](https://onco.cc/terms/neoantigen/), [Obstructive jaundice and biliary obstruction](https://onco.cc/terms/obstructive-jaundice/), [Performance status (ECOG, Karnofsky)](https://onco.cc/terms/performance-status/), [Platinum-sensitive / platinum-resistant](https://onco.cc/terms/platinum-sensitivity/), [Positive predictive value (PPV)](https://onco.cc/terms/ppv/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Stenting (biliary, oesophageal, airway)](https://onco.cc/terms/biliary-stent/), [Total neoadjuvant therapy (TNT, rectal cancer)](https://onco.cc/terms/total-neoadjuvant-therapy/), [Tumour markers (CEA, LDH, chromogranin, thyroglobulin)](https://onco.cc/terms/tumour-markers/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/)
- trials: [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 to Evaluate Chemotherapy With or Without INCB161734 in Previously Untreated, KRAS G12D-Mutated Metastatic Pancreatic Ductal Adenocarcinoma](https://onco.cc/trials/nct07522073/), [AMPLIFY-7P](https://onco.cc/trials/amplify-7p/), [CONKO-001](https://onco.cc/trials/conko-001/), [ESPAC-4](https://onco.cc/trials/espac-4/), [ESPAC-5](https://onco.cc/trials/espac-5/), [LAP07](https://onco.cc/trials/lap07/), [NAPOLI 3](https://onco.cc/trials/napoli-3/), [PANOVA-3](https://onco.cc/trials/panova-3/), [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/), [PRECEDE](https://onco.cc/trials/precede/), [PREOPANC-1](https://onco.cc/trials/preopanc/), [PRODIGE 24 / CCTG PA6](https://onco.cc/trials/prodige-24/), [RASolute 302](https://onco.cc/trials/rasolute-302/), [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 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/)
- people: [Anirban Maitra](https://onco.cc/people/anirban-maitra/), [Daniel D. Von Hoff](https://onco.cc/people/daniel-von-hoff/), [Diane M. Simeone](https://onco.cc/people/diane-simeone/), [Eileen M. O'Reilly](https://onco.cc/people/eileen-oreilly/), [Eric Van Cutsem](https://onco.cc/people/eric-van-cutsem/), [Hedy L. Kindler](https://onco.cc/people/hedy-kindler/), [Kevan M. Shokat](https://onco.cc/people/kevan-shokat/), [Marc G. Besselink](https://onco.cc/people/marc-besselink/), [Talia Golan](https://onco.cc/people/talia-golan/), [Thierry Conroy](https://onco.cc/people/thierry-conroy/), [Uğur Şahin](https://onco.cc/people/ugur-sahin/), [Vinod P. Balachandran](https://onco.cc/people/vinod-balachandran/), [Zev A. Wainberg](https://onco.cc/people/zev-wainberg/)
- bottlenecks: [Acquired resistance to every therapy](https://onco.cc/bottlenecks/b-resistance/), [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [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/), [Failures are hidden](https://onco.cc/bottlenecks/b-negative-results/), [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/), [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/), [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/), [The undruggable drivers](https://onco.cc/bottlenecks/b-undruggable-targets/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/), [Tumour heterogeneity and clonal evolution](https://onco.cc/bottlenecks/b-tumor-heterogeneity/)
- key papers: [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/), [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/), [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/), [Burris 1997: gemcitabine becomes the first standard treatment for advanced pancreatic cancer](https://onco.cc/key-papers/paper-burris-gemcitabine-pancreatic-jco-1997/), [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/), [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/), [Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer](https://onco.cc/key-papers/paper-daraxonrasib-pancreatic-n-engl-j-med-2026/), [Definition and classification of cancer cachexia: an international consensus](https://onco.cc/key-papers/paper-fearon-lancet-oncol/), [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/), [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 and capecitabine versus gemcitabine monotherapy in resected pancreatic cancer](https://onco.cc/key-papers/paper-espac-4-gemcitabine-capecitabine-adjuvant-neoptolemos-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/), [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/), [Genomic analyses identify molecular subtypes of pancreatic cancer](https://onco.cc/key-papers/paper-bailey-molecular-subtypes-pancreatic-nature-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/), [LAP07: chemoradiotherapy versus chemotherapy after four months of gemcitabine in locally advanced pancreatic cancer](https://onco.cc/key-papers/paper-lap07-chemoradiotherapy-locally-advanced-pancreatic-hammel-jama-2016/), [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/), [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/), [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/), [Ostrem and Shokat: the hidden pocket that made KRAS G12C druggable](https://onco.cc/key-papers/paper-ostrem-kras-g12c-nature-2013/), [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: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up](https://onco.cc/key-papers/paper-esmo-pancreatic-cancer-guideline-ann-oncol-2023/), [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/), [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/), [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/), [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/), [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/), [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/), [The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival](https://onco.cc/key-papers/paper-dbouk-caps5-stage-survival-jco-2022/), [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/), [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 genomes redefine the mutational landscape of pancreatic cancer](https://onco.cc/key-papers/paper-waddell-whole-genomes-pancreatic-nature-2015/)

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JSON: https://onco.cc/api/v1/entities/pancreatic-roadmap.json