Metastatic pancreatic ductal adenocarcinoma
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.
Overview
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.
Gemcitabine 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.
The 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.
State of the art
- Three combination regimens lengthen life first line and NALIRIFOX is the newest (NAPOLI 3, approved 2024).
- 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.
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Daraxonrasib is the first RAS inhibitor to lengthen survival in pancreatic cancer (RASolute 302, 2026) and is approved after first-line chemotherapy.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowFainting or palpitations
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
- Emergency services nowBlood clot
A swollen painful calf, or sudden breathlessness with chest pain; venous thromboembolism including pulmonary embolism is a labelled warning.
- Emergency services nowBlood clot (lenalidomide, pomalidomide, thalidomide)
A swollen painful calf, or sudden breathlessness with chest pain; venous and arterial thromboembolism is a boxed warning and blood-thinning prophylaxis is recommended.
- Emergency services nowHypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
- Check before combiningFood and drink: Dabrafenib + trametinib
Dabrafenib: take on an empty stomach. Trametinib: take on an empty stomach; both cause pyrexia.
See all on the product pages:Dabrafenib + trametinibDaraxonrasibFluorouracil (5-FU)FOLFIRINOX / mFOLFIRINOXGemcitabineGemcitabine + nab-paclitaxelIrinotecan (and liposomal irinotecan)NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)OlaparibPembrolizumabZoldonrasib·Printable cards in the navigator
Anatomy and lymph node drainage
- Pancreatic head (most PDAC)
- Body and tail
- Ampulla
- Islets (pancreatic NET)
- Intrahepatic ducts
- Perihilar (Klatskin)
- Distal bile duct
- Gallbladder
- Nodes: peripancreatic
- Nodes: hepatic hilar
- Nodes: coeliac and superior mesenteric
Most pancreatic cancers arise in the head next to the bile duct, which is why jaundice is the presenting sign; bile duct cancers are named by where along the tree they sit.
- Pancreatic head (most PDAC)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
- Body and tail
- Ampulla
- Islets (pancreatic NET)
- Intrahepatic ducts
- Perihilar (Klatskin)
- Distal bile duct
- Gallbladder
- peripancreatic
- hepatic hilar
- coeliac and superior mesenteric
Same organ: Pancreatic ductal adenocarcinoma, Biliary tract cancer (cholangiocarcinoma), Intrahepatic cholangiocarcinoma, Extrahepatic cholangiocarcinoma (perihilar and distal), Biliary tract cancer (all types), Neuroendocrine tumours, Pancreatic neuroendocrine tumours, Grade 3 well-differentiated neuroendocrine tumour, Extrapulmonary neuroendocrine carcinoma, Gallbladder cancer, Ampullary cancer (ampulla of Vater), Resectable pancreatic ductal adenocarcinoma, Borderline resectable pancreatic ductal adenocarcinoma, Locally advanced unresectable pancreatic ductal adenocarcinoma, KRAS G12C-mutant pancreatic ductal adenocarcinoma, KRAS wild-type pancreatic ductal adenocarcinoma, BRCA or PALB2-mutant pancreatic ductal adenocarcinoma, Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma, Pancreatic acinar cell carcinoma, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Pancreatoblastoma
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 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.
- Liquid biopsy (ctDNA)Standard of care
Nothing recorded yet.
Nothing recorded yet.
Background: CA 19-9. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Modified FOLFIRINOX or NALIRIFOX (NAPOLI 3); gemcitabine plus nab-paclitaxel as the alternative, chosen by fitness, biliary drainage and neuropathy.
Gemcitabine plus nab-paclitaxel at reduced dose or gemcitabine alone; best supportive care when chemotherapy would do harm.
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.
Daraxonrasib after first-line chemotherapy (RASolute 302); otherwise switch backbone, liposomal irinotecan with fluorouracil after gemcitabine or a gemcitabine-based regimen after FOLFIRINOX.
Biliary stenting, pancreatic enzyme replacement, dietetic support, early palliative care, anticoagulation for thrombosis and coeliac plexus block for pain.
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.
Subtypes & biomarkers
top- 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
- 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)
How often this target appears
- 1997Gemcitabine approved after showing clinical benefit over fluorouracil (Burris)
- 2011PRODIGE 4/ACCORD 11: FOLFIRINOX lengthens survival over gemcitabine in fit patients
- 2013MPACT: gemcitabine plus nab-paclitaxel lengthens survival over gemcitabine
- 2019POLO: olaparib maintenance delays progression in germline BRCA carriers
- 2023NAPOLI 3: NALIRIFOX beats gemcitabine plus nab-paclitaxel first line
- 2024Zenocutuzumab approved for NRG1 fusion-positive pancreatic cancer
- 2026RASolute 302: daraxonrasib lengthens survival after first-line chemotherapy, the first RAS inhibitor to do so
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 22 changes by month →- 2026-09-18This recordMetastatic pancreatic ductal adenocarcinomaFacts on this page last checked
When this page itself was last checked or edited.
- 2026ApprovalDaraxonrasibDaraxonrasib approved in US
Metastatic pancreatic cancer (previously treated)
- 2026Trial resultRASolute 302RASolute 302 reported
OS 13.
- 2026MilestoneRASolute 302RASolute 302: daraxonrasib lengthens survival after first-line chemotherapy, the first RAS inhibitor to do so
A milestone in how this cancer is treated.
- 2024-06RegulatoryDaraxonrasibDaraxonrasib: designation granted (US)
Breakthrough Therapy designation, previously treated metastatic PDAC
- 2024ApprovalIrinotecan (and liposomal irinotecan)Irinotecan (and liposomal irinotecan) approved in US
Liposomal irinotecan in NALIRIFOX first-line metastatic pancreatic cancer
What is in development for Metastatic pancreatic ductal adenocarcinoma, drawn from the whole corpus: 32 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Drugs in phase 3 · 2
Drugs in phase 2 · 5
Drugs in phase 1 · 1
Drugs at an unstated stage · 4
Technologies being tested · 3
Trials under way · 12
- Study of Daraxonrasib and Daraxonrasib + GnP as First-line Treatment in Patients With Metastatic Pancreatic Adenocarcinoma · phase 3 · Revolution Medicines, Inc.
- Study of Zoldonrasib (RMC-9805) Plus Daraxonrasib (RMC-6236) Versus Gemcitabine and Nab-Paclitaxel as First-Line Treatment in Metastatic KRAS G12D-Mut · phase 3 · Revolution Medicines, Inc.
- Study of Zoldonrasib + Chemo of Investigator's Choice vs Placebo + Chemo of Investigator's Choice as First-line Treatment in Metastatic KRAS G12D-muta · phase 3 · Revolution Medicines, Inc.
- A Study to Evaluate Chemotherapy With or Without INCB161734 in Previously Untreated, KRAS G12D-Mutated Metastatic Pancreatic Ductal Adenocarcinoma · phase 3 · Incyte
- A Multicenter Study of IBI343 Monotherapy Versus Placebo in Subjects With Previously Treated, Claudin (CLDN) 18.2-positive, Pancreatic Cancer(G-HOPE-002) · phase 3 · Innovent Biologics (Suzhou)
- Claudin18.2 CAR-T (CT041) in Patients With Gastric, Pancreatic Cancer, or Other Specified Digestive Cancers · phase 1/2 · CARsgen Therapeutics Co., Ltd.
- 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 · phase 1/2 · A2 Biotherapeutics Inc.
- Atebimetinib + GnP as a First Line Treatment in Patients With Metastatic Pancreatic Adenocarcinoma · phase 3 · Immuneering
- Study of Quemliclustat and Chemotherapy Versus Placebo and Chemotherapy in Patients With Metastatic Pancreatic Ductal Adenocarcinoma · phase 3 · Arcus Biosciences
- Relacorilant With Nab-Paclitaxel and Gemcitabine in Patients With Metastatic Pancreatic Adenocarcinoma · phase 2 · Corcept Therapeutics
- A Study of Nuzefatide Pevedotin (BT5528) in Patients With Metastatic Pancreatic Ductal Adenocarcinoma (PDAC) · phase 2 · BicycleTx Limited
- 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) · phase 2/3 · Bristol-Myers Squibb
Trials reported · 3
- Precision Promise · phase platform · completed
- NAPOLI 3 · phase 3 · 2023 · positive
- RASolute 302 · phase 3 · 2026 · positive
Ideas not yet in a trial · 2
Open problems and what is being done
Resistance to RAS inhibitors emerges within months and the best partner drugs are unknown.
and how the field plans to fix it →What is being done about thisResistance to treatmentAvailable now- Comprehensive genomic profilingStandard of care
- Liquid biopsy (ctDNA)Standard of care
In trials- ElraglusibPhase 2
Ideas and roadmapsNothing recorded yet.
Background: Drug resistance (primary and acquired). Also on OnCo: Resistance atlas · Lines of therapy.
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.
and how the field plans to fix it →What is being done about thisFinding cancer earlierAvailable now- Liquid biopsy (ctDNA)Standard of care
In trialsNothing recorded yet.
Ideas and roadmapsNothing recorded yet.
Background: CA 19-9. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
London · cancer center | United Kingdom | none recorded | 0 | 1,026 | 17,745 | #7 | |
Baltimore · cancer center | United States | 0 | 2,955 | 41,449 | #10 | ||
Boston · cancer center | United States | 1 | 4,335 | 73,845 | none recorded | #15 | |
Los Angeles · cancer center | United States | 0 | 2,019 | 32,934 | - | ||
Beijing · cancer center | China | none recorded | 0 | 1,344 | 18,195 | - | |
Ramat Gan · hospital | Israel | none recorded | 0 | 715 | 9,094 | - | |
| United Kingdom | none recorded | 0 | 693 | 7,168 | - | ||
Düsseldorf · hospital | Germany | none recorded | 0 | 686 | 7,181 | - | |
London · research institute | United Kingdom | none recorded | 0 | 641 | 10,459 | none recorded | - |
Lausanne · hospital | Switzerland | none recorded | 0 | 509 | 9,176 | - | |
Brussels · cancer center | Belgium | none recorded | 0 | 489 | 8,689 | - | |
Mainz · university | Germany | none recorded | 0 | 483 | 5,527 | - | |
Aurora, CO · cancer center | United States | 0 | 483 | 13,480 | - | ||
Montréal, QC · hospital | Canada | none recorded | 0 | 408 | 6,239 | - | |
Vandœuvre-lès-Nancy · cancer center | France | none recorded | 0 | 175 | 2,594 | none recorded | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Metastatic pancreatic ductal adenocarcinoma but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Metastatic pancreatic ductal adenocarcinoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example KRAS mutation subtype by tissue or plasma sequencing, Germline BRCA1, BRCA2, PALB2 and ATM, Mismatch repair status by immunohistochemistry or sequencing, NRG1, NTRK, ALK, ROS1, FGFR2 and RET fusions and BRAF alterations in KRAS wild-type tumours, CA 19-9 for response monitoring), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Metastatic PDAC, fit for combination chemotherapy, Metastatic PDAC, unfit for combination chemotherapy, Metastatic PDAC with a KRAS G12D, G12V or G12R mutation.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
First line, fit patients
- For my situation (first line, fit patients), which of the standard options do you recommend and why?Why: Guideline options include: Modified FOLFIRINOX or NALIRIFOX (NAPOLI 3); gemcitabine plus nab-paclitaxel as the alternative, chosen by fitness, biliary drainage and neuropathy.
- Am I a candidate for FOLFIRINOX / mFOLFIRINOX, NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV), Gemcitabine + nab-paclitaxel, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of NAPOLI 3 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
First line, less fit patients
- For my situation (first line, less fit patients), which of the standard options do you recommend and why?Why: Guideline options include: Gemcitabine plus nab-paclitaxel at reduced dose or gemcitabine alone; best supportive care when chemotherapy would do harm.
- Am I a candidate for Gemcitabine + nab-paclitaxel, Gemcitabine, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Maintenance and biomarker-directed therapy
- For my situation (maintenance and biomarker-directed therapy), which of the standard options do you recommend and why?Why: Guideline options include: 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.
- Am I a candidate for Olaparib, Pembrolizumab, Zenocutuzumab or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of POLO apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Second line
- For my situation (second line), which of the standard options do you recommend and why?Why: Guideline options include: Daraxonrasib after first-line chemotherapy (RASolute 302); otherwise switch backbone, liposomal irinotecan with fluorouracil after gemcitabine or a gemcitabine-based regimen after FOLFIRINOX.
- Am I a candidate for Daraxonrasib, Irinotecan (and liposomal irinotecan), Fluorouracil (5-FU) or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of RASolute 302 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Supportive care throughout
- For my situation (supportive care throughout), which of the standard options do you recommend and why?Why: Guideline options include: Biliary stenting, pancreatic enzyme replacement, dietetic support, early palliative care, anticoagulation for thrombosis and coeliac plexus block for pain.
Clinical trials
- For my situation (clinical trials), which of the standard options do you recommend and why?Why: Guideline options include: 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.
- Am I a candidate for Zoldonrasib, ELI-002 7P, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of Study of Daraxonrasib and Daraxonrasib + GnP as First-line Treatment in Patients With Metastatic Pancreatic Adenocarcinoma and Study of Zoldonrasib (RMC-9805) Plus Daraxonrasib (RMC-6236) Versus Gemcitabine and Nab-Paclitaxel as First-Line Treatment in Metastatic KRAS G12D-Mut apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of 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, Study of Zoldonrasib + Chemo of Investigator's Choice vs Placebo + Chemo of Investigator's Choice as First-line Treatment in Metastatic KRAS G12D-muta?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Resistance to RAS inhibitors emerges within months and the best partner drugs are unknown”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Checkpoint inhibitors fail outside mismatch repair deficient disease because the tumour excludes T cells”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Metastatic pancreatic ductal adenocarcinoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
20targets
11drugs
25companies
23pathways
4terms
11trials
21roadmaps
1ideas
2people
11key papers
5For fit patients with newly diagnosed metastatic pancreatic cancer, a FOLFIRINOX-type regimen is now proven to be better than gemcitabine plus nab-paclitaxel, settling a long-standing debate. The absolute gain is about two months of median survival, and the regimen is more toxic for the gut. Whether liposomal irinotecan adds anything over conventional irinotecan (standard FOLFIRINOX) has never been tested head-to-head.
This paper reframed pancreatic and liver cancer as the coming burden and is cited in most arguments for investing in them. Its pancreatic cancer projection has been tracking close to reality in the years since.
With FOLFIRINOX this trial defined the two chemotherapy standards for metastatic pancreatic cancer that still apply, and the gemcitabine and nab-paclitaxel backbone is the comparator in most current first-line pancreatic trials.
FOLFIRINOX and, soon after, gemcitabine plus nab-paclitaxel ended the era of single-agent gemcitabine for metastatic pancreatic cancer. The regimen's modified form later improved survival after surgery in PRODIGE 24, and its toxicity is why fitness, not just stage, decides which treatment a patient is offered.
This trial introduced a patient-centred composite endpoint and a drug that remained the backbone of pancreatic cancer treatment for a generation. Its small survival gain also shows how low the bar was, which is the context for the FOLFIRINOX and MPACT trials that followed.
Latest papers
topQuery for this cancer: (TITLE:"Metastatic pancreatic ductal adenocarcinoma" OR ABSTRACT:"Metastatic pancreatic ductal adenocarcinoma" OR TITLE:"Metastatic pancreatic cancer" OR ABSTRACT:"Metastatic pancreatic cancer" OR TITLE:"Stage IV pancreatic adenocarcinoma" OR ABSTRACT:"Stage IV pancreatic adenocarcinoma" OR TITLE:"Advanced pancreatic cancer" OR ABSTRACT:"Advanced pancreatic cancer" OR TITLE:"mPDAC" OR ABSTRACT:"mPDAC") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Metastatic pancreatic ductal adenocarcinoma, not a curated reading list.
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