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31 treatment settings, 26 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids, not advice.
Annual MRI/MRCP or EUS for germline carriers and familial kindreds (CAPS/PRECEDE); germline testing for every diagnosed patient and first-degree relatives.
Yearly MRI or endoscopic ultrasound for people with inherited risk, which catches pancreatic cancers while they are still operable.
A test of the DNA you were born with, to find inherited risk genes such as BRCA or Lynch syndrome.
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
No headline result recorded yet.
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Neoadjuvant mFOLFIRINOX (borderline; increasingly resectable), surgery, then adjuvant mFOLFIRINOX to complete ~6 months (PRODIGE 24); gemcitabine/capecitabine if unfit. Chemoradiation selectively (PREOPANC).
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
Surgeons operate through small incisions using robotic arms with tremor-free precision and 3D vision.
OS 54.4 vs 35.0 months, HR 0.64.
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.
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FOLFIRINOX or gem/nab-paclitaxel; TTFields with gem/nab-paclitaxel (Optune Pax, 2026); SBRT or MR-guided ablative radiotherapy; IRE in selected centres; reassess for conversion surgery.
Optune is a wearable device delivering electric fields that disrupt cell division. It is approved for glioblastoma and, in 2026, pancreatic cancer.
Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.
Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways.
OS 16.2 vs 14.2 months, HR 0.82.
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mFOLFIRINOX or NALIRIFOX (fit) or gemcitabine/nab-paclitaxel; olaparib maintenance if gBRCA after ≥16 weeks platinum; zenocutuzumab if NRG1 fusion; pembrolizumab if MSI-H; trials of RAS inhibitors + chemotherapy.
NALIRIFOX is a version of FOLFIRINOX using a liposome-wrapped irinotecan, approved in 2024 as a first-line option for metastatic pancreatic cancer.
The first drug aimed specifically at KRAS G12D, the single most common mutation in pancreatic cancer. Early combination data in 2026 showed half of previously treated patients responding.
OS HR 0.84; PFS HR 0.69.
PFS HR 0.53; OS HR 0.83 (not significant).
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
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Daraxonrasib after one prior line (FDA approval 26 August 2026; RASolute 302: OS 13.2 vs 6.7 months, HR 0.40); otherwise switch backbone (gem/nab-pac after FOLFIRINOX, or liposomal irinotecan/5-FU after gemcitabine). No European or UK decision on daraxonrasib by 24 September 2026.
The first drug that blocks all active RAS variants, approved by the FDA in August 2026 for metastatic pancreatic cancer, where KRAS drives 90% of tumours.
OS 13.2 vs 6.7 months, HR 0.40.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
Pancreatic protocol CT of chest, abdomen and pelvis before any biliary drainage; FDG PET-CT for localised disease before treatment; EUS with tissue sampling when a diagnosis or node staging is needed; MRI for suspected liver metastases and laparoscopy with laparoscopic ultrasound before an attempted resection when small-volume spread is suspected; CA 19-9 at baseline; germline testing for every patient; decision by a specialist pancreatic multidisciplinary team.
A CT scan is a fast 3D X-ray that shows the size and shape of tumours and whether they have spread.
PET and CT in one machine, so hot spots on the PET are pinned to exact locations on the CT.
Endoscopes with an ultrasound probe on the tip, passed down the gullet or windpipe, that see through the wall of the gut or airway to stage tumours and guide a needle into lymph nodes and the pancreas without an operation.
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
A test of the DNA you were born with, to find inherited risk genes such as BRCA or Lynch syndrome.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Enteric-coated pancreatin for everyone with unresectable disease and consideration before and after resection; early enteral rather than parenteral nutrition after pancreatoduodenectomy; no fish oils for weight loss in unresectable disease; dietitian assessment for the weight loss, malabsorption and cachexia that affect most patients.
Screening for malnutrition, dietitian-led counselling, supplements and tube or intravenous feeding where indicated, plus treatment of cancer cachexia, the muscle-wasting syndrome that affects up to 80% of advanced patients.
Nutrition screening means weighing every patient, asking a few screening questions, and referring those at risk to a dietitian. It is simple, guideline-endorsed, and still not done routinely.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
About one in five pancreatic cancers can be removed at diagnosis (the OnCo record; Pancreatic Cancer UK says only a small number of people can have surgery), and the word the multidisciplinary team gives you decides the order. Resectable (no contact with the main arteries, no more than abutment of the veins, no spread): NICE NG85 says surgery first, and only consider chemotherapy before surgery within a clinical trial; the operation is usually a Whipple procedure for the head of the pancreas or a distal pancreatectomy for the body and tail, followed by six months of chemotherapy. Borderline resectable (the tumour touches a main vein or artery, so an operation straight away would probably leave cancer behind): chemotherapy first for two to four months, usually modified FOLFIRINOX, then restaging, with surgery about 6 to 8 weeks after chemotherapy if the disease has not spread; NICE NG85 also places this within a trial, and Cancer Research UK says your doctor may offer one because the best treatment is uncertain. In the Dutch PREOPANC trial, chemoradiotherapy before surgery improved five-year survival over surgery first (20.5% against 6.5%), most clearly for borderline disease; the record's open problems note the question is unresolved for resectable disease after PREOPANC-2, NORPACT-1 and Alliance A021806. Fitness matters as much as anatomy: only people well enough for a major operation are offered one, prehabilitation (exercise, nutrition, stopping smoking) is offered in some hospitals, and if jaundice needs relieving first a metal stent is placed. A second opinion from a specialist pancreatic centre is reasonable when the scan is read differently by different teams.
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
Prehabilitation is a few weeks of structured exercise, nutrition and psychological preparation between diagnosis and surgery to make patients fitter for the operation and speed recovery.
Multidisciplinary tumour boards are regular meetings where surgeons, oncologists, radiologists and pathologists review each patient's case with the full dataset and agree a plan before treatment starts. They are mandatory in the UK and for accreditation in the US, Europe and Germany, and change the diagnosis or plan in 10 to 30% of cases, though randomised evidence is lacking.
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.
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.
Add these to your appointment list, or take the full question set for this cancer.
Three combinations are used for cancer that cannot be removed, chosen by how well you are (performance status), your liver tests, any nerve damage and what you prefer. FOLFIRINOX (fluorouracil, folinic acid, irinotecan and oxaliplatin, every two weeks with a 46-hour pump): NICE NG85 offers it to people with metastatic disease and a performance status of 0 to 1; in the 2011 trial median survival was 11.1 months against 6.8 with gemcitabine, with more diarrhoea, neuropathy and low blood counts, so most UK units give the modified doses. Gemcitabine with nab-paclitaxel (weekly drips for three weeks in four): improved survival over gemcitabine alone in MPACT (8.5 against 6.7 months) and causes hair loss, neuropathy and low counts; NICE TA476 funds it on the NHS only when other combinations are unsuitable and gemcitabine alone would otherwise be given. NALIRIFOX (liposomal irinotecan, oxaliplatin, fluorouracil): in NAPOLI 3 median survival was 11.1 months against 9.2 with gemcitabine and nab-paclitaxel; it is on the OnCo record beside modified FOLFIRINOX for fit patients but NHS funding follows NICE appraisals, so ask what applies where you are treated. Gemcitabine alone, or GemCap, for people not well enough for these; best supportive care when chemotherapy would do harm. Everyone has a DPD blood test before fluorouracil or capecitabine, blood counts before each dose, scans about every three months, and the same temperature rule for the 24-hour line. Second line follows NICE NG85: an oxaliplatin-based regimen if you have not had oxaliplatin, a gemcitabine-based one after FOLFIRINOX; liposomal irinotecan with fluorouracil after gemcitabine is not NICE-recommended (TA440). Daraxonrasib after first-line chemotherapy is on the record's second-line row.
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.
NALIRIFOX is a version of FOLFIRINOX using a liposome-wrapped irinotecan, approved in 2024 as a first-line option for metastatic pancreatic cancer.
A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.
OS HR 0.84; PFS HR 0.69.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
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Chemotherapy after the operation is what turns surgery into a real chance of cure. NICE NG85 says start once you have had time to recover and as soon as you are well enough to tolerate all six cycles, offers gemcitabine plus capecitabine (GemCap, from ESPAC-4: median survival 28.0 months against 25.5 with gemcitabine alone) and considers gemcitabine alone for those not well enough for a combination; since PRODIGE 24 (2018), modified FOLFIRINOX has become the standard for fit patients, with a median survival of 54.4 months against 35.0 with gemcitabine in the 2018 report (53.5 against 35.5 months at the five-year update in 2022), at the cost of more diarrhoea, neuropathy and tiredness, and Pancreatic Cancer UK lists all three as the options, chosen by how well you are. Cancer Research UK and Pancreatic Cancer UK say it should start within 12 weeks (3 months) of surgery and lasts up to 6 months, so sorting out eating, weight, enzyme doses and blood sugar in the weeks after the operation matters: they are the usual reasons for a delay. Ask what the pathology showed about the resection margin (R0 or R1) and the lymph nodes. Follow-up after chemotherapy is usually a CT scan every 6 months for 5 years with blood tests and sometimes CA 19-9; contact the team about any new symptom between visits.
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.
Capecitabine (Xeloda) is a tablet form of the chemotherapy fluorouracil. It is a backbone of treatment for bowel cancer and a standard option in advanced breast cancer.
OS 54.4 vs 35.0 months, HR 0.64.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
About one in ten pancreatic cancers runs in families (Pancreatic Cancer UK), and the OnCo record asks for a germline panel (BRCA1, BRCA2, PALB2, ATM, CDKN2A, STK11 and the Lynch genes) for everyone diagnosed. Three things follow from a BRCA1 or BRCA2 (or PALB2) result. Treatment: platinum chemotherapy (FOLFIRINOX or NALIRIFOX, which contain oxaliplatin) is favoured, and in the POLO trial maintenance olaparib after at least 16 weeks of platinum without progression lengthened the time before the cancer grew (7.4 against 3.8 months) without lengthening survival overall; NICE could not make a recommendation on olaparib in pancreatic cancer (TA750, terminated December 2021) because the company made no submission, so ask what is funded where you are treated. Family: Macmillan says each child of a carrier has a 1 in 2 chance of inheriting the variant; the genetics team can offer relatives predictive testing, and NICE NG85 says offer pancreatic surveillance (MRI/MRCP or EUS) to people with BRCA1, BRCA2, PALB2 or CDKN2A variants who have a first-degree relative with pancreatic cancer, and to those with Peutz-Jeghers syndrome or hereditary pancreatitis. Time: results usually take weeks to a few months; a variant of uncertain significance means the effect on risk is not yet known and the genetics team will explain it. Tumour testing (KRAS subtype, NRG1 and other fusions, mismatch repair) is separate and decides trial eligibility and the rare targeted drugs on the record.
A test of the DNA you were born with, to find inherited risk genes such as BRCA or Lynch syndrome.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
PFS HR 0.53; OS HR 0.83 (not significant).
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
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Jaundice (yellow eyes or skin, dark urine, pale stools, itch) means the tumour is blocking the bile duct, and how it is relieved depends on the plan for the cancer. NICE NG85 says: if the cancer is resectable and you are well enough, offer the operation rather than draining the duct first (unless a trial requires drainage); if you are not yet fit for surgery, or will have chemotherapy first, offer a self-expanding metal stent placed by endoscopy (ERCP), a fully covered one where it may need removing later; if the cancer cannot be removed, offer a metal stent rather than a surgical bypass; and consider a surgical bypass (and a prophylactic gastrojejunostomy) only when the cancer turns out to be unresectable during an attempted resection. Pancreatic Cancer UK says most people feel better within a couple of days of a stent, the jaundice takes two to three weeks to clear completely, and that relieving it may be what allows chemotherapy to start; the problems are blockage (symptoms return), infection (antibiotics), the stent moving, and pancreatitis from the procedure. If ERCP fails the stent is placed through the skin (PTC). Macmillan says plastic stents may need replacing and metal ones usually do not. A blocked duodenum (vomiting large amounts, feeling full) is treated with a duodenal stent, or a gastrojejunostomy for people expected to live longer.
A small tube placed by endoscope or through the skin reopens a blocked bile duct, relieving jaundice so chemotherapy can be given.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
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Many people with pancreatic cancer have pain in the upper tummy or back, often because the tumour presses on the coeliac plexus, the bundle of nerves behind the pancreas; Pancreatic Cancer UK says asking for help early makes it easier to control. The steps Cancer Research UK describes: paracetamol and anti-inflammatories, then weak and strong opioids (morphine-based medicines as tablets, liquids, patches or injections) with regular laxatives because opioids constipate, and anti-sickness medicine for the first week; amitriptyline or gabapentin for burning, tingling or shooting nerve pain; radiotherapy or chemotherapy to shrink what is pressing on the nerves, which takes weeks to work; and relaxation, TENS, acupuncture and distraction alongside. NICE NG85 says consider an EUS-guided or image-guided coeliac plexus block for uncontrolled pain, unacceptable opioid side effects or escalating doses, and not to offer thoracic splanchnicectomy; Macmillan describes the injection through the back or from inside the stomach during an endoscopic ultrasound, and a randomised trial (Wyse 2011) found early EUS-guided neurolysis reduced pain at three months. Pain after a Whipple operation is normal for weeks and eases; sudden worse pain with a temperature means A&E. Palliative care and pain teams can be involved at any stage, alongside treatment.
Systematic treatment of cancer pain with opioids, adjuvant drugs, radiation and procedures such as nerve blocks and intrathecal pumps. Most pain can be controlled, yet under-treatment remains common, especially where opioids are unavailable.
Specialist care for symptoms, decision-making and quality of life given alongside cancer treatment from diagnosis, not just at the end. Trials show it improves quality of life and mood and may lengthen survival.
Short courses of radiation, often a single treatment, to relieve pain from bone metastases, stop bleeding, open blocked airways or protect the spinal cord. Among the most cost-effective treatments in cancer.
Endoscopes with an ultrasound probe on the tip, passed down the gullet or windpipe, that see through the wall of the gut or airway to stage tumours and guide a needle into lymph nodes and the pancreas without an operation.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
The pancreas digests food and controls blood sugar, and the cancer, the operation or both can take away either job. Enzymes: Pancreatic Cancer UK says most people with pancreatic cancer will need pancreatic enzyme replacement therapy (PERT: Creon, Nutrizym, Pancrex) for life, and that the signs of needing it are weight loss, bloating, wind, tummy pain after eating and pale, oily, floating stools. NICE NG85 says offer enteric-coated pancreatin in unresectable disease and consider it before and after resection. How to take it: with all meals, snacks and milky drinks, half with the first mouthfuls and half spread through the meal, swallowed with a cool drink, starting at about 50,000 to 75,000 units for a main meal and 25,000 to 50,000 for a snack, more for larger or fattier meals, reviewed by the dietitian and increased until symptoms settle; if it is not working, a proton pump inhibitor, another brand, or another cause (bile acid diarrhoea, bacterial overgrowth, medicines) is looked for. Supplies have been disrupted since 2024; NICE points prescribers to the Specialist Pharmacy Service tool for equivalents. Diabetes: pancreatic cancer or surgery can cause type 3c diabetes, which differs from type 1 and 2, usually needs tablets or insulin, and is managed by a diabetes nurse and specialist dietitian who know you have pancreatic cancer; a systematic review found new diabetes in about 16 in 100 people after a Whipple operation, and removing the whole pancreas means insulin for life. If you take insulin, tell the DVLA before driving. Ask both questions at the first appointment: they are the most fixable causes of feeling terrible.
Screening for malnutrition, dietitian-led counselling, supplements and tube or intravenous feeding where indicated, plus treatment of cancer cachexia, the muscle-wasting syndrome that affects up to 80% of advanced patients.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Most people with pancreatic cancer lose appetite and weight (Cancer Research UK), and the loss has two parts: undigested food, which enzymes fix, and the cancer's own effect on appetite and muscle (cachexia), which needs a dietitian early. Cancer Research UK says most pancreatic teams include a dietitian, and its advice is small frequent meals, high-calorie and high-protein snacks and full-fat versions, prescribed supplement drinks sipped through the day (with enzymes, and checked against diabetes), and eating what you feel like rather than what you think you should. Pancreatic Cancer UK says there is no special diet and no foods to avoid, and not to cut fat but to take more PERT with it. Medicines for appetite: Macmillan says steroids or an appetite stimulant may help for a time; the ASCO cachexia guideline recommends dietary counselling and says no drug is established. NICE NG85 says do not offer fish oils to manage weight loss in unresectable disease, and after a Whipple operation to offer early feeding by mouth or tube rather than into a vein when the gut works. With a duodenal stent: soft, moist, lower-fibre foods, little and often, chewed well, upright after eating. Weight and muscle are also what decide whether chemotherapy can be given on time and in full, so ask for the referral in the first weeks, not when the weight has gone.
Screening for malnutrition, dietitian-led counselling, supplements and tube or intravenous feeding where indicated, plus treatment of cancer cachexia, the muscle-wasting syndrome that affects up to 80% of advanced patients.
Nutrition support means tube feeding into the gut, or nutrition into a vein when the gut cannot be used. It is life-saving in the right patient, harmful or futile in the wrong one.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
At every stage a trial can be a reasonable choice beside standard treatment, and in pancreatic cancer it is where the next answers are coming from: NICE NG85 itself places chemotherapy before surgery for resectable or borderline disease within trials, Cancer Research UK says your doctor may offer a trial for borderline disease because the best treatment is uncertain, and the record's pipeline is led by RAS inhibitors (daraxonrasib after first-line chemotherapy in RASolute 302, G12D-selective drugs, vaccines) that Pancreatic Cancer UK describes as a promising group of treatments. Ask what the comparison arm is, whether a placebo is used (the NHS says only where no proven treatment exists), whether a biopsy or tumour gene test is needed to qualify and whether tissue already taken can be used, what extra visits, scans and travel are involved and whether costs are paid, and what happens to your standard treatment if you leave; the NHS says you can leave at any time without giving a reason and without it affecting your care. Pancreatic Cancer UK has a trial finder and its nurses can talk through what a trial would mean for you.
The first drug that blocks all active RAS variants, approved by the FDA in August 2026 for metastatic pancreatic cancer, where KRAS drives 90% of tumours.
OS 13.2 vs 6.7 months, HR 0.40.
No headline result recorded yet.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
Palliative care is symptom control and support, not a stage; Pancreatic Cancer UK says these services are not just for the end of life and are available at any point for cancer that cannot be cured, and a randomised trial (Temel 2010) found early palliative care alongside cancer treatment improved quality of life and mood. In pancreatic cancer the reasons to involve the team early are concrete: pain that may need a nerve block, sickness from a slow or blocked stomach, itch from jaundice, poor appetite and weight loss, fatigue, low mood, sleep, and the practical side (a written plan with numbers to ring at night, help at home, district nurses, a hospice's day services, money and work). The NHS says people whose cancer cannot be cured are referred to the palliative care or symptom control team, which works with you, your GP and the clinical nurse specialist, and that this team can help your loved ones too. NICE NG85 asks teams to assess the psychological impact of fatigue, pain, gut symptoms, nutrition, anxiety and depression throughout care. It is also the place to talk about what matters most to you and to record your wishes (advance care planning) while you are well enough to do it in your own words; Pancreatic Cancer UK's end of life pages, Marie Curie and Maggie's cover the conversations, and Pancreatic Cancer UK's nurses can be reached by phone, email or WhatsApp.
Specialist care for symptoms, decision-making and quality of life given alongside cancer treatment from diagnosis, not just at the end. Trials show it improves quality of life and mood and may lengthen survival.
Systematic treatment of cancer pain with opioids, adjuvant drugs, radiation and procedures such as nerve blocks and intrathecal pumps. Most pain can be controlled, yet under-treatment remains common, especially where opioids are unavailable.
Psycho-oncology recognises and treats the anxiety, depression, fear of recurrence and existential distress that affect a third of people with cancer, using screening, psychotherapy adapted to cancer, and medication.
Cancer-related fatigue and anxiety respond to structured talking therapy that targets the thoughts and habits that keep them going. Randomised trials show benefits during treatment and, for persistent fatigue, years afterwards; guidelines recommend it.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Upfront pancreatoduodenectomy or distal pancreatectomy followed by six months of adjuvant chemotherapy remains the reference for clearly resectable tumours: NORPACT-1 found 18-month survival 60 percent with neoadjuvant FOLFIRINOX against 73 percent with surgery first, SWOG S1505 found two-year survival of 47 to 48 percent with either perioperative regimen (no better than adjuvant history), and NEONAX missed its 18-month disease-free target in both arms. In favour of treating first: PREOPANC-1's neoadjuvant gemcitabine chemoradiotherapy gave five-year survival 20.5 against 6.5 percent (hazard ratio 0.73) across resectable and borderline patients, and PREOPANC-2 found neoadjuvant FOLFIRINOX and neoadjuvant chemoradiotherapy equivalent (21.9 against 21.3 months). Alliance A021806 (358 patients, perioperative against adjuvant modified FOLFIRINOX, primary completion December 2028) and PREOPANC-3 (378 patients) will settle the question; NICE NG85 restricts neoadjuvant therapy to trials (1.8.1, 1.8.2).
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
Surgeons operate through small incisions using robotic arms with tremor-free precision and 3D vision.
OS 54.4 vs 35.0 months, HR 0.64.
Alive at 18 months: 60 percent with neoadjuvant FOLFIRINOX against 73 percent with upfront surgery (p 0.032); median overall survival 25.1 against 38.5 months (hazard ratio 1.52, p 0.050).
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.
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.
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.
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.
No headline result recorded yet.
No headline result recorded yet.
Add these to your appointment list, or take the full question set for this cancer.
Modified FOLFIRINOX for six months in fit patients (PRODIGE 24: median overall survival 53.5 against 35.5 months with gemcitabine, hazard ratio 0.68, five-year survival 43.2 against 31.4 percent). Gemcitabine plus capecitabine for those not eligible (ESPAC-4: 28.0 against 25.5 months, hazard ratio 0.82; long-term 31.6 against 28.4 months, and 49.9 against 32.2 months after R0 resection); this is the NICE NG85 recommendation for England (1.8.6, off-label). Gemcitabine alone for the frail (CONKO-001: five-year survival 20.7 against 10.4 percent with observation; NG85 1.8.7). S-1 for six months in Japan (JASPAC 01: five-year survival 44.1 against 24.4 percent with gemcitabine, hazard ratio 0.57), not licensed for this use in Europe. Nab-paclitaxel with gemcitabine missed its primary endpoint (APACT) and is not a standard. Start within 12 weeks of surgery once recovered.
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.
Capecitabine (Xeloda) is a tablet form of the chemotherapy fluorouracil. It is a backbone of treatment for bowel cancer and a standard option in advanced breast cancer.
Teysuno (S-1) is an oral chemotherapy combining a fluorouracil pro-drug with two protectors. It is a standard in Japan and approved in Europe for stomach cancer with cisplatin and for bowel cancer when other fluoropyrimidines cause hand-foot syndrome or heart problems.
Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.
OS 54.4 vs 35.0 months, HR 0.64.
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.
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.
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.
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.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
Neoadjuvant chemotherapy for two to four months, then restaging and surgery: ESPAC-5 (90 patients, UK and Germany) found one-year survival 39 percent with immediate surgery against 78 percent after gemcitabine plus capecitabine, 84 percent after FOLFIRINOX and 60 percent after chemoradiotherapy. Alliance A021501 established modified FOLFIRINOX alone as the reference regimen (18-month survival 66.7 percent, median 29.8 months) after its stereotactic radiotherapy arm closed at interim analysis for fewer R0 resections (10 against 17 of the first 30). PREOPANC-1 and PREOPANC-2 included borderline patients with the same conclusions as above. NICE NG85 still asks for neoadjuvant therapy to be given within a trial (1.8.1).
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.
Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways.
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.
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.
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.
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.
Add these to your appointment list, or take the full question set for this cancer.
Four to six months of modified FOLFIRINOX or gemcitabine plus nab-paclitaxel (NEOLAP: conversion to resection in 36 to 44 percent of randomised patients with either sequence, median survival 18.5 to 20.7 months). Chemoradiotherapy after induction improves local control but not survival: LAP07 (15.2 against 16.5 months; local progression 32 against 46 percent), CONKO-007 (R0 resection 25 against 18 percent overall, not significant; 69 against 50 percent among those operated; survival hazard ratio 0.94). When it is used, capecitabine is the radiosensitiser (SCALOP: median survival 15.2 against 13.4 months with gemcitabine; NG85 1.9.3). Stereotactic radiotherapy and irreversible electroporation are options in centres with experience: CROSSFIRE (68 patients after FOLFIRINOX) found MRI-guided stereotactic radiotherapy and electroporation equivalent (16.1 against 12.5 months, hazard ratio 1.39, stopped for futility), and PANFIRE-2 (50 patients) reported median survival 17 months from diagnosis with major complications in 42 percent. Tumour treating fields added to gemcitabine plus nab-paclitaxel are approved in the United States (PANOVA-3).
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.
Capecitabine (Xeloda) is a tablet form of the chemotherapy fluorouracil. It is a backbone of treatment for bowel cancer and a standard option in advanced breast cancer.
Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways.
An MR-linac is a radiation machine with an MRI scanner built in, so images taken during setup let the plan be re-optimised in minutes to that day's anatomy. It allows tighter margins and higher doses in pancreatic and prostate cancer, but treatment is slow and costly, and whether daily adaptation improves cure rates rather than only toxicity is unproven.
Irreversible electroporation uses short high-voltage pulses that punch permanent holes in tumour cells while sparing nearby vessels and ducts.
Optune is a wearable device delivering electric fields that disrupt cell division. It is approved for glioblastoma and, in 2026, pancreatic cancer.
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.
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.
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.
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.
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.
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.
OS 16.2 vs 14.2 months, HR 0.82.
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FOLFIRINOX for performance status 0 to 1 (PRODIGE 4/ACCORD 11: median overall survival 11.1 against 6.8 months with gemcitabine, hazard ratio 0.57; febrile neutropenia 5.4 percent) or NALIRIFOX (NAPOLI 3: 11.1 against 9.2 months with nab-paclitaxel and gemcitabine, hazard ratio 0.83 in the Lancet report and 0.84 on the Onivyde label; FDA approval 13 February 2024, EU indication listed; NICE appraisal TA1052 terminated on 2 April 2025 without a company submission). Gemcitabine plus nab-paclitaxel for those less fit or with biliary stents (MPACT: 8.5 against 6.7 months, hazard ratio 0.72; grade 3 or worse neuropathy 17 percent); in England only when other combinations are unsuitable (NICE TA476). Gemcitabine alone for the frail. Four months of FOLFIRINOX then fluorouracil and leucovorin maintenance is an alternative to six months (PANOPTIMOX-PRODIGE 35: six-month progression-free survival 42.9 against 47.1 percent, survival without quality-of-life deterioration 11.4 against 7.2 months). Germline and tumour testing at diagnosis (BRCA, PALB2, mismatch repair, KRAS subtype, NRG1 and NTRK fusions) steers maintenance and later lines.
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
NALIRIFOX is a version of FOLFIRINOX using a liposome-wrapped irinotecan, approved in 2024 as a first-line option for metastatic pancreatic cancer.
Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.
A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.
A test of the DNA you were born with, to find inherited risk genes such as BRCA or Lynch syndrome.
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.
OS HR 0.84; PFS HR 0.69.
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.
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.
Add these to your appointment list, or take the full question set for this cancer.
Daraxonrasib after one prior line (RASolute 302: median overall survival 13.2 against 6.7 months with chemotherapy, hazard ratio 0.40; progression-free 7.2 against 3.6 months; FDA approval 26 August 2026 for metastatic pancreatic adenocarcinoma after one systemic therapy or for people not fit for multi-agent chemotherapy; no EU or UK decision). Otherwise switch backbone: after gemcitabine, liposomal irinotecan with fluorouracil and leucovorin (NAPOLI-1: 6.1 against 4.2 months, hazard ratio 0.67; FDA 2015, EU 2016, not recommended by NICE TA440) or OFF (CONKO-003: 5.9 against 3.3 months, hazard ratio 0.66), noting that PANCREOX found modified FOLFOX6 worse than fluorouracil alone; after FOLFIRINOX, gemcitabine plus nab-paclitaxel. NG85 recommends oxaliplatin-based or gemcitabine-based second line (1.9.7, 1.9.8). Pegilodecakin (SEQUOIA) and eryaspase (TRYbeCA-1) failed here.
The first drug that blocks all active RAS variants, approved by the FDA in August 2026 for metastatic pancreatic cancer, where KRAS drives 90% of tumours.
Irinotecan wrapped in a fat bubble so it circulates longer. It is approved for pancreatic cancer, and in bile duct and gallbladder cancer one Korean trial found it helped as second-line treatment while a German trial did not.
FOLFOX is the workhorse chemotherapy combination for bowel cancer, used after surgery to cure and in advanced disease as the backbone that targeted drugs are added to.
Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.
The platinum drug that works in bowel cancer where cisplatin does not, the 'OX' in FOLFOX and CAPOX; its cost is nerve damage in hands and feet.
The 1957 chemotherapy that remains the backbone of treatment for bowel, stomach, pancreatic, anal, head and neck and breast cancers, and as a cream for skin precancers.
OS 13.2 vs 6.7 months, HR 0.40.
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.
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.
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.
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.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia (grade 3-4) · NIFTY, liposomal irinotecan arm | - | 24% |
| Fatigue or asthenia (grade 3-4) · NIFTY | - | 13% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Olaparib 300 mg twice daily for people with a germline BRCA1 or BRCA2 mutation whose metastatic disease has not progressed after at least 16 weeks of platinum chemotherapy (POLO: progression-free survival 7.4 against 3.8 months, hazard ratio 0.53; overall survival 19.0 against 19.2 months, hazard ratio 0.83, not significant; three-year survival 33.9 against 17.8 percent; FDA approval 2019, EU indication listed; NICE appraisal TA750 terminated on 8 December 2021 without a company submission). Continued chemotherapy, or fluorouracil and leucovorin maintenance after FOLFIRINOX (PANOPTIMOX), are the alternatives for everyone else. About 2 to 3 percent of unselected patients carry a germline BRCA1 or BRCA2 variant (Hu 2018, 3,030 patients: BRCA2 1.9 percent, BRCA1 0.6 percent), more in familial disease; 7.5 percent of the 3,315 screened for POLO carried one and 154 were randomised.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
A test of the DNA you were born with, to find inherited risk genes such as BRCA or Lynch syndrome.
Pills that block a DNA repair backup, killing cancer cells that already lost their main repair system (BRCA).
PFS HR 0.53; OS HR 0.83 (not significant).
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.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
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RAS: daraxonrasib works across RAS G12 mutations (91.8 percent of RASolute 302) and is approved regardless of subtype; KRAS G12C (1 to 2 percent of tumours) responds to sotorasib (CodeBreaK 100 pancreatic cohort, 38 patients: response 21 percent, median survival 6.9 months) and adagrasib (KRYSTAL-1: 7 of 21 responses), which NCCN lists but no regulator has approved for pancreatic cancer; KRAS G12D (about 40 percent) has zoldonrasib in phase 3 first line (RASolute 305 with chemotherapy, RASolute 309 with daraxonrasib) after MRTX1133 was stopped. NRG1 fusions (KRAS wild-type tumours): zenocutuzumab (eNRGy: response 42 percent in 36 pancreatic patients; FDA accelerated approval 4 December 2024; not authorised in the EU). Mismatch repair deficiency (about 1 percent): pembrolizumab (KEYNOTE-158 pancreatic cohort: 4 of 22 responses, 18 percent) or dostarlimab under tumour-agnostic US approvals; NICE TA914 does not cover pancreatic cancer. NTRK fusions: larotrectinib (NICE TA630, Cancer Drugs Fund) or entrectinib (TA644 replaced by the terminated TA1118); repotrectinib after resistance. BRAF V600E: dabrafenib plus trametinib. Erlotinib with gemcitabine is licensed for metastatic disease in the US and EU but added under two weeks in its pivotal trial and nothing in later trials, and is not used.
The first drug that blocks all active RAS variants, approved by the FDA in August 2026 for metastatic pancreatic cancer, where KRAS drives 90% of tumours.
Sotorasib (Lumakras) was the first drug to hit KRAS, approved in 2021 after four decades of failure.
Adagrasib was the second KRAS G12C inhibitor, with a long half-life and brain penetration, and is approved in lung and colorectal cancer.
The first drug aimed specifically at KRAS G12D, the single most common mutation in pancreatic cancer. Early combination data in 2026 showed half of previously treated patients responding.
MRTX1133 was the first potent chemical tool against KRAS G12D, and proved the mutation could be drugged even though it lacks the reactive handle G12C has.
Zenocutuzumab is the first drug for cancers driven by NRG1 gene fusions, working by blocking HER3 from receiving its growth signal.
Pembrolizumab is a PD-1 blocking antibody approved in more than 40 settings, from melanoma and lung cancer to the first tumour-agnostic approval for mismatch-repair-deficient tumours in 2017, and before and after surgery in triple-negative breast cancer. A subcutaneous form arrived in 2025, and it is the backbone partner for ADCs and personalised neoantigen vaccines.
Dostarlimab is a PD-1 blocker famous for making rectal cancer disappear without surgery in every patient with a mismatch-repair-deficient tumour.
The first drug approved for a gene fusion regardless of where the cancer started; it works in about 75% of NTRK-fusion cancers, from infant fibrosarcoma to salivary and thyroid cancers.
Entrectinib (Rozlytrek) is a pill for NTRK-fusion cancers and ROS1 lung cancer that reaches brain metastases.
A ROS1 and NTRK pill that also works after other ROS1 drugs fail, with dizziness as its signature side effect.
Dabrafenib plus trametinib is the BRAF-plus-MEK pill combination, approved for BRAF V600E lung cancer and, since 2022, for any solid tumour with that mutation.
Erlotinib was one of the first EGFR pills for lung cancer; it was approved before anyone knew EGFR mutations predicted who would respond, then redefined by them.
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.
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.
No headline result recorded yet.
No headline result recorded yet.
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.
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.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Hepatotoxicity · CodeBreaK 100 | 25% | 12% |
| Interstitial lung disease · CodeBreaK 100 | 2.2% | 1.1% |
| Diarrhoea · CodeBreaK 100 | 42% | - |
| Musculoskeletal pain · CodeBreaK 100 | 35% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Hepatotoxicity · KRYSTAL-1 NSCLC | 37% | 10% |
| Dyspnoea · KRYSTAL-1 NSCLC | 35% | 10% |
| Fatigue · KRYSTAL-1 NSCLC | 59% | 7% |
| Musculoskeletal pain · KRYSTAL-1 NSCLC | 41% | 7% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Hypothyroidism (immune-mediated) · Pooled monotherapy data, >2,800 patients | 8% | - |
| Pneumonitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 3.4% | - |
| Colitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 1.7% | - |
| Hepatitis (immune-mediated) · Pooled monotherapy data, >2,800 patients | 0.7% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Alternating electric fields at 150 kHz worn for at least 18 hours a day through skin arrays, with gemcitabine plus nab-paclitaxel (PANOVA-3, 571 patients: median overall survival 16.2 against 14.2 months, hazard ratio 0.82; pain-free survival 15.2 against 9.1 months; progression-free survival, local control and response not improved; device-related skin events in 76.3 percent, grade 3 in 7.7 percent). FDA approval of Optune Pax in 2026; no NICE appraisal. Open-label design and the modest effect are debated, and the device is not yet part of European guidelines.
Optune is a wearable device delivering electric fields that disrupt cell division. It is approved for glioblastoma and, in 2026, pancreatic cancer.
Wearable electrodes that deliver alternating electric fields disrupting cancer cell division.
Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.
OS 16.2 vs 14.2 months, HR 0.82.
Add these to your appointment list, or take the full question set for this cancer.
Personalised mRNA neoantigen vaccine: in the 16-patient phase 1, autogene cevumeran after surgery with atezolizumab and modified FOLFIRINOX induced T cells in 8, whose recurrence-free survival was not reached against 13.4 months in non-responders at 3.2 years, with vaccine-induced T cell clones estimated to live 7.7 years; the randomised phase 2 IMCODE003 (260 patients, eight UK sites) is closed to recruitment with disease-free survival due in 2031. Shared KRAS peptide vaccine ELI-002 7P missed its primary endpoint in AMPLIFY-7P (2026). GVAX with CRS-207 failed in ECLIPSE. Claudin 18.2 CAR-T (satricabtagene autoleucel) and mesothelin-directed cells are in early trials. Checkpoint inhibitors alone do not work outside mismatch repair deficient disease.
Autogene cevumeran is BioNTech and Genentech's personalised mRNA vaccine encoding each patient's own tumour neoantigens. In a small phase 1 in resected pancreatic cancer, half of patients mounted T-cell responses and stayed free of recurrence far longer; phase 2 IMCODE003 tests whether that holds.
A ready-made vaccine against the seven commonest KRAS mutations, given after pancreatic cancer surgery. Its phase 2 missed the main goal in 2026 but showed signs of activity.
A patient's T cells are removed, given a synthetic receptor that recognises the cancer, multiplied, and put back as a living drug.
A vaccine made for one patient, encoding the unique mutations in their own tumour, to train the immune system to hunt it.
Off-the-shelf cancer vaccines target antigens shared across patients, such as mutant KRAS or HER2 peptides, so they are made in advance rather than per person. Sipuleucel-T is still the only approved therapeutic cancer vaccine in the US; tolerance to self-antigens and weak past results hold them back.
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.
No headline result recorded yet.
Primary DFS endpoint not met.
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.
Add these to your appointment list, or take the full question set for this cancer.
Added to chemotherapy without survival benefit in phase 3: pegvorhyaluronidase alfa (HALO-301), pegilodecakin (SEQUOIA), napabucasin (CanStem111P), ibrutinib (RESOLVE), devimistat (AVENGER 500), pamrevlumab (LAPIS), eryaspase (TRYbeCA-1), algenpantucel-L (IMPRESS), erlotinib as adjuvant (CONKO-005, RTOG 0848) and in locally advanced disease (LAP07). Chemoradiotherapy after induction improved local control or R0 rates but not survival (LAP07, CONKO-007), and adjuvant chemoradiotherapy was harmful in ESPAC-1. MRTX1133 (KRAS G12D) was terminated in 2025 and the ELI-002 7P vaccine missed in 2026. Neoadjuvant FOLFIRINOX for clearly resectable disease was not better than surgery first (NORPACT-1) or than chemoradiotherapy (PREOPANC-2), and adjuvant nab-paclitaxel with gemcitabine missed its primary endpoint (APACT).
This setting names no product or technology record yet; the approach above is the standard as written. Ask your team which specific treatments they mean.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
No headline result recorded yet.
Primary DFS endpoint not met.
Alive at 18 months: 60 percent with neoadjuvant FOLFIRINOX against 73 percent with upfront surgery (p 0.032); median overall survival 25.1 against 38.5 months (hazard ratio 1.52, p 0.050).
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.
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.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
Commissioned in England: FOLFIRINOX first line for performance status 0 to 1 and gemcitabine combinations or gemcitabine alone otherwise (NG85 1.9.4 to 1.9.6, several off-label); nab-paclitaxel with gemcitabine only when other combinations are unsuitable (TA476); adjuvant gemcitabine plus capecitabine or gemcitabine (NG85 1.8.6, 1.8.7); oxaliplatin-based or gemcitabine-based second line (1.9.7, 1.9.8); larotrectinib for NTRK fusions through the Cancer Drugs Fund (TA630). Not recommended: liposomal irinotecan with fluorouracil after gemcitabine (TA440). Ended: entrectinib (TA1118 terminated, January 2026). Terminated without a recommendation because the company made no submission: olaparib maintenance for germline BRCA carriers (TA750, December 2021) and NALIRIFOX (TA1052, April 2025). Not appraised: daraxonrasib, zenocutuzumab, tumour treating fields, sotorasib and adagrasib for pancreatic cancer; pembrolizumab for mismatch repair deficient tumours (TA914) does not include pancreatic cancer. Neoadjuvant therapy is trial-only under NG85.
FOLFIRINOX is a four-drug chemotherapy combination that, in 2011, became the first treatment to meaningfully extend life in metastatic pancreatic cancer; it is now the standard before and after surgery.
Gemcitabine plus nab-paclitaxel is the gentler of the two standard chemotherapy backbones for pancreatic cancer, and the base on which most new drugs are being tested.
Capecitabine (Xeloda) is a tablet form of the chemotherapy fluorouracil. It is a backbone of treatment for bowel cancer and a standard option in advanced breast cancer.
Irinotecan wrapped in a fat bubble so it circulates longer. It is approved for pancreatic cancer, and in bile duct and gallbladder cancer one Korean trial found it helped as second-line treatment while a German trial did not.
The first drug approved for a gene fusion regardless of where the cancer started; it works in about 75% of NTRK-fusion cancers, from infant fibrosarcoma to salivary and thyroid cancers.
Entrectinib (Rozlytrek) is a pill for NTRK-fusion cancers and ROS1 lung cancer that reaches brain metastases.
NALIRIFOX is a version of FOLFIRINOX using a liposome-wrapped irinotecan, approved in 2024 as a first-line option for metastatic pancreatic cancer.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
The first drug that blocks all active RAS variants, approved by the FDA in August 2026 for metastatic pancreatic cancer, where KRAS drives 90% of tumours.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia (grade 3-4) · NIFTY, liposomal irinotecan arm | - | 24% |
| Fatigue or asthenia (grade 3-4) · NIFTY | - | 13% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Self-expanding metal stent by ERCP for jaundice in unresectable disease and, when drainage is needed before surgery, in resectable disease (NG85 1.7.3 to 1.7.5); metal stents stay open 4.45 months longer than plastic with fewer cholangitis episodes and re-interventions (Almadi 2017, 20 trials). Endoscopic ultrasound-guided drainage when ERCP fails or is expected to be difficult (Paik 2018; DRA-MBO 2023). Surgery first rather than preoperative drainage in fit resectable patients (1.7.1). For duodenal obstruction, an enteral stent relieves symptoms within days and gastrojejunostomy lasts longer (SUSTENT); choose bypass for people with a better prognosis (1.7.8) and consider prophylactic gastrojejunostomy when a tumour is found unresectable at operation (1.7.6).
A small tube placed by endoscope or through the skin reopens a blocked bile duct, relieving jaundice so chemotherapy can be given.
Endoscopes with an ultrasound probe on the tip, passed down the gullet or windpipe, that see through the wall of the gut or airway to stage tumours and guide a needle into lymph nodes and the pancreas without an operation.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Opioid analgesia with endoscopic ultrasound-guided or percutaneous coeliac plexus block for uncontrolled pain, opioid side effects or escalating doses (NG85 1.5.1; Wyse 2011 randomised trial: pain scores lower at three months, no survival effect); no thoracic splanchnicectomy (1.5.2). Enteric-coated pancreatin with every meal for everyone with unresectable disease and around surgery (1.6.1, 1.6.2); no fish oils for weight loss (1.6.3); early enteral rather than parenteral nutrition after pancreatoduodenectomy (1.6.4). Dietetic review and early palliative care from diagnosis. Cachexia drugs are in trials (ponsegromab, seven UK sites). Thromboprophylaxis is decided by risk score under the NICE venous thromboembolism guideline; in CASSINI's pancreatic subgroup rivaroxaban cut clots during treatment (3.7 against 10.1 percent) but not over 180 days.
Enzyme capsules taken with every meal replace the digestive enzymes a pancreas blocked or removed by cancer no longer delivers; NICE says to offer them to everyone with unresectable pancreatic cancer and to consider them around surgery.
Specialist care for symptoms, decision-making and quality of life given alongside cancer treatment from diagnosis, not just at the end. Trials show it improves quality of life and mood and may lengthen survival.
Screening for malnutrition, dietitian-led counselling, supplements and tube or intravenous feeding where indicated, plus treatment of cancer cachexia, the muscle-wasting syndrome that affects up to 80% of advanced patients.
Blood clots are the second commonest cause of death in people with cancer. Risk scores identify who should take preventive blood thinners during chemotherapy, and direct oral anticoagulants have largely replaced injections for treatment.
Ponsegromab is a monoclonal antibody from Pfizer, in registered phase 3 trials for pancreatic ductal adenocarcinoma.
No headline result recorded yet.
Add these to your appointment list, or take the full question set for this cancer.