KRAS wild-type pancreatic ductal adenocarcinoma: lines of therapy
7 standard-of-care settings across 3 lines and 4 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | BRAF | NRG1 | NTRK |
|---|---|---|---|---|
| Screening, prevention and diagnosis | 1 | · | · | · |
| Advanced, first line | 1 | · | · | · |
| Other settings | 2 | 1 | 1 | 1 |
Screening, prevention and diagnosis
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Diagnosis | Comprehensive genomic profiling with fusion detection (RNA sequencing where DNA panels are negative) for every KRAS wild-type tumour; pathology review to exclude a periampullary primary. | NCCN Guidelines: Pancreatic Adenocarcinoma | 87 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | First line | Chemotherapy as for other pancreatic adenocarcinoma while sequencing is completed; a targeted drug first line only for NTRK or NRG1 fusions where the patient is unfit for chemotherapy. | NCCN Guidelines: Pancreatic Adenocarcinoma | 85 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Other fusions | ALK, ROS1, RET and FGFR2 inhibitors extrapolated from other cancers; mismatch repair deficient tumours receive pembrolizumab. | NCCN Guidelines: Pancreatic Adenocarcinoma | 98 | |
| All comers | No identified driver | Chemotherapy; nimotuzumab plus gemcitabine approved in China after NOTABLE. | NCCN Guidelines: Pancreatic Adenocarcinoma | 90 | |
| BRAF | BRAF alteration | Dabrafenib plus trametinib for BRAF V600E (tumour-agnostic approval); MEK inhibitors for BRAF in-frame deletions on case-series evidence. | NCCN Guidelines: Pancreatic Adenocarcinoma | 88 | |
| NRG1 | NRG1 fusion | Zenocutuzumab (eNRGy), approved December 2024 for pancreatic cancer with an NRG1 fusion after prior systemic therapy. | NCCN Guidelines: Pancreatic Adenocarcinoma | 58 | |
| NTRK | NTRK fusion | Larotrectinib or entrectinib, approved for NTRK fusion-positive solid tumours; repotrectinib after resistance. | NCCN Guidelines: Pancreatic Adenocarcinoma | 69 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.