OnCo

Pancreatic ductal adenocarcinoma: lines of therapy

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8 standard-of-care settings across 4 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersRisk group
Screening, prevention and diagnosis·1
Locally advanced4·
Advanced, first line2·
Second line1·

Screening, prevention and diagnosis

SubgroupSettingApproachProducts and trialsEvidence
Risk groupHigh-risk surveillanceAnnual MRI/MRCP or EUS for germline carriers and familial kindreds (CAPS/PRECEDE); germline testing for every diagnosed patient and first-degree relatives.40

Locally advanced

SubgroupSettingApproachProducts and trialsEvidence
All comersResectable/borderlineNeoadjuvant FOLFIRINOX → surgery → adjuvant chemotherapy.93
All comersLocally advancedChemotherapy ± TTFields (Optune Pax, 2026); SBRT or MR-guided RT; IRE in selected cases.85
All comersResectable / borderlineNeoadjuvant mFOLFIRINOX (borderline; increasingly resectable), surgery, then adjuvant mFOLFIRINOX to complete ~6 months (PRODIGE 24); gemcitabine/capecitabine if unfit. Chemoradiation selectively (PREOPANC).87
All comersLocally advanced unresectableFOLFIRINOX 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.85

Advanced, first line

SubgroupSettingApproachProducts and trialsEvidence
All comersMetastaticFOLFIRINOX or gem/nab-pac; olaparib maintenance if gBRCA; zenocutuzumab if NRG1; trials of RAS inhibitors.87
All comersMetastatic, first linemFOLFIRINOX 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.94

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersMetastatic, second lineDaraxonrasib once approved (RASolute 302: OS 13.2 vs 6.7 months) is expected to become the standard; otherwise switch backbone (gem/nab-pac after FOLFIRINOX, or liposomal irinotecan/5-FU after gemcitabine).83

Regimens in the library

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.