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What is pancreatic cancer?
The pancreas sits deep behind the stomach and makes both digestive enzymes and hormones like insulin. About 92 percent of pancreatic cancers start in the enzyme making cells, and this page is mostly about those. The other 8 percent are neuroendocrine tumors, which grow more slowly, have their own trials, and a five year survival of 72 percent against 8 percent. The pancreas gives no early warning. Jaundice, back pain, weight loss and new diabetes usually appear only after the cancer has grown or spread, and fewer than 20 percent of people can have surgery at diagnosis.
Smoking roughly doubles the risk, and type 2 diabetes, extra weight, chronic pancreatitis and family history raise it. About 10 percent of cases come from inherited mutations, so guidelines now recommend genetic testing for everyone diagnosed. That can change treatment and flag relatives who should be watched. The hope comes from biology. More than 90 percent of pancreatic cancers carry a KRAS mutation. That target was called undruggable for decades. Now several RAS inhibitors are in trials, with the first Phase 3 studies recruiting. Pancreatic cancer shares risk factors with type 2 diabetes and inherited genes with breast and ovarian cancer.
Our guide to new treatments for pancreatic cancer covers what has been approved and what is being tested.
Types of pancreatic cancer clinical trials
KRAS and RAS targeted trials. The most watched area: pills that block the mutated KRAS protein, tested alone and with chemotherapy, in first line and after progression. Several are in Phase 3.
Chemotherapy combination trials. New drugs added to standard regimens such as FOLFIRINOX, NALIRIFOX, or gemcitabine with nab-paclitaxel, including antibody drug conjugates and targeted agents.
Surgery and perioperative trials. Studies of chemotherapy before surgery to shrink borderline resectable tumors, and of treatment sequencing for the minority who can have an operation.
Immunotherapy and vaccine trials. Pancreatic cancer has resisted immunotherapy, so trials test combinations, personalized mRNA vaccines after surgery, and cell therapies designed to overcome the tumor's defenses.
Early detection and high risk studies. Surveillance of people with inherited mutations or a strong family history using MRI and endoscopic ultrasound, and blood tests aimed at finding cancer earlier.
Supportive care and genetic testing studies. Nutrition, pain control including nerve blocks, and programs to increase germline genetic testing for everyone diagnosed.
Who can participate in pancreatic cancer clinical trials?
Most treatment trials enroll adults with pancreatic adenocarcinoma at a specific stage: metastatic, locally advanced and unresectable, or borderline resectable. Many first line trials want people who have not yet had chemotherapy, while others require progression after a specific regimen. KRAS targeted trials require a tumor test showing the mutation, and some BRCA related trials require a germline result. Because the disease often affects nutrition and liver function, trials require adequate organ function and performance status, meaning you can manage most daily activities. Neuroendocrine tumors have separate studies. High risk surveillance studies enroll people with no cancer but a family history or known mutation. Eligibility always varies by study.
What causes pancreatic cancer?
Smoking is the largest known cause, roughly doubling risk. Type 2 diabetes, excess body weight, chronic pancreatitis, heavy alcohol use, and family history also raise it, and about 10 percent of cases involve inherited mutations such as BRCA2 or Lynch syndrome. In most people no single cause can be identified.
The stages of pancreatic cancer, and why they matter for trials
Resectable (roughly stage I to II). Confined to the pancreas or nearby tissue and removable by surgery. Only about 17 percent of cases are localized at diagnosis, with five year survival of 44 percent. Trials here test chemotherapy before or after surgery and vaccines to prevent recurrence.
Borderline resectable and locally advanced (stage III). The tumor involves major blood vessels; surgery may become possible after chemotherapy, or may not be possible at all. Trials test treatment to shrink tumors and radiation techniques.
Metastatic (stage IV). Spread to the liver, lungs, or lining of the abdomen. About half of cases are metastatic at diagnosis, and five year survival is 3 percent. This is where most drug trials, including the KRAS inhibitors, recruit.
Study titles say "resectable," "locally advanced," "metastatic," or "first line" and "second line," and increasingly "KRAS G12D" or another specific mutation. Your stage, your prior chemotherapy, and your tumor's mutation report tell you at a glance which studies fit.
How to enroll in a pancreatic cancer clinical trial
Identify your trial. Use the filters. Titles name the stage and line of treatment, and often a mutation. Speed matters in this disease, so apply to every study that fits rather than one at a time.
Select your preferred location. Enter your city or state. Early phase and KRAS trials run at major cancer centers; chemotherapy trials often run at community oncology practices too, and many sponsors help with travel.
Explore study details. Click "Learn More" for eligibility, including which prior treatments are required or excluded, whether a fresh biopsy or mutation test is needed, and the visit schedule.
Complete the health profile. Click "Get started" to begin the 5-step application. Have three things ready: your stage and whether the tumor is exocrine or neuroendocrine, your tumor and germline genetic test results if available, and the list of treatments you have had. If you have not had genetic testing, say so; guidelines recommend it for everyone diagnosed.
Submit the application. A clinical trial coordinator reviews it and contacts you, usually within days. Nothing is decided until informed consent, and participation is voluntary at every step.