What is pancreatic cancer, in plain language?

Most pancreatic cancers are pancreatic ductal adenocarcinoma (PDAC). Staging is usually described by whether the tumor can be removed with surgery: resectable, borderline resectable, locally advanced, or metastatic. Those details, plus biomarkers, decide which treatments are standard and which trials may fit.

Why does resectable versus advanced matter for trials?

Adjuvant or resectable trials are written for cancer that can be operated on, or that was just operated on. Locally advanced and metastatic first-line trials enroll a different setting. Those lists are not interchangeable.

Which biomarkers separate pancreatic cancer trials?

KRAS is common, and the exact substitution matters (especially G12D and G12C). BRCA1, BRCA2, and HRD open a different set of studies. MSI-high or dMMR is uncommon but is named in some immunotherapy protocols.

Do clinical trials replace approved pancreatic cancer treatment?

No. A trial is one option to discuss with an oncologist. It is not automatically better than approved treatment. What is considered standard depends on resectability, biomarkers, prior treatment, and country.

What should I ask an oncologist before looking at listings?

Ask whether the tumor is resectable or advanced, which KRAS, BRCA, HRD, and MSI tests were done, which treatments have already been used, what is standard where you live, and whether any recruiting trial matches that profile.

Pancreatic Cancer Clinical Trials: Stage, Biomarkers, and Recruiting Studies

Most pancreatic cancers are pancreatic ductal adenocarcinoma (PDAC). PDAC is the large majority. Two people with "pancreatic cancer" on a report can still have a different stage and different gene changes in the tumor. Those details are what usually decide which treatments are standard and which clinical trials may fit.

Staging is often described by resectability: whether the tumor can be removed with surgery. The usual groups are resectable, borderline resectable, locally advanced, and metastatic. Resectable and adjuvant trials sit in one setting. Locally advanced and metastatic trials sit in another. A listing written for adjuvant treatment after surgery is not interchangeable with a first-line trial for metastatic disease.

Biomarkers also split the lists. KRAS changes are common in PDAC. The exact substitution matters, especially G12D and G12C. BRCA1, BRCA2, and homologous recombination deficiency (HRD) open a different set of studies. MSI-high or mismatch-repair deficiency (dMMR) is uncommon here, but some immunotherapy protocols name it.

A clinical trial is one option to raise with the treating oncologist. It is not automatically better than approved treatment. The useful question is whether a given study matches this resectability, biomarker profile, and treatment history.

Resectable and advanced trials are not interchangeable

Resectable disease, including borderline resectable disease, is treated with surgery in mind. Adjuvant trials enroll after the tumor has been removed, or around the time of surgery. Locally advanced disease cannot be removed up front. Metastatic disease has already spread. First-line metastatic trials and later-line trials after prior treatment are written for those settings.

Resectable and advanced trials are not interchangeable

Biomarkers that actually separate one trial from another

Recruiting pancreatic cancer trials

Trials whose title or listed conditions name KRAS G12D

A Study to Evaluate Chemotherapy With or Without INCB161734 in Previously Untreated, KRAS G12D-Mutated Metastatic Pancreatic Ductal Adenocarcinoma

Study of Zoldonrasib (RMC-9805) Plus Daraxonrasib (RMC-6236) Versus Gemcitabine and Nab-Paclitaxel as First-Line Treatment in Metastatic KRAS G12D-Mutated Pancreatic Adenocarcinoma

Study of RMC-9805 in Participants With KRAS G12D-Mutant Solid Tumors

Trials whose title or listed conditions name KRAS

Study of JAB-23E73 in Combination With Chemotherapy in Participants With Metastatic PDAC Harboring KRAS Gene Alterations

KRAS-Targeted Vaccine Combined With Balstilimab and Botensilimab for Patients With Stage IV MMR-p Colorectal Cancer and Pancreatic Ductal Cancer

A Registry to Capture Patient Outcomes With KRAS G12R Altered Advanced Pancreatic Ductal Adenocarcinoma Treated With MEK Inhibitor-based Combination Therapy

Trials whose title or listed conditions name BRCA or HRD

Cisplatin to Patients With Pancreatic Cancer and Homologous Recombination Deficiency

Other recruiting pancreatic cancer trials

A Study to Assess Adverse Events and Change in Disease Activity With Treatment Combinations With Telisotuzumab Adizutecan in Adults Participants With Pancreatobiliary Cancers

A Study to Learn About the Medicine Ponsegromab in Adults With Cancer of the Pancreas Which Has Spread and Caused Significant Body Weight Loss and Fatigue

Namodenoson Treatment of Advanced Pancreatic Cancer

Metarrestin (ML-246) in Subjects With Metastatic Solid Tumors

GLP-1 RA Plus SOC Treatment in First-line, Metastatic Pancreatic, Colorectal, or Hepatocellular Cancer

Exploratory Clinical Evaluation of Personalized Functional Profiling in GI Tumors: Predicting Drug Response in CRC and PDAC

Prospectively Defining Metastatic Pancreatic Ductal Adenocarcinoma Subtypes by Comprehensive Genomic Analysis

PTM-101 in Pancreatic Ductal Adenocarcinoma (PDAC)

A Study of ASP2138 Given Before Surgery, Then Chemotherapy After Surgery, in People With Pancreatic Ductal Cancer

Phase I Study of JFI447 [68Ga]Ga-DFC413 and Comparison to FFG233 [68Ga]Ga-NNS309 in Patients With Solid Tumors

Hyperpolarized C Pyruvate Magnetic Resonance Imaging, and Blood-Based Biomarkers for Early Detection of Pancreatic Adenocarcinoma in Patients With Intraductal Papillary Mucinous Neoplasms

Artidis Nanomechanical Signature Profiling of Pancreatic Cancer Specimens

A Study of GC203 TIL in PDCA (RJ)

Questions to ask an oncologist

Sources

In depth

Breakthrough in Pancreatic Cancer: Compassionate Use for KRAS Mutations Explained

Further reading

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