Journal: CA: a cancer journal for clinicians
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer with a poor prognosis, mainly due to late diagnosis and resistance to therapy.
Its incidence is rising, influenced by factors such as:
- Chronic pancreatitis
- Diabetes
- Smoking
- Obesity
- Familial risk
Early symptoms are nonspecific, resulting in most diagnoses occurring at advanced stages. Curative surgery is possible in only 15%-20% of cases.
Efforts to improve early detection focus on:
- Serum biomarkers like CA 19-9
- Advanced imaging techniques such as endoscopic ultrasound and MRI
- Liquid biopsies, especially in high-risk groups
Neoadjuvant chemotherapy is increasingly used to improve surgical outcomes.
For locally advanced or metastatic disease, combination chemotherapy regimens—FOLFIRINOX, NALIRIFOX, and gemcitabine/nab-paclitaxel—provide survival benefits but come with significant toxicity.
Molecular profiling has enabled targeted therapies such as sotorasib and olaparib.
Immunotherapy has limited efficacy due to the tumor’s immunosuppressive environment, but novel strategies are under investigation, including:
- Quadruplet regimens
- Checkpoint inhibitors combined with oncolytic viruses
- Stromal-targeting agents
- Neoantigen vaccines
Future research priorities include developing early detection biomarkers, refining targeted therapy selection, and overcoming treatment resistance.