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Pancreatic CancerA Review

Educational Objective
To review the pathophysiology and clinical management of pancreatic cancer.
1 Credit CME

Importance  Pancreatic ductal adenocarcinoma (PDAC) is a relatively uncommon cancer, with approximately 60 430 new diagnoses expected in 2021 in the US. The incidence of PDAC is increasing by 0.5% to 1.0% per year, and it is projected to become the second-leading cause of cancer-related mortality by 2030.

Observations  Effective screening is not available for PDAC, and most patients present with locally advanced (30%-35%) or metastatic (50%-55%) disease at diagnosis. A multidisciplinary management approach is recommended. Localized pancreas cancer includes resectable, borderline resectable (localized and involving major vascular structures), and locally advanced (unresectable) disease based on the degree of arterial and venous involvement by tumor, typically of the superior mesenteric vessels. For patients with resectable disease at presentation (10%-15%), surgery followed by adjuvant chemotherapy with FOLFIRINOX (fluorouracil, irinotecan, leucovorin, oxaliplatin) represents a standard therapeutic approach with an anticipated median overall survival of 54.4 months, compared with 35 months for single-agent gemcitabine (stratified hazard ratio for death, 0.64 [95% CI, 0.48-0.86]; P = .003). Neoadjuvant systemic therapy with or without radiation followed by evaluation for surgery is an accepted treatment approach for resectable and borderline resectable disease. For patients with locally advanced and unresectable disease due to extensive vascular involvement, systemic therapy followed by radiation is an option for definitive locoregional disease control. For patients with advanced (locally advanced and metastatic) PDAC, multiagent chemotherapy regimens, including FOLFIRINOX, gemcitabine/nab-paclitaxel, and nanoliposomal irinotecan/fluorouracil, all have a survival benefit of 2 to 6 months compared with a single-agent gemcitabine. For the 5% to 7% of patients with a BRCA pathogenic germline variant and metastatic PDAC, olaparib, a poly (adenosine diphosphate [ADB]-ribose) polymerase inhibitor, is a maintenance option that improves progression-free survival following initial platinum-based therapy.

Conclusions and Relevance  Approximately 60 000 new cases of PDAC are diagnosed per year, and approximately 50% of patients have advanced disease at diagnosis. The incidence of PDAC is increasing. Currently available cytotoxic therapies for advanced disease are modestly effective. For all patients, multidisciplinary management, comprehensive germline testing, and integrated supportive care are recommended.

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Article Information

Corresponding Author: Eileen M. O’Reilly, MD, Memorial Sloan Kettering Cancer Center, 300 E 66th St, Office 1021, New York, NY 10065 (

Accepted for Publication: July 27, 2021.

Author Contributions: Dr O’Reilly had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Obtained funding: Park, O'Reilly.

Administrative, technical, or material support: Park, O'Reilly.

Supervision: O'Reilly.

Other - involved in writing: Chawla.

Conflict of Interest Disclosures: Dr Park reported receiving grant and research support from Astellas, Gossamer Bio, and Merck and providing consultancy to Ipsen. Dr O'Reilly reported receiving grants and research funding to the institution from Genentech-Roche, Celgene-BMS, BioNTech, Arcus, AstraZeneca, and BioAtla; personal fees for serving on a data and safety monitoring board from Cytomx Therapeutics, Rafael Therapeutics, personal fees from Sobi Consulting, non-financial support from Silenseed Consulting, personal fees from Molecular Templates Consulting, personal fees from Boehringer Ingelheim Consulting, personal fees from BioNTech Consulting, personal fees from Ipsen Consulting, personal fees from Polaris Consulting, and personal fees from Merck Consulting during the conduct of the study; other from Bayer Spouse consulting, other from Celgene/BMS Spouse consulting, other from Genentech-Roche Spouse consulting, and other from Eisai Spouse consulting outside the submitted work. No other disclosures were reported.

Funding/Support: Cancer Center Support Grant P30 CA008748; David M. Rubenstein Center for Pancreas Cancer Research; Paul Calabresi Career Development Award K12 CA184746; Parker Institute for Immunotherapy Pilot Grant; Elsa U. Pardee Foundation Grant.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Siegel  RL , Miller  KD , Fuchs  HE , Jemal  A .  Cancer statistics, 2021.   CA Cancer J Clin. 2021;71(1):7-33. doi:10.3322/caac.21654PubMedGoogle ScholarCrossref
Rahib  L , Smith  BD , Aizenberg  R , Rosenzweig  AB , Fleshman  JM , Matrisian  LM .  Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States.   Cancer Res. 2014;74(11):2913-2921. doi:10.1158/0008-5472.CAN-14-0155PubMedGoogle ScholarCrossref
Conroy  T , Desseigne  F , Ychou  M ,  et al; Groupe Tumeurs Digestives of Unicancer; PRODIGE Intergroup.  FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer.   N Engl J Med. 2011;364(19):1817-1825. doi:10.1056/NEJMoa1011923PubMedGoogle ScholarCrossref
Von Hoff  DD , Ervin  T , Arena  FP ,  et al.  Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine.   N Engl J Med. 2013;369(18):1691-1703. doi:10.1056/NEJMoa1304369PubMedGoogle ScholarCrossref
Conroy  T , Hammel  P , Hebbar  M ,  et al; Canadian Cancer Trials Group and the Unicancer-GI–PRODIGE Group.  FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer.   N Engl J Med. 2018;379(25):2395-2406. doi:10.1056/NEJMoa1809775PubMedGoogle ScholarCrossref
Pancreatic Adenocarcinoma, Version 1.2020. National Comprehensive Cancer Network; 2019.
Sohal  DPS , Duong  M , Ahmad  SA ,  et al.  Efficacy of perioperative chemotherapy for resectable pancreatic adenocarcinoma: a phase 2 randomized clinical trial.   JAMA Oncol. 2021;7(3):421-427. doi:10.1001/jamaoncol.2020.7328PubMedGoogle ScholarCrossref
Golan  T , Hammel  P , Reni  M ,  et al.  Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer.   N Engl J Med. 2019;381(4):317-327. doi:10.1056/NEJMoa1903387PubMedGoogle ScholarCrossref
O’Reilly  EM , Lee  JW , Zalupski  M ,  et al.  Randomized, multicenter, phase ii trial of gemcitabine and cisplatin with or without veliparib in patients with pancreas adenocarcinoma and a germline BRCA/PALB2 mutation.   J Clin Oncol. 2020;38(13):1378-1388. doi:10.1200/JCO.19.02931PubMedGoogle ScholarCrossref
Wong  MCS , Jiang  JY , Liang  M , Fang  Y , Yeung  MS , Sung  JJY .  Global temporal patterns of pancreatic cancer and association with socioeconomic development.   Sci Rep. 2017;7(1):3165. doi:10.1038/s41598-017-02997-2PubMedGoogle ScholarCrossref
Rawla  P , Sunkara  T , Gaduputi  V .  Epidemiology of pancreatic cancer: global trends, etiology and risk factors.   World J Oncol. 2019;10(1):10-27. doi:10.14740/wjon1166PubMedGoogle ScholarCrossref
Terhune  PG , Phifer  DM , Tosteson  TD , Longnecker  DS .  K-ras mutation in focal proliferative lesions of human pancreas.   Cancer Epidemiol Biomarkers Prev. 1998;7(6):515-521.PubMedGoogle Scholar
Konstantinidis  IT , Vinuela  EF , Tang  LH ,  et al.  Incidentally discovered pancreatic intraepithelial neoplasia: what is its clinical significance?   Ann Surg Oncol. 2013;20(11):3643-3647. doi:10.1245/s10434-013-3042-2PubMedGoogle ScholarCrossref
Oyama  H , Tada  M , Takagi  K ,  et al.  Long-term risk of malignancy in branch-duct intraductal papillary mucinous neoplasms.   Gastroenterology. 2020;158(1):226-237.e5. doi:10.1053/j.gastro.2019.08.032PubMedGoogle ScholarCrossref
Tanaka  M , Chari  S , Adsay  V ,  et al; International Association of Pancreatology.  International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas.   Pancreatology. 2006;6(1-2):17-32. doi:10.1159/000090023PubMedGoogle ScholarCrossref
Hackert  T , Fritz  S , Klauss  M ,  et al.  Main-duct intraductal papillary mucinous neoplasm: high cancer risk in duct diameter of 5 to 9 mm.   Ann Surg. 2015;262(5):875-880. doi:10.1097/SLA.0000000000001462PubMedGoogle ScholarCrossref
Vege  SS , Ziring  B , Jain  R ,  et al.  American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts.   Gastroenterology. 2015;148(4):819-822. doi:10.1053/j.gastro.2015.01.015PubMedGoogle ScholarCrossref
Owens  DK , Davidson  KW , Krist  AH ,  et al; US Preventive Services Task Force.  Screening for pancreatic cancer: US Preventive Services Task Force reaffirmation recommendation statement.   JAMA. 2019;322(5):438-444. doi:10.1001/jama.2019.10232PubMedGoogle Scholar
Bosetti  C , Lucenteforte  E , Silverman  DT ,  et al.  Cigarette smoking and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (Panc4).   Ann Oncol. 2012;23(7):1880-1888. doi:10.1093/annonc/mdr541PubMedGoogle ScholarCrossref
Iodice  S , Gandini  S , Maisonneuve  P , Lowenfels  AB .  Tobacco and the risk of pancreatic cancer: a review and meta-analysis.   Langenbecks Arch Surg. 2008;393(4):535-545. doi:10.1007/s00423-007-0266-2PubMedGoogle ScholarCrossref
Wang  YT , Gou  YW , Jin  WW , Xiao  M , Fang  HY .  Association between alcohol intake and the risk of pancreatic cancer: a dose-response meta-analysis of cohort studies.   BMC Cancer. 2016;16:212. doi:10.1186/s12885-016-2241-1PubMedGoogle ScholarCrossref
Genkinger  JM , Spiegelman  D , Anderson  KE ,  et al.  Alcohol intake and pancreatic cancer risk: a pooled analysis of fourteen cohort studies.   Cancer Epidemiol Biomarkers Prev. 2009;18(3):765-776. doi:10.1158/1055-9965.EPI-08-0880PubMedGoogle ScholarCrossref
Johansen  D , Stocks  T , Jonsson  H ,  et al.  Metabolic factors and the risk of pancreatic cancer: a prospective analysis of almost 580,000 men and women in the Metabolic Syndrome and Cancer Project.   Cancer Epidemiol Biomarkers Prev. 2010;19(9):2307-2317. doi:10.1158/1055-9965.EPI-10-0234PubMedGoogle ScholarCrossref
Sung  H , Siegel  RL , Rosenberg  PS , Jemal  A .  Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry.   Lancet Public Health. 2019;4(3):e137-e147. doi:10.1016/S2468-2667(18)30267-6PubMedGoogle ScholarCrossref
Shindo  K , Yu  J , Suenaga  M ,  et al.  Deleterious germline mutations in patients with apparently sporadic pancreatic adenocarcinoma.   J Clin Oncol. 2017;35(30):3382-3390. doi:10.1200/JCO.2017.72.3502PubMedGoogle ScholarCrossref
Hu  C , Hart  SN , Polley  EC ,  et al.  Association between inherited germline mutations in cancer predisposition genes and risk of pancreatic cancer.   JAMA. 2018;319(23):2401-2409. doi:10.1001/jama.2018.6228PubMedGoogle ScholarCrossref
Golan  T , Kindler  HL , Park  JO ,  et al.  Geographic and ethnic heterogeneity of germline BRCA1 or BRCA2 mutation prevalence among patients with metastatic pancreatic cancer screened for entry into the POLO trial.   J Clin Oncol. 2020;38(13):1442-1454. doi:10.1200/JCO.19.01890PubMedGoogle ScholarCrossref
Hu  C , LaDuca  H , Shimelis  H ,  et al.  Multigene hereditary cancer panels reveal high-risk pancreatic cancer susceptibility genes.   JCO Precis Oncol. 2018;2. doi:10.1200/po.17.00291PubMedGoogle Scholar
Hu  ZI , Hellmann  MD , Wolchok  JD ,  et al.  Acquired resistance to immunotherapy in MMR-D pancreatic cancer.   Journal Immunother Cancer. 2018;6(1):127. doi:10.1186/s40425-018-0448-1PubMedGoogle ScholarCrossref
Rainone  M , Singh  I , Salo-Mullen  EE , Stadler  ZK , O’Reilly  EM .  An emerging paradigm for germline testing in pancreatic ductal adenocarcinoma and immediate implications for clinical practice: a review.   JAMA Oncol. 2020;6(5):764-771. doi:10.1001/jamaoncol.2019.5963PubMedGoogle ScholarCrossref
Kanda  M , Matthaei  H , Wu  J ,  et al.  Presence of somatic mutations in most early-stage pancreatic intraepithelial neoplasia.   Gastroenterology. 2012;142(4):730-733.e9. doi:10.1053/j.gastro.2011.12.042PubMedGoogle ScholarCrossref
Waddell  N , Pajic  M , Patch  AM ,  et al; Australian Pancreatic Cancer Genome Initiative.  Whole genomes redefine the mutational landscape of pancreatic cancer.   Nature. 2015;518(7540):495-501. doi:10.1038/nature14169PubMedGoogle ScholarCrossref
Aguirre  AJ , Nowak  JA , Camarda  ND ,  et al.  Real-time genomic characterization of advanced pancreatic cancer to enable precision medicine.   Cancer Discov. 2018;8(9):1096-1111. doi:10.1158/2159-8290.CD-18-0275PubMedGoogle ScholarCrossref
Bailey  P , Chang  DK , Nones  K ,  et al; Australian Pancreatic Cancer Genome Initiative.  Genomic analyses identify molecular subtypes of pancreatic cancer.   Nature. 2016;531(7592):47-52. doi:10.1038/nature16965PubMedGoogle ScholarCrossref
Moffitt  RA , Marayati  R , Flate  EL ,  et al.  Virtual microdissection identifies distinct tumor- and stroma-specific subtypes of pancreatic ductal adenocarcinoma.   Nat Genet. 2015;47(10):1168-1178. doi:10.1038/ng.3398PubMedGoogle ScholarCrossref
Hayashi  A , Fan  J , Chen  R ,  et al.  A unifying paradigm for transcriptional heterogeneity and squamous features in pancreatic ductal adenocarcinoma.   Nature Cancer. 2020;1(1):59-74. doi:10.1038/s43018-019-0010-1Google ScholarCrossref
Aung  KL , Fischer  SE , Denroche  RE ,  et al.  Genomics-driven precision medicine for advanced pancreatic cancer: early results from the COMPASS trial.   Clin Cancer Res. 2018;24(6):1344-1354. doi:10.1158/1078-0432.CCR-17-2994PubMedGoogle ScholarCrossref
Knox  JJ  Clinical advances in pancreas adenocarcinoma.   Cancer Res. 2020;80(22 suppl). AACR Virtual Special Conference on Pancreatic Cancer abstract IA-08.Google Scholar
Lowery  MA , Jordan  EJ , Basturk  O ,  et al.  Real-time genomic profiling of pancreatic ductal adenocarcinoma: potential actionability and correlation with clinical phenotype.   Clin Cancer Res. 2017;23(20):6094-6100PubMedGoogle ScholarCrossref
Pishvaian  MJ , Blais  EM , Brody  JR ,  et al.  Overall survival in patients with pancreatic cancer receiving matched therapies following molecular profiling: a retrospective analysis of the Know Your Tumor registry trial.   Lancet Oncol. 2020;21(4):508-518. doi:10.1016/S1470-2045(20)30074-7PubMedGoogle ScholarCrossref
Balachandran  VP , Łuksza  M , Zhao  JN ,  et al; Australian Pancreatic Cancer Genome Initiative; Garvan Institute of Medical Research; Prince of Wales Hospital; Royal North Shore Hospital; University of Glasgow; St Vincent’s Hospital; QIMR Berghofer Medical Research Institute; University of Melbourne, Centre for Cancer Research; University of Queensland, Institute for Molecular Bioscience; Bankstown Hospital; Liverpool Hospital; Royal Prince Alfred Hospital, Chris O’Brien Lifehouse; Westmead Hospital; Fremantle Hospital; St John of God Healthcare; Royal Adelaide Hospital; Flinders Medical Centre; Envoi Pathology; Princess Alexandria Hospital; Austin Hospital; Johns Hopkins Medical Institutes; ARC-Net Centre for Applied Research on Cancer.  Identification of unique neoantigen qualities in long-term survivors of pancreatic cancer.   Nature. 2017;551(7681):512-516. doi:10.1038/nature24462PubMedGoogle ScholarCrossref
Beatty  GL , Eghbali  S , Kim  R .  Deploying immunotherapy in pancreatic cancer: defining mechanisms of response and resistance.   Am Soc Clin Oncol Educ Book. 2017;37:267-278. doi:10.1200/EDBK_175232PubMedGoogle ScholarCrossref
Teng  MW , Ngiow  SF , Ribas  A , Smyth  MJ .  Classifying cancers based on T-cell infiltration and PD-L1.   Cancer Res. 2015;75(11):2139-2145. doi:10.1158/0008-5472.CAN-15-0255PubMedGoogle ScholarCrossref
Ott  PA , Bang  YJ , Piha-Paul  SA ,  et al.  T-cell-inflamed gene-expression profile, programmed death ligand 1 expression, and tumor mutational burden predict efficacy in patients treated with pembrolizumab across 20 cancers: KEYNOTE-028.   J Clin Oncol. 2019;37(4):318-327. doi:10.1200/JCO.2018.78.2276PubMedGoogle ScholarCrossref
Royal  RE , Levy  C , Turner  K ,  et al.  Phase 2 trial of single agent ipilimumab (anti-CTLA-4) for locally advanced or metastatic pancreatic adenocarcinoma.   J Immunother. 2010;33(8):828-833. doi:10.1097/CJI.0b013e3181eec14cPubMedGoogle ScholarCrossref
Ho  WJ , Jaffee  EM , Zheng  L .  The tumour microenvironment in pancreatic cancer: clinical challenges and opportunities.   Nat Rev Clin Oncol. 2020;17(9):527-540. doi:10.1038/s41571-020-0363-5PubMedGoogle ScholarCrossref
Nevala-Plagemann  C , Hidalgo  M , Garrido-Laguna  I .  From state-of-the-art treatments to novel therapies for advanced-stage pancreatic cancer.   Nat Rev Clin Oncol. 2020;17(2):108-123. doi:10.1038/s41571-019-0281-6PubMedGoogle ScholarCrossref
Walter  FM , Mills  K , Mendonça  SC ,  et al.  Symptoms and patient factors associated with diagnostic intervals for pancreatic cancer (SYMPTOM pancreatic study): a prospective cohort study.   Lancet Gastroenterol Hepatol. 2016;1(4):298-306. doi:10.1016/S2468-1253(16)30079-6PubMedGoogle ScholarCrossref
Aslanian  HR , Lee  JH , Canto  MI .  AGA Clinical Practice Update on pancreas cancer screening in high-risk individuals: expert review.   Gastroenterology. 2020;159(1):358-362. doi:10.1053/j.gastro.2020.03.088PubMedGoogle ScholarCrossref
Wang  XY , Yang  F , Jin  C , Fu  DL .  Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer.   World J Gastroenterol. 2014;20(42):15580-15589. doi:10.3748/wjg.v20.i42.15580PubMedGoogle ScholarCrossref
Tzeng  CW , Balachandran  A , Ahmad  M ,  et al.  Serum carbohydrate antigen 19-9 represents a marker of response to neoadjuvant therapy in patients with borderline resectable pancreatic cancer.   HPB (Oxford). 2014;16(5):430-438. doi:10.1111/hpb.12154PubMedGoogle ScholarCrossref
Fahrmann  JF , Schmidt  CM , Mao  X ,  et al.  Lead-time trajectory of CA19-9 as an anchor marker for pancreatic cancer early detection.   Gastroenterology. 2021;160(4):1373-1383. doi:10.1053/j.gastro.2020.11.052PubMedGoogle ScholarCrossref
Lee  J-S , Park  SS , Lee  YK , Norton  JA , Jeffrey  SS .  Liquid biopsy in pancreatic ductal adenocarcinoma: current status of circulating tumor cells and circulating tumor DNA.   Mol Oncol. 2019;13(8):1623-1650. doi:10.1002/1878-0261.12537PubMedGoogle ScholarCrossref
Vauthey  JN , Dixon  E .  AHPBA/SSO/SSAT Consensus Conference on Resectable and Borderline Resectable Pancreatic Cancer: rationale and overview of the conference.   Ann Surg Oncol. 2009;16(7):1725-1726. doi:10.1245/s10434-009-0409-5PubMedGoogle ScholarCrossref
Allen  PJ , Kuk  D , Castillo  CF ,  et al.  Multi-institutional validation study of the American Joint Commission on Cancer (8th Edition) changes for T and N staging in patients with pancreatic adenocarcinoma.   Ann Surg. 2017;265(1):185-191. doi:10.1097/SLA.0000000000001763PubMedGoogle ScholarCrossref
Gilbert  JW , Wolpin  B , Clancy  T ,  et al.  Borderline resectable pancreatic cancer: conceptual evolution and current approach to image-based classification.   Ann Oncol. 2017;28(9):2067-2076. doi:10.1093/annonc/mdx180PubMedGoogle ScholarCrossref
Schmidt  CM , Turrini  O , Parikh  P ,  et al.  Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience.   Arch Surg. 2010;145(7):634-640. doi:10.1001/archsurg.2010.118PubMedGoogle ScholarCrossref
Correa-Gallego  C , Dinkelspiel  HE , Sulimanoff  I ,  et al.  Minimally-invasive vs open pancreaticoduodenectomy: systematic review and meta-analysis.   J Am Coll Surg. 2014;218(1):129-139. doi:10.1016/j.jamcollsurg.2013.09.005PubMedGoogle ScholarCrossref
de Rooij  T , Lu  MZ , Steen  MW ,  et al; Dutch Pancreatic Cancer Group.  Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies.   Ann Surg. 2016;264(2):257-267. doi:10.1097/SLA.0000000000001660PubMedGoogle ScholarCrossref
Ramacciato  G , Nigri  G , Petrucciani  N ,  et al.  Pancreatectomy with mesenteric and portal vein resection for borderline resectable pancreatic cancer: multicenter study of 406 patients.   Ann Surg Oncol. 2016;23(6):2028-2037. doi:10.1245/s10434-016-5123-5PubMedGoogle ScholarCrossref
Moffat  GT , Epstein  AS , O’Reilly  EM .  Pancreatic cancer: a disease in need: optimizing and integrating supportive care.   Cancer. 2019;125(22):3927-3935. doi:10.1002/cncr.32423PubMedGoogle ScholarCrossref
Oettle  H , Neuhaus  P , Hochhaus  A ,  et al.  Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial.   JAMA. 2013;310(14):1473-1481. doi:10.1001/jama.2013.279201PubMedGoogle ScholarCrossref
Neoptolemos  JP , Stocken  DD , Bassi  C ,  et al; European Study Group for Pancreatic Cancer.  Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial.   JAMA. 2010;304(10):1073-1081. doi:10.1001/jama.2010.1275PubMedGoogle ScholarCrossref
Neoptolemos  JP , Palmer  DH , Ghaneh  P ,  et al.  Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial.   Lancet. 2017;389(10073):1011-1024. doi:10.1016/s0140-6736(16)32409-6PubMedGoogle ScholarCrossref
Oettle  H , Post  S , Neuhaus  P ,  et al.  Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial.   JAMA. 2007;297(3):267-277. doi:10.1001/jama.297.3.267PubMedGoogle ScholarCrossref
Neoptolemos  JP , Palmer  DH , Ghaneh  P ,  et al; European Study Group for Pancreatic Cancer.  Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial.   Lancet. 2017;389(10073):1011-1024. doi:10.1016/S0140-6736(16)32409-6PubMedGoogle ScholarCrossref
Wang-Gillam  A , Li  CP , Bodoky  G ,  et al; NAPOLI-1 Study Group.  Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial.   Lancet. 2016;387(10018):545-557. doi:10.1016/S0140-6736(15)00986-1PubMedGoogle ScholarCrossref
Klinkenbijl  JH , Jeekel  J , Sahmoud  T ,  et al.  Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group.   Ann Surg. 1999;230(6):776-782. doi:10.1097/00000658-199912000-00006PubMedGoogle ScholarCrossref
Neoptolemos  JP , Stocken  DD , Friess  H ,  et al; European Study Group for Pancreatic Cancer.  A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer.   N Engl J Med. 2004;350(12):1200-1210. doi:10.1056/NEJMoa032295PubMedGoogle ScholarCrossref
Murphy  JE , Wo  JY , Ryan  DP ,  et al.  Total neoadjuvant therapy with folfirinox followed by individualized chemoradiotherapy for borderline resectable pancreatic adenocarcinoma: a phase 2 clinical trial.   JAMA Oncol. 2018;4(7):963-969. doi:10.1001/jamaoncol.2018.0329PubMedGoogle ScholarCrossref
Chawla  A , Molina  G , Pak  LM ,  et al.  Neoadjuvant therapy is associated with improved survival in borderline-resectable pancreatic cancer.   Ann Surg Oncol. 2020;27(4):1191-1200. doi:10.1245/s10434-019-08087-zPubMedGoogle ScholarCrossref
Jang  JY , Han  Y , Lee  H ,  et al.  Oncological benefits of neoadjuvant chemoradiation with gemcitabine versus upfront surgery in patients with borderline resectable pancreatic cancer: a prospective, randomized, open-label, multicenter phase 2/3 trial.   Ann Surg. 2018;268(2):215-222. doi:10.1097/SLA.0000000000002705PubMedGoogle ScholarCrossref
Katz  MHG , Ou  FS , Herman  JM ,  et al; Alliance for Clinical Trials on Oncology.  Alliance for clinical trials in oncology (ALLIANCE) trial A021501: preoperative extended chemotherapy vs. chemotherapy plus hypofractionated radiation therapy for borderline resectable adenocarcinoma of the head of the pancreas.   BMC Cancer. 2017;17(1):505. doi:10.1186/s12885-017-3441-zPubMedGoogle ScholarCrossref
Versteijne  E , Suker  M , Groothuis  K ,  et al; Dutch Pancreatic Cancer Group.  Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase III PREOPANC trial.   J Clin Oncol. 2020;38(16):1763-1773. doi:10.1200/JCO.19.02274PubMedGoogle ScholarCrossref
Loehrer  PJ  Sr , Feng  Y , Cardenes  H ,  et al.  Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial.   J Clin Oncol. 2011;29(31):4105-4112. doi:10.1200/JCO.2011.34.8904PubMedGoogle ScholarCrossref
Gastrointestinal Tumor Study Group.  Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone.   J Natl Cancer Inst. 1988;80(10):751-755. doi:10.1093/jnci/80.10.751PubMedGoogle ScholarCrossref
Katz  MHG , Shi  Q , Meyers  JP ,  et al.  Alliance A021501: preoperative mFOLFIRINOX or mFOLFIRINOX plus hypofractionated radiation therapy (RT) for borderline resectable (BR) adenocarcinoma of the pancreas.   J Clin Oncol. 2021;39(3_suppl):377. doi:10.1200/JCO.2021.39.3_suppl.377Google ScholarCrossref
van der Gaag  NA , Rauws  EA , van Eijck  CH ,  et al.  Preoperative biliary drainage for cancer of the head of the pancreas.   N Engl J Med. 2010;362(2):129-137. doi:10.1056/NEJMoa0903230PubMedGoogle ScholarCrossref
Pancreatic Cancer, Version 1.2021. National Comprehensive Cancer Network; 2020.
Sultana  A , Tudur Smith  C , Cunningham  D ,  et al.  Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy.   Br J Cancer. 2007;96(8):1183-1190. doi:10.1038/sj.bjc.6603719PubMedGoogle ScholarCrossref
Mukherjee  S , Hurt  CN , Bridgewater  J ,  et al.  Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced pancreatic cancer (SCALOP): a multicentre, randomised, phase 2 trial.   Lancet Oncol. 2013;14(4):317-326. doi:10.1016/S1470-2045(13)70021-4PubMedGoogle ScholarCrossref
Glazer  ES , Hornbrook  MC , Krouse  RS .  A meta-analysis of randomized trials: immediate stent placement vs. surgical bypass in the palliative management of malignant biliary obstruction.   J Pain Symptom Manage. 2014;47(2):307-314. doi:10.1016/j.jpainsymman.2013.03.013PubMedGoogle ScholarCrossref
Uemura  S , Iwashita  T , Iwata  K ,  et al.  Endoscopic duodenal stent versus surgical gastrojejunostomy for gastric outlet obstruction in patients with advanced pancreatic cancer.   Pancreatology. 2018;18(5):601-607. doi:10.1016/j.pan.2018.04.015PubMedGoogle ScholarCrossref
Park  W , Chen  J , Chou  JF ,  et al.  Genomic methods identify homologous recombination deficiency in pancreas adenocarcinoma and optimize treatment selection.   Clin Cancer Res. 2020;26(13):3239-3247. doi:10.1158/1078-0432.CCR-20-0418PubMedGoogle ScholarCrossref
Florou  V , Nevala-Plagemann  C , Barber  KE , Mastroianni  JN , Cavalieri  CC , Garrido-Laguna  I .  Treatment rechallenge with checkpoint inhibition in patients with mismatch repair-deficient pancreatic cancer after planned treatment interruption.   JCO Precis Oncol. 2020;4(4):780-784. doi:10.1200/PO.20.00052PubMedGoogle Scholar
Varghese  AM , Singh  I , Singh  R ,  et al.  Early-onset pancreas cancer: clinical descriptors, genomics, and outcomes.   J Natl Cancer Inst. 2021;djab038. doi:10.1093/jnci/djab038PubMedGoogle Scholar
Drilon  A , Laetsch  TW , Kummar  S ,  et al.  Efficacy of Larotrectinib in TRK fusion-positive cancers in adults and children.   N Engl J Med. 2018;378(8):731-739. doi:10.1056/NEJMoa1714448PubMedGoogle ScholarCrossref
Heining  C , Horak  P , Uhrig  S ,  et al.  NRG1 Fusions in KRAS Wild-Type Pancreatic Cancer.   Cancer Discov. 2018;8(9):1087-1095. doi:10.1158/2159-8290.CD-18-0036PubMedGoogle ScholarCrossref
O’Reilly  EM , Oh  DY , Dhani  N ,  et al.  Durvalumab with or without tremelimumab for patients with metastatic pancreatic ductal adenocarcinoma: a phase 2 randomized clinical trial.   JAMA Oncol. 2019;5(10):1431-1438. doi:10.1001/jamaoncol.2019.1588PubMedGoogle ScholarCrossref
O’Hara  MH , O’Reilly  EM , Varadhachary  G ,  et al.  CD40 agonistic monoclonal antibody APX005M (sotigalimab) and chemotherapy, with or without nivolumab, for the treatment of metastatic pancreatic adenocarcinoma: an open-label, multicentre, phase 1b study.   Lancet Oncol. 2021;22(1):118-131. doi:10.1016/S1470-2045(20)30532-5PubMedGoogle ScholarCrossref
Bendell  JC , Manji  GA , Pant  S ,  et al.  A phase I study to evaluate the safety and tolerability of AB680 combination therapy in participants with gastrointestinal malignancies.   J Clin Oncol. 2020;38(4_suppl):TPS788. doi:10.1200/JCO.2020.38.4_suppl.TPS788Google Scholar
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