A growing body of evidence shows that starting treatment before surgery, known as a neoadjuvant-first approach, is helping more patients with locally advanced or borderline resectable pancreatic cancer become eligible for surgery and achieve longer survival. Experts emphasize that the best outcomes come from combining chemotherapy, radiation, surgery, and multidisciplinary care rather than relying on any single treatment.
At one leading cancer center, patients with locally advanced disease are divided into two groups. Those whose tumors mainly involve nearby blood vessels often receive chemotherapy and radiation first, allowing more than 60% to eventually undergo surgery. Patients with initially unresectable tumors are typically treated with systemic therapy and radiation to control disease symptoms and improve quality of life.
Clinicians are also increasingly using biopsy-based tumor profiling to help select the most effective chemotherapy regimen for each patient.
Meanwhile, the investigational RAS(ON) inhibitor daraxonrasib has shown promising results in metastatic pancreatic cancer, nearly doubling median overall survival in second-line treatment. Researchers are exploring how to safely move these targeted therapies into earlier-stage disease while preserving opportunities for curative surgery.