Advances in Pancreatic Cancer Research
NCI-funded researchers are working to advance our understanding of how to prevent, detect, and treat pancreatic cancer. The disease is very hard to detect early and currently there is no screening test available.
Pancreatic cancer is often diagnosed at an advanced stage, for people usually have no symptoms until the cancer has already spread to other organs.
This page highlights some of the latest research in pancreatic cancer, including clinical advances that may soon translate into improved care, NCI-supported programs that are fueling progress, and research findings from recent studies.
Early Detection of Pancreatic Cancer
Currently, no routine tests exist that can catch pancreatic cancer early, before symptoms develop. NCI is now funding several large research projects that are working to develop such an early-detection tool.
One known risk factor for developing pancreatic cancer is a new diagnosis of diabetes, sometimes called new-onset diabetes. About 1 in 100 people with new onset diabetes are diagnosed with pancreatic cancer within 3 years after learning they have diabetes. And 1 in 4 people who get pancreatic cancer had already been diagnosed with diabetes.
The NCI-funded New Onset Diabetes (NOD) Study, which is scheduled to run through 2025, is currently enrolling 10,000 people with new-onset diabetes or hyperglycemia (also known as prediabetes). The NOD researchers hope to develop a blood test that can identify the few individuals with a new diabetes diagnosis who may need further testing for pancreatic cancer.
Other NCI-funded teams, coordinated through the Pancreatic Cancer Detection Consortium (PCDC), are trying to create a blood test that could pick up early pancreatic cancer in the general population. PCDC researchers are also working to improve imaging of the pancreas, by developing methods that may be able to pick up tiny deposits of tumor cells.
Pancreatic Cancer Treatment
Pancreatic cancer can be hard to treat surgically due to the location of the organ, and because the disease has often spread in the body by the time it is diagnosed.
Beyond these standard treatments, NCI scientists continue to look for ways to treat pancreatic cancer more effectively. Researchers are looking at the potential of new drugs, ways to combine standard drugs, and new therapies to give to patients.
Testing Treatments for Early-Stage Pancreatic Cancer
Therapies for early-stage disease being tested in clinical trials right now are:
- New adjuvant chemotherapy drug combinations
Some of these postsurgical drug combinations are already known to extend the lives of patients with metastatic disease, but it's not clear if they are better at killing cancer cells left behind after surgery than standard treatments.
- Neoadjuvant chemotherapy
This form of chemotherapy is given before surgery, with the goal of improving outcomes by shrinking the tumor before it’s removed. Presurgical chemotherapy also may help by killing cancer cells that have escaped from the tumor that would continue to grow as the patient recovers from surgery.
Testing Treatments for Advanced Pancreatic Cancer
New treatments for metastatic pancreatic cancer that are being investigated in clinical trials are:
- Stroma modifying drugs
The stroma is the dense tissue around a tumor that does not contain cancer cells. Pancreatic cancers have much denser stroma than most tumors. Agents that help break down this stroma may help more chemotherapy drugs reach cancer cells. These drugs are being tested now.
- Platinum chemotherapy
Some patients have mutations in BRCA or other genes that prevent cells from repairing DNA damage. Research has shown that some patients with these genetic mutations are more sensitive to chemotherapy drugs containing platinum. In addition, use of another class of drugs called PARP inhibitors may be effective for these patients.
- RAS-directed therapies
- The RAS genes make proteins that take part in signaling pathways that control cell growth. Altered forms of these genes are found in more than 90% of pancreatic cancers. Developing drugs that target mutant forms of RAS has proved challenging. However such drugs are now becoming available, such as a drug that targets a form of RAS that has a mutation called G12C. Although few pancreatic cancer patients have this mutation, scientists hope to develop drugs that target RAS alterations more common in pancreatic cancers.
- Researchers have found that drugs blocking the activity of proteins that mediate the effects of RAS, force cancer cells to rely on a way of creating energy called autophagy. A study in mice found that a combination of two drugs shrank pancreatic tumors. One drug targets a protein that RAS works through, and the other drug blocks autophagy. Whether such combinations will be effective in pancreatic patients is still being studied.
- Pembrolizumab. A rare group of people with pancreatic cancer have mutations in their tumor that cause high microsatellite instability (MSI). Pembrolizumab (Keytruda) is an immune checkpoint inhibitor approved for patients with pancreatic cancer that has high MSI. Immune checkpoint inhibitors work by helping the patient's own immune system fight their tumor. Patients should ask to have their tumors tested for high MSI.
- Immune checkpoint inhibitor combinations. Using one drug for immunotherapy treatment has not been effective for most people with pancreatic cancer. Therefore, researchers are combining several immunotherapies that can act on different parts of the immune system. For example, combining immune checkpoint inhibitors with a type of drug called CD40 agonist (which helps activate T cells), has shown some evidence of benefit in patients with advanced pancreatic cancer.
- Combinations of drugs and treaments. Scientists are now studying combinations of immunotherapy drugs. They are also studying combinations of immunotherapy drugs with other treatments, such as radiation therapy, stromal modifying agents, and other targeted drugs.
- Natural Killer (NK) Cells. NK cells are a type of white blood cell that can kill tumor cells or cells infected with a virus. NK cell therapies for pancreatic cancer are being tested in early-stage clinical trials.
Because of the complex nature of pancreatic cancer, many experts believe it’s important for all patients to join a clinical trial, even if they have early-stage disease. NCI funds and oversees both early- and late-phase clinical trials to develop new treatments and improve patient care. Trials are available for pancreatic cancer treatment.
NCI-Supported Research Programs
See a full list of pancreatic cancer research projects that NCI funded in FY 2018.
Many NCI-funded researchers at the NIH campus, and across the United States and world, are seeking ways to address pancreatic cancer more effectively. Some research is basic, exploring questions as diverse as the biological underpinnings of cancer and the social factors that affect cancer risk. And some is more clinical, seeking to translate this basic information into improved patient outcomes. The programs listed below are a small sampling of NCI’s research efforts in pancreatic cancer.
- The Pancreatic Cancer Detection Consortium (PCDC) develops and tests biomarkers to detect early stage pancreatic cancer and identify individuals at high risk for the disease.
- The Pancreatic Cancer Microenvironment Network (PaCMEN) is an NCI-funded consortium created to conduct both laboratory-based and clinical studies to improve therapeutic outcomes for patients with pancreatic cancer.
- The Pancreatic Specialized Programs of Research Excellence (Pancreatic SPOREs) are designed to quickly move basic scientific findings into clinical settings. The Pancreatic SPORE grants support new and diverse approaches to the prevention, early detection, diagnosis, and treatment of pancreatic cancer. Two of NCI's Gastrointestinal (GI) SPOREs also conduct research in pancreatic cancer.
- The Pancreatic Cancer Cohort Consortium consists of more than a dozen prospective epidemiologic cohort studies that investigate the causes and natural history of pancreatic cancer.
- The RAS Initiative looks to understand mutations in RAS genes to ultimately create effective, new therapies for RAS-related cancers. More than 90% of pancreatic cancers are caused by mutations in the RAS family of genes.
Pancreatic Cancer Research Results
The following are some of our latest news articles on pancreatic cancer research:
- Could A Diabetes Diagnosis Help Detect Pancreatic Cancer Early?
- Boosting Dendritic Cells Helps the Immune System Find Pancreatic Cancer
- To Treat Pancreatic Cancer, Mouse Study Suggests Altering Tumor Microbiome
- Trial Highlights Complexities of Targeted Therapy for Pancreatic Cancer
- Researchers Discover Potential Way to Hit Elusive Target in Pancreatic Cancer
- Altering Chemotherapy Improves Outcomes in Early-Stage Pancreatic Cancer
View the full list of Pancreatic Cancer Research Results and Study Updates.