Pancreatic Cancer

UGT1A1 genotype testing for irinotecan: A guideline developed by the UK Centre of Excellence in Regulatory Science and Innovation in Pharmacogenomics (CERSI-PGx).

British journal of clinical pharmacology · 2026 · PMID 42389808

Irinotecan, a topoisomerase I inhibitor, is available as both non-pegylated and pegylated formulations. The non-pegylated formulation is licensed for use in advanced colorectal cancer either in combination with other agents or as monotherapy. However, it is also used off-label across a range of gastrointestinal malignancies and in rare malignancies such as glioblastoma and sarcomas. The pegylated formulation is licensed for use as combination therapy in adult patients with metastatic pancreatic adenocarcinoma. Irin…

The São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer.

HPB : the official journal of the International Hepato Pancreato Biliary Association · 2026 · PMID 41419350

BACKGROUND: Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the São Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances. METHODS: A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (…

NCCN Guidelines® Insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate, Version 2.2026.

Journal of the National Comprehensive Cancer Network : JNCCN · 2026 · PMID 41671423

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate are intended to serve as a resource for health care providers to identify individuals who may benefit from cancer risk assessment and genetic counseling and testing; help guide decisions related to genetic testing; and facilitate a multidisciplinary approach in the comprehensive care of individuals at increased risk for hereditary breast, ovarian, pancreatic, and p…

Clinical Practice Guidelines for Pancreatic Cancer 2025 From the Japan Pancreas Society: A Synopsis.

Pancreas · 2026 · PMID 41342569

OBJECTIVES: The Clinical Practice Guidelines for Pancreatic Cancer were first published in 2006 by the Japan Pancreas Society and have been revised in 2009, 2013, 2016, 2019, and 2022. In July 2025, a newly revised version was released in Japanese. METHODS: This latest revision was developed in accordance with the Minds Manual for Guideline Development 2020, which incorporates the principles of GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to improve clarity, transparency, and reliabili…

Position statement on the pathological assessment of pancreatic resection specimens in pancreatic ductal adenocarcinoma by the Societat Catalana de Pàncrees and the Societat Catalana d'Anatomia Patològica.

Gastroenterologia y hepatologia · 2026 · PMID 41655901

BACKGROUND: The lack of standardised protocols for the pathological assessment of pancreatic resection specimens in pancreatic ductal adenocarcinoma results in substantial variability in diagnostic practice, with relevant clinical and organisational implications. OBJECTIVE: To present a position statement of the Societat Catalana de Pàncrees (SCPanc) and the Societat Catalana d'Anatomia Patològica (SCAP) on the pathological assessment of pancreatic resection specimens in exocrine pancreatic cancer. METHODS: Both sc…

pRECIST: Guidelines for Response Criteria for Use in Trials Testing Therapeutics in Pancreatic Cancer.

Pancreas · 2026 · PMID 41941588

IMPORTANCE: Pancreatic tumor response to treatment remains challenging and varies greatly. In order to establish a standardized approach to measuring and evaluating pancreatic tumor metabolic activity (MA), a consensus guideline called Pancreatic RECIST (pRECIST) was developed. This guideline is based on modified Response Evaluation Criteria in Solid Tumors (RECIST version 1.1), incorporating concurrent CT/PET scan quantitative assessments. OBJECTIVE: The aims were to ensure consistent design, data collection, and …

ACR Appropriateness Criteria® Staging and Follow-Up of Pancreatic Neuroendocrine Tumors.

Journal of the American College of Radiology : JACR · 2026 · PMID 41823937

Accurate staging and appropriate follow-up imaging of pancreatic neuroendocrine tumors (PNET) are essential for guiding management and optimizing outcomes. This document provides evidence-based recommendations for the imaging evaluation of patients with PNET across six clinical variants: local staging, staging for metastatic disease, surveillance postresection, follow-up after treatment of liver-dominant and non-liver dominant disease, and follow-up of untreated disease. Contrast-enhanced CT is usually appropriate …

Symptom Management for Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors: ASCO Guideline.

JCO oncology practice · 2026 · PMID 40344544

PURPOSE: To develop a clinical practice guideline and recommendations for symptom management of patients with well-differentiated grade 1 to grade 3 metastatic gastroenteropancreatic neuroendocrine tumors. METHODS: ASCO convened an Expert Panel to develop a clinical practice guideline by reviewing the literature for relevant guidelines, systematic reviews, randomized controlled trials (RCTs), and observational studies to develop recommendations for clinical practice. RESULTS: The literature review identified eight …

Recommendations on the surveillance and supplementation of vitamins and minerals for upper gastrointestinal cancer survivors: a scoping review.

Journal of cancer survivorship : research and practice · 2026 · PMID 39207682

BACKGROUND: Early-stage upper gastrointestinal (UGI) cancer patients, after surgery, have altered gastrointestinal functions, compromising their nutritional status and health outcomes. Nutritional care provision to UGI survivors rarely focuses on long-term survivorship. Here, we explore recommendations for surveillance of micronutrient deficiency and supplementation for UGI cancer survivors after surgery. METHODS: A scoping review, based on the Joanna Briggs Institute methodology for scoping reviews. Six databases …

Recommendations for selection, treatment, and follow-up in peptide receptor radionuclide therapy (PRRT) for neuroendocrine tumors: a Delphi consensus from the Galician Multidisciplinary Group on Neuroendocrine and Endocrine Tumors (GGNET).

Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026 · PMID 41806239

BACKGROUND: Peptide receptor radionuclide therapy (PRRT) is an established treatment for patients with well-differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs) expressing somatostatin receptors (SSTR). Despite robust trial and real-world data, heterogeneity persists regarding patient selection, therapeutic sequencing, and follow-up strategies. METHODS: A Delphi consensus was conducted by the Galician Multidisciplinary Group on Neuroendocrine and Endocrine Tumors (GGNET). Ten experts in oncology, …

Nutritional Therapy in Pancreatic Cancer: Mechanisms, Clinical Applications, and Future Perspectives.

Nutrition and cancer · 2026 · PMID 42411702

BACKGROUND: Pancreatic cancer is frequently complicated by malnutrition, cancer cachexia, pancreatic exocrine insufficiency (PEI), and sarcopenia, all of which adversely affect treatment tolerance, quality of life, and survival. OBJECTIVE: To review the pathophysiology, assessment, and contemporary nutritional management of pancreatic cancer, with a focus on cachexia, PEI, body composition, and personalized nutritional care. METHODS: This narrative review summarizes evidence from clinical guidelines, randomized tri…

The Concept of Biological Resectability in Pancreatic Ductal Adenocarcinoma - An Updated Narrative Review.

Annali italiani di chirurgia · 2026 · PMID 42610296

Resectability in pancreatic ductal adenocarcinoma (PDAC) has traditionally been defined according to tumor-vessel relationship on cross-sectional imaging. However, anatomical criteria alone fail to identify occult systemic disease and do not reliably predict early postoperative recurrence or the likelihood of meaningful oncological benefit from surgery. This structured narrative review evaluated contemporary evidence regarding biological resectability and the emerging role of biomarkers in perioperative decision-ma…

Impact of learning phase on complications and oncological quality in robotic left-sided pancreatectomy: A multicenter international analysis.

Surgery · 2026 · PMID 42361532

BACKGROUND: Robotic left-sided pancreatectomy is increasingly adopted worldwide, yet the impact of the learning curve on clinical and oncological outcomes remains unclear. The Brescia consensus defines the first 21 cases as the competency phase, but real-world validation is limited. We evaluated whether the surgical learning phase influenced major morbidity and oncological quality following robotic left-sided pancreatectomy. METHODS: This multicenter retrospective cohort study included consecutive patients undergoi…

Futility in adenosquamous pancreatic cancer.

World journal of surgical oncology · 2026 · PMID 42157261

BACKGROUND: Adenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive subtype of pancreatic cancer with a dismal prognosis. Futility in ASCP has been inadequately studied. The aim is to assess the incidence of futility in ASCP cases within a European cohort. METHODS: Retrospective, multicenter European study including all consecutive patients who underwent surgery for ASCP between 2010 and 2024. INCLUSION CRITERIA: patients operated for ASCP during the study period. EXCLUSION CRITERIA: patients withou…

Impact of GLP-1 receptor agonists on patients with intraductal papillary mucinous neoplasms: Study protocol for a multicentric cohort study.

PloS one · 2026 · PMID 42715243

AIM OF THE STUDY: Intraductal papillary mucinous neoplasms (IPMNs) are among the most common cystic pancreatic neoplasms, with a potential to progress to malignancy. The increasing prevalence of IPMNs, coupled with the widespread use of GLP-1 receptor agonists (GLP-1 RAs) for diabetes and obesity management, raises concerns about the safety of these medications in patients with preexisting pancreatic conditions. Despite their proven metabolic benefits, questions remain about their impact on pancreatic pathology. Th…

Combined Impact of Neoadjuvant Therapy and Preoperative Cachexia in Patients Undergoing Pancreatoduodenectomy: Is There a "Double Jeopardy"? A National Cohort Study Investigating the Association with Short- and Long-Term Outcomes.

Annals of surgical oncology · 2026 · PMID 41486235

BACKGROUND: Cachexia is associated with worse postoperative outcomes, but the added role of neoadjuvant therapy (NAT) is unclear. This study evaluated whether preoperative cachexia and NAT act as a "double jeopardy" after pancreatoduodenectomy. PATIENTS AND METHODS: A nationwide observational cohort study was conducted using the Norwegian NORGAST registry (2016-2023). Adults undergoing pancreatoduodenectomy for malignancy were included. Cachexia was defined by consensus weight-loss criteria. Modified Poisson and Co…

Reproducibility and Consistency of Methods to Define Hospital-Level Procedural Volume Thresholds for Pancreatectomy.

Journal of surgical oncology · 2026 · PMID 41241876

INTRODUCTION: Procedural volume thresholds (VTs) for hospital quality reporting rely on expert consensus or analytic methods that may produce inconsistent VTs (e.g. restricted cubic splines (RCS), optimal cutpoints, classification and regression trees (CART), stratum specific likelihood ratios (SSLR)). The objective of this study was to compare variation in hospital-level VTs for pancreatectomy across multiple methodologies. METHODS: Patients undergoing pancreatectomy from 2004 to 2021 were identified using the Nat…

Quantitative MRI of pancreatic parenchyma in intraductal papillary mucinous neoplasm: association with risk stratification based on guideline features.

European radiology · 2026 · PMID 42209832

OBJECTIVES: To investigate the association between quantitative MRI parameters of the pancreatic parenchyma and risk stratification of intraductal papillary mucinous neoplasm (IPMN). MATERIALS AND METHODS: This study included 235 participants: 163 with IPMN and 72 with a normal pancreas. IPMN cases were stratified into IPMN without guideline-based features (n = 111) and with guideline-based features (n = 52) groups based on the 2024 International Consensus Guidelines. The MRI parameters analyzed included pancreas-t…

Stakeholder Consensus Selection of Data Elements and Indicators for a Pancreatic Cancer Surgical Outcomes Registry in Australia and Aotearoa New Zealand: Modified Delphi Process.

ANZ journal of surgery · 2026 · PMID 42274276

BACKGROUND: The data elements and indicators in a clinical quality registry (CQR) contribute towards the utility of its output and should be informed by stakeholder input. In Australia and Aotearoa New Zealand (AANZ), there is no CQR for pancreatic cancer surgery. This study aimed to select data elements and registry aims with stakeholder input. METHODS: A three-round modified Delphi consensus process was conducted involving clinicians and consumers. An initial list of data elements was generated through a review o…

Evaluating Tumor Regression and Survival Outcomes in Pancreatic Ductal Adenocarcinoma After Neoadjuvant Treatment according to CAP Grading System: Clinical Usefulness and Limitations.

Annals of surgical oncology · 2025 · PMID 40858953

BACKGROUND: Neoadjuvant treatment (NAT) is increasingly employed for pancreatic ductal adenocarcinoma (PDAC), necessitating reliable methods to assess tumor response. The College of American Pathologists (CAP) grading system is widely used to predict chemo-responsiveness and survival, but consensus on the most effective grading system and treatment regimen remains elusive. PATIENTS AND METHODS: This retrospective study included 462 patients with PDAC who underwent resection after NAT between 2009 and 2023. Survival…

Postoperative recurrence patterns and anatomy-stratified clinical target volume delineation in pancreatic cancer.

Radiation oncology (London, England) · 2026 · PMID 41520105

OBJECTIVES: This study aims to characterize postoperative recurrence patterns and anatomical distribution in patients with pancreatic cancer within the framework of extrapancreatic neural tract anatomy. Based on the observed recurrence sites, we propose stratified clinical target volume (CTV) delineation recommendations for postoperative adjuvant radiotherapy. METHODS: We retrospectively analysed 352 patients who underwent resection for pancreatic adenocarcinoma and recorded the sites of initial postoperative recur…

Molecular Subtype Identification and Prognostic Prediction of Pancreatic Cancer Based on m6A/m5C/m1A-Related Genes.

Journal of cellular and molecular medicine · 2026 · PMID 42366608

Pancreatic cancer, characterized by an unfavourable prognosis, necessitates early diagnosis and prompt therapeutic intervention. This study aimed to delineate the functional implications of m6A/m1A/m5C-related genes in pancreatic carcinogenesis and establish a prognostic model. Utilizing data from the TCGA-PAAD cohort (n=178) combined with GTEx normal pancreatic tissues (n=332), we identified 43 genes associated with m6A/m1A/m5C methylation pathways. Significant expression differences in these genes were observed b…

A Generalizable and Interpretable Framework for Molecular Subtype Classification of Pancreatic Ductal Adenocarcinoma Integrating Conformal Uncertainty Quantification and Consensus-Based Explainable Artificial Intelligence Across Multiple Cohorts.

International journal of molecular sciences · 2026 · PMID 42589641

Pancreatic ductal adenocarcinoma (PDAC) has two principal molecular subtypes-classical and basal-like-with divergent prognosis and chemotherapy response, yet transcriptomic classifiers rarely generalize across cohorts or quantify per-patient uncertainty. We trained a classical-versus-basal-like classifier on CPTAC-PDAC (n = 140) and externally validated it on histology-filtered TCGA-PAAD (n = 150). Twelve algorithms were benchmarked under stratified nested cross-validation with four-method consensus feature selecti…

Testing remote feedback using a virtual semi-automated educational tool for the detection of pancreatic tumour-vessel contact on staging CT.

Current problems in diagnostic radiology · 2026 · PMID 41162206

PURPOSE: Assessing tumour-vessel contact in pancreatic adenocarcinoma on CT is challenging for trainees and time-intensive for educators. Semi-automating feedback on this task may optimize radiologist time and standardize resident education. We hypothesized that residents who reviewed expert annotations of tumour-vessel contact would outperform those without feedback on an independent test set. METHODS: We retrospectively reviewed pre-operative staging CTs from 60 patients who underwent upfront surgical resection f…

Site-specific limitations of ctDNA in PDAC surveillance: imaging detects pulmonary and local recurrence missed by liquid biopsy.

Abdominal radiology (New York) · 2026 · PMID 41860708

OBJECTIVES: To evaluate the concordance between circulating tumor DNA (ctDNA) and imaging in the postoperative surveillance of patients with resected pancreatic ductal adenocarcinoma (PDAC). METHODS: This single-center, retrospective study included 50 patients with resected PDAC who underwent both ctDNA testing and surveillance imaging between January 2015 and February 2025. Imaging included CT or CT/MRI of the chest, abdomen, and pelvis at 3-6 month intervals, with ctDNA testing performed on a similar schedule. Tw…

Beyond predictive performance: A systematic review and critical methodological appraisal of AI/ML and conventional modelling strategies in breast, colorectal, and pancreatic Cancer.

Artificial intelligence in medicine · 2026 · PMID 42641254

BACKGROUND: Predictive modelling for cancer risk, treatment-related complications, and survival is central to precision oncology. Conventional logistic regression (LR) and Cox proportional hazards (CoxPH) regression remain widely used but are limited when modelling nonlinear interactions, high-dimensional imaging features, and multimodal clinical-metabolic predictors. Artificial intelligence (AI) and machine learning (ML) methods offer expanded capability through automated feature extraction, ensemble learning, and…

Prognostic and predictive values of transcriptomic signatures in metastatic pancreatic cancer: A biomarker analysis of three French multicenter prospective randomized controlled phase 2 trials (Prodige35, Prodige37 and AFUGEM).

Cancer letters · 2026 · PMID 42521075

To evaluate the clinical applicability of previously established transcriptomic signatures (molecular subtypes, components and GemPred status) in metastatic pancreatic cancer, we conducted a retrospective pooled analysis of 178 patients from three phase 2 trials (PRODIGE35/37, AFUGEM; 2013-2016) testing first-line regimens (FOLFIRINOX, GemNab, FuNab, FOLFIRI3). RNA sequencing was performed on primary/metastatic tumors across French centers, with blinded assessment of subtypes (immune classical, pure basal-like, str…

Endoscopic Ultrasound-Guided Franseen Fine-Needle Biopsy for Solid Pancreatic Lesions: A Systematic Review and Meta-Analysis.

Digestive diseases and sciences · 2026 · PMID 42156629

INTRODUCTION: Accurate tissue acquisition (TA) of solid pancreatic lesions is essential for guiding treatment with endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) being the preferred method. Among FNB designs, the three-pronged Franseen-tip needle demonstrates strong diagnostic performance, though direct head-to-head comparisons with other FNB designs remain limited. METHODOLOGY: This meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251123856). Eligible studies enrolled pa…

Vertical distribution of accessory canals in different tooth types: A systematic review and meta-analysis.

Journal of dentistry · 2026 · PMID 42492648

OBJECTIVE: To systematically analyze the vertical distribution of accessory canals and propose potential root-end resection levels in different tooth types. DATA: Proportional distribution of accessory canals (PD-AC) in 1 mm intervals, cumulative proportions within 2 mm and 3 mm (CP-AC0-2 and CP-AC0-3), mean distance from accessory foramen to root apex or main foramen (MD-AF), and prevalence of accessory canals in 2D cross-sections (PR-AC-2D). SOURCES: A systematic search of electronic databases was conducted throu…

CT-derived body composition predicts futile upfront resection in pancreatic cancer: a multicenter study.

European radiology · 2026 · PMID 42209831

PURPOSE: To evaluate the utility of CT-derived body composition in predicting futile pancreatectomy and to develop a risk-stratification model for patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS: Patients with anatomically resectable PDAC who underwent upfront pancreatectomy between March 2015 and November 2024 at three institutions were retrospectively included. Futile pancreatectomy was defined as death or recurrence within 6 months postoperatively. Body composition metrics were deriv…

Immune Markers and Risk of Pancreatic Cancer in the European EPIC Cohort.

International journal of cancer · 2026 · PMID 42334072

The immune system is a major driver in pancreatic cancer development. Several prospective cohort studies have found associations for single immune system-derived proteins such as IL6 or CRP, but results are inconclusive, and Omics-based research is scarce. Hence, we aimed to investigate associations of a comprehensive protein panel with the risk of pancreatic cancer. Within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, 92 immune proteins were measured in baseline blood samples of 4…

Anthropometric traits, metabolic biomarkers, and pancreatic cancer risk: a causal mediation analysis in UK Biobank.

British journal of cancer · 2026 · PMID 42436322

BACKGROUND: Obesity is a risk factor for pancreatic cancer, but mechanisms remain unclear. We investigated how anthropometric traits, individually and combined, relate to pancreatic cancer risk and whether associations are mediated by metabolic biomarkers. METHODS: We analysed 462,300 adults (40-69 years) in the UK Biobank. Principal component analysis derived three body shape phenotypes combining body mass index (BMI), height, weight, waist and hip circumference, and waist-to-hip ratio (WHR). Mediation was assesse…

Quantitative MRI of pancreatic parenchyma in intraductal papillary mucinous neoplasm: association with risk stratification based on guideline features.

European radiology · 2026 · PMID 42209832

OBJECTIVES: To investigate the association between quantitative MRI parameters of the pancreatic parenchyma and risk stratification of intraductal papillary mucinous neoplasm (IPMN). MATERIALS AND METHODS: This study included 235 participants: 163 with IPMN and 72 with a normal pancreas. IPMN cases were stratified into IPMN without guideline-based features (n = 111) and with guideline-based features (n = 52) groups based on the 2024 International Consensus Guidelines. The MRI parameters analyzed included pancreas-t…

Investigation of CRP and NLR as potential biomarkers for redefining biological borderline resectable pancreatic cancer.

Oncology letters · 2026 · PMID 42577659

Anatomically resectable pancreatic cancer with markedly elevated carbohydrate antigen 19-9 (CA19-9) levels has recently been recognized as a biologically borderline resectable (BR-B) disease due its poor prognosis. The present study evaluated whether C-reactive protein (CRP) levels and the neutrophil-to-lymphocyte ratio (NLR) could further refine preoperative prognostic stratification. Data from 154 patients with resectable (R) and BR-B pancreatic cancer who underwent resection with curative intent between March 20…

Machine learning-enabled multi-omics discovery of prognostic biomarkers and signaling targets in pancreatic cancer.

Computational biology and chemistry · 2026 · PMID 42617351

Pancreatic ductal adenocarcinoma (PDAC) remains difficult to subtype using single omics layers. We conducted an exploratory investigation integrating reverse-phase protein array (RPPA) and DNA methylation data from the cancer genome atlas (TCGA)- pancreatic adenocarcinoma (PAAD) to assess the feasibility of multi-omics subtyping, alongside a supervised machine learning analysis of a small gene expression omnibus (GEO) transcriptomic cohort (n = 26) to identify candidate diagnostic genes. RPPA-based K-means clusteri…

Percutaneous abdominal lavage cytology screening reduces non-therapeutic laparotomy in patients with pancreatic cancer considered for curative-intent resection: A single-institutional retrospective study.

Surgery · 2026 · PMID 42551279

BACKGROUND: Assessing peritoneal cytology status is essential for determining the optimal treatment strategy in patients with pancreatic cancer. This study aimed to evaluate the safety and technical feasibility of percutaneous abdominal lavage cytology screening and its clinical utility in identifying patients unlikely to benefit from resection, thereby reducing nontherapeutic laparotomy. METHODS: We retrospectively analyzed 225 consecutive patients with pancreatic cancer referred for potential curative-intent rese…

S100A6 expression in resected specimens predicts lymph node metastasis in small pancreatic ductal adenocarcinoma: A retrospective cohort study.

Surgery · 2026 · PMID 42480494

BACKGROUND: Lymph node metastasis is a major prognostic determinant in patients with pancreatic ductal adenocarcinoma. Accurate preoperative prediction of lymph node metastasis remains challenging, particularly in small pancreatic ductal adenocarcinoma. METHODS: We retrospectively analyzed 227 patients with pancreatic ductal adenocarcinoma who underwent upfront resection at a single center (2012-2021). Small pancreatic ductal adenocarcinoma was defined as a pathologically confirmed tumor ≤20 mm. Clinicopathologic f…

Super-resolution deep learning-enhanced 2D MRCP improves main pancreatic duct visualization compared with 3D MRCP.

European journal of radiology · 2026 · PMID 42320143

PURPOSE: The relative merits of 2D and 3D MRCP remain incompletely defined, and the effect of super-resolution deep learning reconstruction (SR-DLR) on main pancreatic duct (MPD) visualization remains unclear. We compared image quality and MPD visualization among 3D MRCP with SR-DLR (3D-SR), conventional 2D MRCP with compressed sensing (2D-CS), and 2D MRCP with SR-DLR (2D-SR), and exploratorily assessed diagnostic performance for MPD abnormalities. MATERIALS AND METHODS: This prospective study included 174 patients…

Grading and detecting gastroenteropancreatic neuroendocrine neoplasms with dual-tracer ( 18 F-AlF-NOTA-octreotide/ 18 F-FDG) PET/CT: a metabolic parameter-based study.

Nuclear medicine communications · 2026 · PMID 42231766

OBJECTIVE: To evaluate quantitative metabolic indices from dual-tracer 18 F-AlF-NOTA-octreotide ( 18 F-AlF-OC) and 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) for grading gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), focusing on total lesion glycolysis ratio (TLGR). METHODS: This retrospective study included 34 patients with GEP-NENs (198 target lesions) who underwent both 18 F-AlF-OC and 18 F-FDG PET/CT. Parameters included maximum standardized uptake value (SUV max ), total lesion gly…

Pretherapeutic radiological sarcopenia in pancreatic ductal adenocarcinoma: a narrative review.

Future science OA · 2026 · PMID 42720063

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest solid malignancies despite advances in surgery, perioperative care, and systemic therapies. Pretherapeutic radiological sarcopenia has emerged as a clinically relevant body-composition phenotype associated with poor outcomes in oncology. This imaging-based concept differs from contemporary geriatric definitions of sarcopenia, which require impaired muscle strength and incorporate low muscle quantity and/or quality. This narrative review critically…

Outcomes of Irreversible Electroporation for Treatment of Refractory Locally Advanced Pancreatic Cancer.

Journal of vascular and interventional radiology : JVIR · 2026 · PMID 42425450

PURPOSE: To evaluate the safety and effectiveness of irreversible electroporation (IRE) as salvage therapy for locally advanced pancreatic cancer (LAPC). MATERIALS AND METHODS: A retrospective cohort study was conducted of IRE performed by interventional radiologists or hepatopancreaticobiliary surgeons at a tertiary care institution for salvage treatment of LAPC. Procedures were performed between 2010 and 2024; 30 subjects (men, 18; women, 12; median age, 63.5 years) with biopsy-proven adenocarcinoma, evidence of …

Report Supervision.

Medical image analysis · 2026 · PMID 42664661

Segmentation models can surpass radiologists, classification models, and vision-language models in tumor detection. Furthermore, segmentation models outline tumors, allowing radiologists to better verify and trust the AI output. However, their main limitation is the scarcity of tumor masks: creating one 3D tumor mask takes up to 30 min, so most public CT datasets contain only a few hundred masks, and even the largest private datasets contain only a couple of thousand. Tumor masks are not produced in clinical routin…

Unraveling the roles of DKK1 and S100P in pancreatic ductal adenocarcinoma: Insights from machine learning, single-cell/spatial transcriptomics, and functional validation.

Translational oncology · 2026 · PMID 42537428

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with a 5-year survival rate of only 13%. Despite recent advances in diagnosis and treatment, the prognosis of PDAC remains poor, largely owing to its complex tumor microenvironment, epithelial heterogeneity, and therapeutic resistance. In this study, we integrated bulk transcriptomic datasets, single-cell RNA sequencing (scRNA-seq), spatial transcriptomics (ST), machine learning analysis, and functional validation to investigate candidate bio…

Histology-derived prediction of a stromal remodeling program in pancreatic ductal adenocarcinoma with transcriptomic and spatial validation.

Translational oncology · 2026 · PMID 42526385

OBJECTIVE: To develop and validate a histology-based model for predicting a stromal stiffness-related molecular surrogate in pancreatic ductal adenocarcinoma (PDAC) and to assess its spatial biological plausibility. METHODS: A stromal stiffness score was defined from COL12A1, LOX, and LOXL2 expression. Candidate genes were derived from two independent PDAC chemotherapy-response studies, refined by Cox-LASSO regularization, and filtered using survival analysis in the TCGA-PAAD cohort. StRoMA, an encoder-decoder Tran…

Pancreatic Cancer Early Detection Biomarkers for High-Risk Individuals: Insights From the PRECEDE Consortium.

International journal of cancer · 2026 · PMID 42298760

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest cancers due to its asymptomatic progression, late-stage diagnosis, and treatment resistance. Efforts in early detection have centered on identifying imaging features and liquid biopsy biomarkers capable of detecting PDAC and its high-grade precursors before clinical symptoms arise in patients at elevated risk of PDAC development. Classical imaging-based surveillance strategies, aligned with current guidelines, form the foundation of screening high…

New-onset diabetes mellitus after pancreatectomy: A scoping review.

Primary care diabetes · 2026 · PMID 42532769

This scoping review investigated the incidence and risk factors of new-onset diabetes mellitus (NODM) after pancreatectomy. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science (2014-2025) identified 14 relevant articles. Results showed NODM incidence of 25% at 1 year, 35% at 2 years, and 39% at 3 years postoperatively. Key risk factors included prediabetic conditions (n = 7), aberrant metabolic parameters (n = 6), age (n = 4), postoperative pancreatic volume (n = 4), and type of surgery (n =…

Single-cell and spatial transcriptomics uncover a THBS2⁺ CAF-KRT17⁺ malignant cell axis drives progression and immunotherapy resistance in pancreatic cancer.

Translational oncology · 2026 · PMID 42520475

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) features a fibrotic stroma dominated by cancer-associated fibroblasts (CAFs), yet the functional heterogeneity of CAFs and their crosstalk with malignant cells in metastasis and immune evasion remain unclear. METHODS: We performed an integrated analysis of single‑cell RNA‑seq data and spatial transcriptomics of PDAC. Pseudotime trajectory reconstruction, regulon activity inference, and ligand-receptor interaction mapping were applied to dissect fibroblast heteroge…

In Silico identification of natural and synthetic inhibitors targeting KRAS mutants (G12D, G12V, and G12C) and wild-type in pancreatic cancer.

Journal of molecular graphics & modelling · 2026 · PMID 42398486

Pancreatic cancer is a highly aggressive malignancy with poor prognosis, largely driven by oncogenic KRAS mutations. Among these, codon 12 substitutions such as G12D and G12V are the most prevalent and contribute to sustained activation of proliferative and survival signaling pathways. In this study, an integrated in silico approach was employed to identify potential inhibitors targeting wild-type and mutant KRAS variants (G12D, G12V, and G12C). Virtual screening, molecular docking, molecular dynamics (MD) simulati…

Systemic therapies for gastroenteropancreatic neuroendocrine carcinomas: Current paradigm and future avenues.

European journal of cancer (Oxford, England : 1990) · 2026 · PMID 42641422

Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are aggressive, poorly differentiated neoplasms representing the most common subtype of extra-pulmonary neuroendocrine carcinomas. Despite increasing recognition, they remain biologically and therapeutically elusive, with limited understanding of their molecular drivers and few established treatment paradigms. Most patients present with advanced disease, making systemic therapy the cornerstone of management. Platinum-based chemotherapy remains the standard …

Disease Burden of Early-Onset Pancreatic Cancer in Adults Aged 20-54 Years in Low- and Middle-Income Countries: A GBD 2023 Analysis.

Digestive diseases and sciences · 2026 · PMID 42360575

BACKGROUND: Pancreatic cancer incidence rises in low- and middle-income countries (LMICs), yet data on early-onset disease (20-54 years) are scarce. METHODS: Using Global Burden of Disease Study 2023 data (1990-2023), we analyzed incidence, mortality, and disability-adjusted life years (DALYs) for early-onset pancreatic cancer in LMIC adults. Trends were assessed via estimated annual percentage change (EAPC), stratified by World Bank income groups. Decomposition analysis quantified epidemiological/demographic drive…

Beyond predictive performance: A systematic review and critical methodological appraisal of AI/ML and conventional modelling strategies in breast, colorectal, and pancreatic Cancer.

Artificial intelligence in medicine · 2026 · PMID 42641254

BACKGROUND: Predictive modelling for cancer risk, treatment-related complications, and survival is central to precision oncology. Conventional logistic regression (LR) and Cox proportional hazards (CoxPH) regression remain widely used but are limited when modelling nonlinear interactions, high-dimensional imaging features, and multimodal clinical-metabolic predictors. Artificial intelligence (AI) and machine learning (ML) methods offer expanded capability through automated feature extraction, ensemble learning, and…

UGT1A1 genotype testing for irinotecan: A guideline developed by the UK Centre of Excellence in Regulatory Science and Innovation in Pharmacogenomics (CERSI-PGx).

British journal of clinical pharmacology · 2026 · PMID 42389808

Irinotecan, a topoisomerase I inhibitor, is available as both non-pegylated and pegylated formulations. The non-pegylated formulation is licensed for use in advanced colorectal cancer either in combination with other agents or as monotherapy. However, it is also used off-label across a range of gastrointestinal malignancies and in rare malignancies such as glioblastoma and sarcomas. The pegylated formulation is licensed for use as combination therapy in adult patients with metastatic pancreatic adenocarcinoma. Irin…

Early onset pancreatic Cancer: epidemiology, molecular features, and clinical outcomes.

Cancer treatment reviews · 2026 · PMID 42341370

Background Early onset pancreatic cancer (EOPC), defined for the primary analysis as pancreatic ductal adenocarcinoma (PDAC) diagnosed before the age of 50 years, is an increasingly recognised clinical and epidemiological entity. Because published studies use heterogeneous age thresholds, the present review prespecified <50 years as the main definition and interpreted studies using other cutoffs in sensitivity or narrative analyses. Methods We systematically searched PubMed, EMBASE, and the Cochrane Library for stu…

Prognostic utility of the Charlson comorbidity index in pancreatic cancer: a systematic review and meta‑analysis.

World journal of surgical oncology · 2026 · PMID 42625189

OBJECTIVE: The prognosis of pancreatic cancer is extremely poor, and patients frequently present with multiple comorbidities. The Charlson Comorbidity Index (CCI) and its age-adjusted version (CACI) are widely used to quantify the burden of comorbidity. This systematic review and meta-analysis aimed to evaluate the association between CCI/CACI and survival outcomes in patients with pancreatic cancer. METHODS: We systematically searched the Cochrane Library, Embase, PubMed, and Web of Science for relevant literature…

Glucagon-like Peptide-1 receptor agonists are not associated with increased risk of pancreatic cancer: A systematic review and meta-analysis.

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026 · PMID 41991368

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for glucose control and weight management. Concerns have arisen regarding a potential association with pancreatic ductal adenocarcinoma (PDAC), though evidence remains conflicting. We performed a systematic review and meta-analysis to evaluate PDAC risk in GLP-1 RA users. METHODS: We included studies with ≥24 weeks of follow-up assessing PDAC incidence in patients treated with GLP-1 RAs. Eligible studies included adults with typ…

Association of dietary intake and serum levels of unsaturated fatty acids and risk of pancreatic cancer: A GRADE-assessed systematic review and dose-response meta-analysis of prospective cohort studies.

Cancer epidemiology · 2026 · PMID 42235418

Lifestyle and dietary factors contribute to about one-third of cancer deaths. The fatty acid composition in diets may be related to pancreatic cancer. A prior meta-analysis examining the connection between mono- and polyunsaturated fatty acid intake and pancreatic cancer risk has not investigated the dose-response relationship. This systematic review and dose-response meta-analysis aims to explore the association between dietary intake and serum levels of unsaturated fatty acids and the risk of pancreatic cancer in…

pRECIST: Guidelines for Response Criteria for Use in Trials Testing Therapeutics in Pancreatic Cancer.

Pancreas · 2026 · PMID 41941588

IMPORTANCE: Pancreatic tumor response to treatment remains challenging and varies greatly. In order to establish a standardized approach to measuring and evaluating pancreatic tumor metabolic activity (MA), a consensus guideline called Pancreatic RECIST (pRECIST) was developed. This guideline is based on modified Response Evaluation Criteria in Solid Tumors (RECIST version 1.1), incorporating concurrent CT/PET scan quantitative assessments. OBJECTIVE: The aims were to ensure consistent design, data collection, and …

Association of multidisciplinary team management with clinical outcomes in hepatobiliary and pancreatic malignancies: A systematic review and meta-analysis.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026 · PMID 42314305

BACKGROUND: Multidisciplinary team (MDT) management is widely endorsed for complex hepatobiliary and pancreatic (HBP) malignancies. However, robust systematic evidence evaluating its survival benefits and heterogeneity across distinct anatomical sites remains limited. METHODS: Our study systematically searched four databases from their inception through Dec 17, 2025, for studies comparing MDT versus non-MDT care in HBP malignancies. The primary outcome was overall survival or mortality risk. Secondary outcomes incl…

Impact of postoperative pancreatic fistula (POPF) on long-term outcomes of patients who underwent pancreatic cancer resection: systematic review and meta-analysis.

Surgical oncology · 2026 · PMID 42242032

INTRODUCTION: Postoperative pancreatic fistula (POPF) is a major complication resulting from pancreatic resection. The long-term oncological outcomes of patients who experience POPF after pancreatic cancer resection remain inconclusive. The purpose of this study was to evaluate the impact of POPF on the long-term survival of patients undergoing pancreatic cancer resection. METHODS: A systematic review and meta-analysis were performed for studies comparing survival outcomes in patients with or without POPF following…

Robotic pancreaticoduodenectomy with venous resection and reconstruction: a systematic review of perioperative, vascular, oncological and survival outcomes.

Journal of robotic surgery · 2026 · PMID 42474838

Robotic pancreaticoduodenectomy with venous resection and reconstruction (RPD-VR) is one of the most technically challenging procedures in hepatopancreaticobiliary surgery. While acceptance of robotic pancreaticoduodenectomy is growing, the safety, feasibility, and oncologic adequacy of combined portal vein (PV) and/or superior mesenteric vein (SMV) resection remain incompletely defined. A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, Scopus and the Cochrane Library were searched from…

Incidence and Determinants of Steatotic Liver Disease after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis.

Journal of hepato-biliary-pancreatic sciences · 2026 · PMID 41879125

BACKGROUND: Steatotic liver disease (SLD) is an unrecognized complication after pancreaticoduodenectomy (PD) and may affect nutrition and long-term recovery. This meta-analysis estimated the incidence of SLD after PD and identified its clinical and surgical risk factors. METHODS: MEDLINE and EMBASE were searched through March 2025 for studies reporting incident SLD after PD. Random-effects models generated pooled incidence and risk estimates. Subgroup, meta-regression, and sensitivity analyses assessed heterogeneit…

Prognostic and predictive values of transcriptomic signatures in metastatic pancreatic cancer: A biomarker analysis of three French multicenter prospective randomized controlled phase 2 trials (Prodige35, Prodige37 and AFUGEM).

Cancer letters · 2026 · PMID 42521075

To evaluate the clinical applicability of previously established transcriptomic signatures (molecular subtypes, components and GemPred status) in metastatic pancreatic cancer, we conducted a retrospective pooled analysis of 178 patients from three phase 2 trials (PRODIGE35/37, AFUGEM; 2013-2016) testing first-line regimens (FOLFIRINOX, GemNab, FuNab, FOLFIRI3). RNA sequencing was performed on primary/metastatic tumors across French centers, with blinded assessment of subtypes (immune classical, pure basal-like, str…

Implications and risk of new versus persisting intraductal papillary mucinous neoplasms after pancreatic surgery: meta-analysis.

BJS open · 2026 · PMID 42441942

BACKGROUND: Interpretation of recurrence following resection of intraductal papillary mucinous neoplasms (IPMNs) is hindered by inconsistent terminology and outcome reporting. A distinction between metachronous/de novo IPMN development, progression of residual disease, and true recurrence of invasive entities is rarely considered. METHODS: A systematic review and meta-analysis were conducted following PRISMA and Cochrane guidelines (PROSPERO-ID: 1009399). The primary endpoint was postoperative recurrence of non-inv…

Splenic hilum nodal involvement in resected left-sided pancreatic cancer: meta-analysis.

BJS open · 2026 · PMID 42725583

BACKGROUND: Splenectomy is standard of care during left pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) to obtain adequate lymphadenectomy. However, evidence supporting this approach is lacking. Splenic preservation would reduce short-term morbidity and is essential for emerging oncological adjunctive therapies, including immunotherapy and personalized cancer vaccines. This study reviewed the incidence of splenic hilum nodal involvement (SHNI) in left-sided PDAC. METHODS: A systematic review of the PubMe…

Impact of prior conventional irinotecan use on nanoliposomal irinotecan efficacy in advanced pancreatic cancer: a meta-analysis.

ESMO open · 2026 · PMID 42462278

BACKGROUND: Nanoliposomal irinotecan (nal-IRI) has become an established therapy for advanced pancreatic ductal adenocarcinoma (PDAC), both in the post-gemcitabine setting and, more recently, in the first-line NALIRIFOX regimen. Concerns remain regarding cross-resistance in patients previously exposed to conventional irinotecan. We performed a systematic review and meta-analysis to evaluate the impact of prior irinotecan exposure on outcomes with nal-IRI. MATERIALS AND METHODS: We conducted a systematic literature …

Prognostic value of albumin-bilirubin grade in patients with pancreatic cancer: A systematic review and meta-analysis.

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026 · PMID 41795748

BACKGROUND: With a five-year survival rate near 10%, pancreatic cancer is among the cancers with poor survival. Understanding the prognostic factors provides clinical insights for better decision-making. This meta-analysis aims to assess the prognostic value of the albumin-bilirubin (ALBI) grade in patients with pancreatic cancer. METHOD: A comprehensive search using "pancreatic cancer" and "ALBI grade" as keywords was conducted on the PubMed, Web of Science, Embase and Scopus until August 14, 2025. Studies investi…

Systematic Review and Pooled Analysis of 1,021 Children With Pancreatic Tumors.

The Journal of surgical research · 2026 · PMID 42335633

INTRODUCTION: Although relatively rare, pediatric pancreatic tumors have been increasingly reported in the literature. Our aim was to systematically review the literature on the clinical characteristics, management, and outcomes of pediatric pancreatic tumors. METHODS: We performed a systematic review of the MEDLINE, Scopus, Web of Science, and Cochrane Library databases (end-of-search date: June 2022) according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. RESULTS: Sixty-four…

Sampling performance of EUS-Guided fine-needle biopsy in pancreatic neuroendocrine tumors: A systematic review and meta-analysis.

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026 · PMID 42509099

BACKGROUND/OBJECTIVES: Pancreatic neuroendocrine tumors (PNETs) account for a growing proportion of pancreatic lesions. Adequate tissue acquisition is essential for accurate diagnosis, tumor grading, and treatment planning. Fine-needle biopsy (FNB) has emerged as a promising alternative to fine-needle aspiration (FNA) for obtaining diagnostic samples. METHODS: We conducted a systematic review and meta-analysis of clinical trials and cohort studies evaluating the sampling performance of FNB in patients with suspecte…

Beyond body surface area: CT-derived body composition as a predictor of chemotherapy toxicity and survival in pancreatic ductal adenocarcinoma: a systematic review.

Cancer treatment reviews · 2026 · PMID 42361440

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is characterised by a high prevalence of severe muscle wasting (sarcopenia) and fatty muscle infiltration (myosteatosis), yet chemotherapy dosing still relies on body surface area (BSA), a metric that does not reflect individual patients' lean body mass (LBM) or muscle quality. A growing body of evidence from oncology meta-analyses demonstrates that low skeletal muscle mass (sarcopenia) independently predicts chemotherapy toxicity across multiple cancer types, and…

Advancing precision immunotherapy in advanced pancreatic cancer: a systematic review and meta-analysis of first-line ICI-based combinations.

Frontiers in immunology · 2026 · PMID 42500667

OBJECTIVE: Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis. Immune checkpoint inhibitor (ICI) monotherapy has shown limited efficacy in PDAC, whereas the potential clinical value of first-line ICI-based combination regimens remains unclear. Through a systematic review and meta-analysis, this study aimed to evaluate the efficacy and safety of first-line ICI-based combination regimens in advanced PDAC. METHODS: PubMed, Embase, The Cochrane Library, Scopus, Web of Science, CNKI, Wanfang Data, V…

Reverse-Bevel (ProCore) EUS-Guided Fine-Needle Biopsy for Solid Pancreatic Mass Lesions: a GRADE-Assessed Systematic Review and Meta-Analysis of Prospective Randomized Trials.

Journal of gastrointestinal cancer · 2026 · PMID 42406286

BACKGROUND AND AIMS: Endoscopic ultrasound-guided tissue acquisition is used to diagnose pancreatic mass lesions, but optimal needle selection remains uncertain. Reverse bevel ProCore fine needle biopsy (FNB) needles aim to enhance histologic procurement and reduce sampling burden; randomized evidence versus standard fine needle aspiration (FNA) is limited. We synthesized randomized trials to compare diagnostic performance, efficiency, and safety. METHODS: We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, Sco…

Feasibility, efficacy and safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC) for hepatobiliary and pancreatic cancers with peritoneal metastases: A systematic review.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026 · PMID 42430883

BACKGROUND: Hepato-pancreato-biliary (HPB) cancers frequently develop peritoneal metastases, signalling a poor prognosis and severely limiting the efficacy of systemic treatments. This review evaluates the feasibility, efficacy, and safety of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for these malignancies. METHODS: We conducted a systematic review in accordance with the PRISMA guidelines. A comprehensive, structured search strategy was applied to PubMed, Scopus, and Web of Science to identify eligib…

The outcomes of surgical resection versus ablation of liver metastases from neuroendocrine tumors: A systematic review.

Hepatobiliary & pancreatic diseases international : HBPD INT · 2026 · PMID 42177126

BACKGROUND: Neuroendocrine liver metastases (NLMs) from gastroenteropancreatic neuroendocrine tumors (GEP-NETs) significantly impact morbidity and mortality. While surgical resection remains the standard treatment, radiofrequency ablation (RFA) has emerged as an alternative for unresectable cases. This systematic review compared the oncological outcomes of surgical resection and RFA. DATA SOURCES: A systematic search of PubMed, Web of Science, and Scopus identified studies published between 2014 and 2025. Eligible …

Defining textbook outcome for distal pancreatectomy by systematic review. Is it clinically relevant?

Surgery · 2026 · PMID 42134067

BACKGROUND: A textbook outcome is a composite score of individual metrics that report an ideal outcome for a given surgery. The objectives of this study were to develop and validate a textbook outcome definition for distal pancreatectomy. METHODS: PubMed, Embase, and Web of Science databases were searched until October 1, 2024 for this systematic review, and studies that evaluated textbook outcome for distal pancreatectomy were selected. Textbook outcome metrics were chosen by data strength and validated by reviewi…

Pancreatic acinar cell cystadenoma: single-center experiences and a systematic review.

Scandinavian journal of gastroenterology · 2026 · PMID 42067962

AIMS: Pancreatic cystic lesions (PCLs) range from benign to malignant, creating diagnostic and therapeutic challenges. While most PCLs are serous or mucinous neoplasms, rare entities such as acinar cell cystadenoma (ACC) remain poorly characterized. This study reports a tertiary center cohort and a systematic literature review. METHODS: We retrospectively analyzed 23 ACC patients at Karolinska University Hospital. A systematic review was performed following PRISMA guidelines. RESULTS: In our cohort (median age 67.0…

Comparative diagnostic performance of endoscopic ultrasound, MRI, and CT for preoperative assessment of pancreatic cancer: a Bayesian network meta-analysis under a graded reference standard.

BMC medical imaging · 2026 · PMID 41680701

OBJECTIVE: Within the framework of a graded reference standard, this study systematically compared the diagnostic performance and certainty of evidence of multiple preoperative imaging modalities—including endoscopic ultrasound, magnetic resonance imaging, and computed tomography—for pancreatic cancer. Based on these findings, a relative ranking of diagnostic effectiveness was established to provide evidence-based guidance for optimizing clinical diagnostic pathways. METHODS: A systematic search was performed in Pu…

REDISCOVER guidelines for borderline-resectable and locally advanced pancreatic cancer: management algorithm, unanswered questions, and future perspectives.

Updates in surgery · 2024 · PMID 38684573

The REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication for resection. Condensed herein, they provide a practical management algorithm for clinical practice. However, the guidelines also highlight the need to redefine LA-PDAC …

Statins and the risk of pancreatic cancer: A systematic review and meta-analysis of 2,797,186 patients.

Cardiology journal · 2024 · PMID 35373328

BACKGROUND: Statin use in many studies is related to the improvement of a patients' condition including reducing the risk of various malignancies. Herein, is a systematic review and meta-analysis to examine the evidence on the association between statin therapy and the risk of the occurrence of pancreatic cancer, mainly in terms of decreased risk of developing pancreatic cancer among patients using statin therapy in the long-term perspective. METHODS: PubMed, Web of Science, Scopus and Cochrane Central Register of …

Early onset pancreatic Cancer: epidemiology, molecular features, and clinical outcomes.

Cancer treatment reviews · 2026 · PMID 42341370

Background Early onset pancreatic cancer (EOPC), defined for the primary analysis as pancreatic ductal adenocarcinoma (PDAC) diagnosed before the age of 50 years, is an increasingly recognised clinical and epidemiological entity. Because published studies use heterogeneous age thresholds, the present review prespecified <50 years as the main definition and interpreted studies using other cutoffs in sensitivity or narrative analyses. Methods We systematically searched PubMed, EMBASE, and the Cochrane Library for stu…

Association of dietary intake and serum levels of unsaturated fatty acids and risk of pancreatic cancer: A GRADE-assessed systematic review and dose-response meta-analysis of prospective cohort studies.

Cancer epidemiology · 2026 · PMID 42235418

Lifestyle and dietary factors contribute to about one-third of cancer deaths. The fatty acid composition in diets may be related to pancreatic cancer. A prior meta-analysis examining the connection between mono- and polyunsaturated fatty acid intake and pancreatic cancer risk has not investigated the dose-response relationship. This systematic review and dose-response meta-analysis aims to explore the association between dietary intake and serum levels of unsaturated fatty acids and the risk of pancreatic cancer in…

One out of four patients with pancreatic cancer experience psychological symptoms: A systematic review and meta-analysis.

PloS one · 2026 · PMID 42201880

The death rate from pancreatic cancer is one of the highest of all cancers, with increasing incidence every year over the past decades. As the prognosis remains extremely poor, this trend brings not only a growing clinical challenge, but also a significant psychological toll for patients. In comparison to other types of cancer, our understanding of the psychological burden of such a deadly disease is still limited. Recognizing and addressing the psychological aspects of pancreatic cancer are crucial for comprehensi…

Evaluating the Rates of Pancreatitis and Pancreatic Cancer Among GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Endocrinology, diabetes & metabolism · 2025 · PMID 40988099

AIMS: This meta-analysis evaluates the rates of pancreatitis/pancreatic cancer among glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in randomised controlled trials (RCTs). METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a systematic search was performed in PubMed, Embase, and Cochrane Library for GLP-1 RA RCTs that evaluated pancreatitis/pancreatic cancer. A meta-analysis was conducted to evaluate this risk; subgroup analysis was performed with and without …

Pancreatic Cancer in Celiac Disease Patients-A Systematic Review and Meta-Analysis.

International journal of environmental research and public health · 2023 · PMID 36674320

Background: Celiac disease (CD) is an autoimmune enteropathy affecting approximately 1% of the population and is associated with an increased risk of enteropathy-associated T-cell lymphoma and small bowel adenocarcinoma, whereas the association between CD and other malignancies is unclear. Since pancreatic cancer (PC) remains one of the most lethal neoplasms and its incidence is increasing despite numerous ongoing research on diagnostic biomarkers and novel therapies, we aimed to investigate whether CD has an impac…

Prognostic value of peripheral blood fibrinogen-to-albumin ratio in pancreatic cancer patients: a systematic review and meta-analysis.

BMC cancer · 2026 · PMID 41796295

BACKGROUND: Pancreatic cancer (PC) is a highly lethal malignancy with poor prognosis, largely due to late diagnosis and limited therapeutic efficacy. Identifying accessible and reliable prognostic biomarkers is essential for individualized patient management. The fibrinogen-to-albumin ratio (FAR) has emerged as a potential indicator reflecting systemic inflammation and nutritional status. METHODS: We performed a systematic review and meta-analysis of studies assessing FAR in PC patients. Databases including PubMed,…

Diagnostic performance of artificial intelligence versus conventional imaging for differentiating G2/G3 from G1 pancreatic neuroendocrine tumors: a systematic review and meta-analysis.

BMC medical imaging · 2026 · PMID 41992154

BACKGROUND: Accurate preoperative grading of pancreatic neuroendocrine tumors (PanNETs), specifically differentiating G2/G3 from G1, is pivotal for treatment planning but challenging with conventional biopsy. This study aims to evaluate the diagnostic performance of imaging modalities, particularly comparing Machine Learning/Deep Learning (ML/DL) algorithms against conventional expert interpretation. METHODS: We conducted a systematic review and meta-analysis of studies from PubMed, Embase, Web of Science, and Coch…

Predictors for Long-Term Survival After Resection of Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis.

Annals of surgical oncology · 2024 · PMID 38710910

BACKGROUND: Improved systemic therapy has made long term (≥ 5 years) overall survival (LTS) after resection of pancreatic ductal adenocarcinoma (PDAC) increasingly common. However, a systematic review on predictors of LTS following resection of PDAC is lacking. METHODS: The PubMed, Embase, Scopus, and Cochrane CENTRAL databases were systematically searched from inception until March 2023. Studies reporting actual survival data (based on follow-up and not survival analysis estimates) on factors associated with LTS w…

Prognostic value of tumor-infiltrating lymphocytes and common subtypes in patients with gastroenteropancreatic neuroendocrine neoplasms: a systematic review and meta-analysis.

BMC cancer · 2026 · PMID 42071196

BACKGROUND: The incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has been rising. However, current prognostic evaluation systems have certain limitations. As a key component of the tumor microenvironment, the prognostic value of tumor-infiltrating lymphocytes (TILs) in GEP-NENs remains controversial. This study aims to systematically evaluate the prognostic impact of common TILs subsets, including CD3+, CD4+, CD8+, and FoxP3 + cells, in patients with GEP-NENs to provide evidence-based support…

Quantifying Weight Loss Prior to Pancreatic Cancer Diagnosis: A Systematic Review and Meta-Analysis.

Cancer medicine · 2026 · PMID 42219540

INTRODUCTION: Pancreatic cancer has a high mortality rate due to late diagnosis and presentation with non-specific symptoms like weight loss. Quantifying weight loss more precisely could enhance its utility as a diagnostic marker. METHODS: In March 2025, we systematically searched PubMed, Embase, Web of Science, The Cochrane Library, and Scopus for studies reporting quantitative pre-diagnosis weight loss in pancreatic cancer, with no date restrictions. The protocol was registered with PROSPERO (CRD42022302985). Pri…

Association between glucose to lymphocyte ratio and prognosis in patients with solid tumors.

Frontiers in immunology · 2024 · PMID 39712026

BACKGROUND: Glucose-to-lymphocyte ratio (GLR) plays an important role in the prognosis of various tumors. The aim of this study was to comprehensively evaluate the prognostic value of GLR in solid tumors through the meta-analysis. METHODS: A comprehensive search of eligible studies was performed by scrutinizing the Pubmed, Embase and Web of science databases until May 30, 2024. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate overall survival (OS), disease-free survival…

The impact of MRI on real-world staging pathways and management timelines in pancreatic cancer: A systematic review.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026 · PMID 41996777

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, and accurate staging is crucial to avoid unnecessary surgery. MRI may improve the detection of occult liver metastases when compared with CT. The impact of adding MRI on treatment timelines and cost-effectiveness remains uncertain. This systematic review synthesises the available evidence of incorporating MRI alongside CT for pre-operative staging of pancreatic cancer. METHODS: We systematically searched MEDLINE, Embase, Web of Science, and t…

Effect of unplanned conversion to open surgery on resection margins and complications in laparoscopic pancreaticoduodenectomy: a systematic review and meta-analysis with meta-regression.

Annals of the Royal College of Surgeons of England · 2026 · PMID 41032060

INTRODUCTION: We aimed to investigate the effect of unplanned conversion to open surgery during laparoscopic pancreaticoduodenectomy on resection margins and complications. METHODS: A systematic review and meta-analysis (proportion and comparison models) with meta-regression using random-effects modelling compliant with PRISMA statement standards was conducted. All studies with a minimum sample size of 15 patients reporting conversion to open surgery in patients undergoing laparoscopic pancreaticoduodenectomy were …

Incidence and Determinants of Steatotic Liver Disease after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis.

Journal of hepato-biliary-pancreatic sciences · 2026 · PMID 41879125

BACKGROUND: Steatotic liver disease (SLD) is an unrecognized complication after pancreaticoduodenectomy (PD) and may affect nutrition and long-term recovery. This meta-analysis estimated the incidence of SLD after PD and identified its clinical and surgical risk factors. METHODS: MEDLINE and EMBASE were searched through March 2025 for studies reporting incident SLD after PD. Random-effects models generated pooled incidence and risk estimates. Subgroup, meta-regression, and sensitivity analyses assessed heterogeneit…

Predictive factors for long-term survival in pancreatic ductal adenocarcinoma that underwent surgery: a systematic review and meta-analysis of literature.

Updates in surgery · 2026 · PMID 40889102

Long-term survivors after pancreatic resection for PDAC are rare, constituting a specific subset of patients that remains poorly understood. This study aims to identify the clinic-pathological, molecular, and therapeutic factors for predicting long-term survival (LTS). A systematic review and random-effect meta-analysis were conducted. Inclusion criteria were PDAC histology, resected patients, studies reporting risk factors, and comparing two groups. The primary endpoint was to evaluate predictive factors for LTS i…

Serum CA19.9 for Detecting High-Grade Dysplasia and Invasive Carcinoma in Patients With Intraductal Papillary Mucinous Neoplasm: A Systematic Review and Meta-Analysis.

JAMA network open · 2026 · PMID 42360746

IMPORTANCE: Current guidelines recommend routine assessment of serum carbohydrate antigen 19.9 (CA19.9) at diagnosis and during follow-up of patients with intraductal papillary mucinous neoplasm (IPMN) to detect high-grade dysplasia (HGD) and invasive carcinoma (IC). Guidelines consider an elevated serum CA19.9 level (≥37 U/mL) a worrisome feature and a relative indication for surgery. OBJECTIVE: To evaluate the diagnostic accuracy of CA19.9 for identifying patients with IPMN at high risk of HGD and IC. DATA SOURCE…

The role of germline BRCA1 & BRCA2 mutations in familial pancreatic cancer: A systematic review and meta-analysis.

PloS one · 2024 · PMID 38809921

BACKGROUND: Familial Pancreatic Cancer (FPC) presents a notable risk, with 3-10% of pancreatic adenocarcinoma cases having a family history. Studies link FPC to syndromes like HBOC, suggesting BRCA1/BRCA2 mutations play a role. BRCA gene functions in DNA repair impact FPC management, influencing sensitivity to therapies like PARP inhibitors. Identifying mutations not only aids FPC treatment but also reveals broader cancer risks. However, challenges persist in selectively applying genetic testing due to cost constra…

Implications and risk of new versus persisting intraductal papillary mucinous neoplasms after pancreatic surgery: meta-analysis.

BJS open · 2026 · PMID 42441942

BACKGROUND: Interpretation of recurrence following resection of intraductal papillary mucinous neoplasms (IPMNs) is hindered by inconsistent terminology and outcome reporting. A distinction between metachronous/de novo IPMN development, progression of residual disease, and true recurrence of invasive entities is rarely considered. METHODS: A systematic review and meta-analysis were conducted following PRISMA and Cochrane guidelines (PROSPERO-ID: 1009399). The primary endpoint was postoperative recurrence of non-inv…

Safety and efficacy of liposomal irinotecan as the second-line treatment for advanced pancreatic cancer: A systematic review and meta-analysis.

Critical reviews in oncology/hematology · 2024 · PMID 38735505

INTRODUCTION: Nanoliposomal irinotecan (nal-IRI) is a novel regimen for pancreatic cancer, featuring a longer half-life and an increased area under the concentration-time curve. This study aims to assess the safety and efficacy of nal-IRI as a second-line treatment for advanced pancreatic cancer. METHODS: A systemic literature search was conducted based on articles published before September 26th, 2023 in databases, including PubMed, Cochrane Library, EMBASE and Web of Science. The fixed effects model was used to c…

Endoscopic Ultrasound-Guided Fine Needle Acquisition for Evaluation of Pancreatic Neuroendocrine Tumors: A Meta-Analysis.

Journal of clinical gastroenterology · 2025 · PMID 39312536

AIMS: The aim of this meta-analysis was to assess the diagnostic performance of EUS-FNA/B in patients with panNETs. METHODS: We conducted a computerized search of the MEDLINE and Embase databases to identify relevant articles. The primary outcomes involved grading concordance rate, diagnostic rate, and correlation coefficient (Cohen's κ) for FNA/B samples compared with surgical specimens. Secondary outcomes included sample adequacy, mean number of passes, and adverse events. RESULTS: Forty-five studies involving 29…

NALIRIFOX, FOLFIRINOX, and Gemcitabine With Nab-Paclitaxel as First-Line Chemotherapy for Metastatic Pancreatic Cancer: A Systematic Review and Meta-Analysis.

JAMA network open · 2024 · PMID 38190183

IMPORTANCE: The NAPOLI 3 trial showed the superiority of fluorouracil, leucovorin, liposomal irinotecan, and oxaliplatin (NALIRIFOX) over the combination of gemcitabine and nab-paclitaxel (GEM-NABP) as first-line treatment of metastatic pancreatic ductal adenocarcinoma (PDAC). Analyses comparing NALIRIFOX and GEM-NABP with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) have not yet been reported. OBJECTIVE: To derive survival, response, and toxic effects data from phase 3 clinical trials and com…

Efficacy and safety of radical antegrade modular pancreatosplenectomy versus standard radical pancreatosplenectomy for pancreatic body/tail cancer: A systematic review and meta-analysis.

Surgery · 2026 · PMID 41924794

OBJECTIVE: To compare the efficacy and safety of radical antegrade modular pancreatosplenectomy with standard radical pancreatosplenectomy in the treatment of pancreatic body and tail cancer. METHODS: A comprehensive literature search was conducted in the PubMed, EMBASE, and Web of Science databases from January 2003 to July 2025. Pooled odds ratios, hazard ratios, or mean differences were calculated with 95% CIs. The analysis was performed using RevMan 5.4.1 and R 4.3.0. RESULTS: Sixteen studies involving 2,136 pa…

Beyond predictive performance: A systematic review and critical methodological appraisal of AI/ML and conventional modelling strategies in breast, colorectal, and pancreatic Cancer.

Artificial intelligence in medicine · 2026 · PMID 42641254

BACKGROUND: Predictive modelling for cancer risk, treatment-related complications, and survival is central to precision oncology. Conventional logistic regression (LR) and Cox proportional hazards (CoxPH) regression remain widely used but are limited when modelling nonlinear interactions, high-dimensional imaging features, and multimodal clinical-metabolic predictors. Artificial intelligence (AI) and machine learning (ML) methods offer expanded capability through automated feature extraction, ensemble learning, and…

UGT1A1 genotype testing for irinotecan: A guideline developed by the UK Centre of Excellence in Regulatory Science and Innovation in Pharmacogenomics (CERSI-PGx).

British journal of clinical pharmacology · 2026 · PMID 42389808

Irinotecan, a topoisomerase I inhibitor, is available as both non-pegylated and pegylated formulations. The non-pegylated formulation is licensed for use in advanced colorectal cancer either in combination with other agents or as monotherapy. However, it is also used off-label across a range of gastrointestinal malignancies and in rare malignancies such as glioblastoma and sarcomas. The pegylated formulation is licensed for use as combination therapy in adult patients with metastatic pancreatic adenocarcinoma. Irin…

Prognostic utility of the Charlson comorbidity index in pancreatic cancer: a systematic review and meta‑analysis.

World journal of surgical oncology · 2026 · PMID 42625189

OBJECTIVE: The prognosis of pancreatic cancer is extremely poor, and patients frequently present with multiple comorbidities. The Charlson Comorbidity Index (CCI) and its age-adjusted version (CACI) are widely used to quantify the burden of comorbidity. This systematic review and meta-analysis aimed to evaluate the association between CCI/CACI and survival outcomes in patients with pancreatic cancer. METHODS: We systematically searched the Cochrane Library, Embase, PubMed, and Web of Science for relevant literature…

Glucagon-like Peptide-1 receptor agonists are not associated with increased risk of pancreatic cancer: A systematic review and meta-analysis.

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026 · PMID 41991368

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for glucose control and weight management. Concerns have arisen regarding a potential association with pancreatic ductal adenocarcinoma (PDAC), though evidence remains conflicting. We performed a systematic review and meta-analysis to evaluate PDAC risk in GLP-1 RA users. METHODS: We included studies with ≥24 weeks of follow-up assessing PDAC incidence in patients treated with GLP-1 RAs. Eligible studies included adults with typ…

Association of multidisciplinary team management with clinical outcomes in hepatobiliary and pancreatic malignancies: A systematic review and meta-analysis.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026 · PMID 42314305

BACKGROUND: Multidisciplinary team (MDT) management is widely endorsed for complex hepatobiliary and pancreatic (HBP) malignancies. However, robust systematic evidence evaluating its survival benefits and heterogeneity across distinct anatomical sites remains limited. METHODS: Our study systematically searched four databases from their inception through Dec 17, 2025, for studies comparing MDT versus non-MDT care in HBP malignancies. The primary outcome was overall survival or mortality risk. Secondary outcomes incl…

Impact of postoperative pancreatic fistula (POPF) on long-term outcomes of patients who underwent pancreatic cancer resection: systematic review and meta-analysis.

Surgical oncology · 2026 · PMID 42242032

INTRODUCTION: Postoperative pancreatic fistula (POPF) is a major complication resulting from pancreatic resection. The long-term oncological outcomes of patients who experience POPF after pancreatic cancer resection remain inconclusive. The purpose of this study was to evaluate the impact of POPF on the long-term survival of patients undergoing pancreatic cancer resection. METHODS: A systematic review and meta-analysis were performed for studies comparing survival outcomes in patients with or without POPF following…

Robotic pancreaticoduodenectomy with venous resection and reconstruction: a systematic review of perioperative, vascular, oncological and survival outcomes.

Journal of robotic surgery · 2026 · PMID 42474838

Robotic pancreaticoduodenectomy with venous resection and reconstruction (RPD-VR) is one of the most technically challenging procedures in hepatopancreaticobiliary surgery. While acceptance of robotic pancreaticoduodenectomy is growing, the safety, feasibility, and oncologic adequacy of combined portal vein (PV) and/or superior mesenteric vein (SMV) resection remain incompletely defined. A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, Scopus and the Cochrane Library were searched from…

Prognostic and predictive values of transcriptomic signatures in metastatic pancreatic cancer: A biomarker analysis of three French multicenter prospective randomized controlled phase 2 trials (Prodige35, Prodige37 and AFUGEM).

Cancer letters · 2026 · PMID 42521075

To evaluate the clinical applicability of previously established transcriptomic signatures (molecular subtypes, components and GemPred status) in metastatic pancreatic cancer, we conducted a retrospective pooled analysis of 178 patients from three phase 2 trials (PRODIGE35/37, AFUGEM; 2013-2016) testing first-line regimens (FOLFIRINOX, GemNab, FuNab, FOLFIRI3). RNA sequencing was performed on primary/metastatic tumors across French centers, with blinded assessment of subtypes (immune classical, pure basal-like, str…

Impact of prior conventional irinotecan use on nanoliposomal irinotecan efficacy in advanced pancreatic cancer: a meta-analysis.

ESMO open · 2026 · PMID 42462278

BACKGROUND: Nanoliposomal irinotecan (nal-IRI) has become an established therapy for advanced pancreatic ductal adenocarcinoma (PDAC), both in the post-gemcitabine setting and, more recently, in the first-line NALIRIFOX regimen. Concerns remain regarding cross-resistance in patients previously exposed to conventional irinotecan. We performed a systematic review and meta-analysis to evaluate the impact of prior irinotecan exposure on outcomes with nal-IRI. MATERIALS AND METHODS: We conducted a systematic literature …

Splenic hilum nodal involvement in resected left-sided pancreatic cancer: meta-analysis.

BJS open · 2026 · PMID 42725583

BACKGROUND: Splenectomy is standard of care during left pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) to obtain adequate lymphadenectomy. However, evidence supporting this approach is lacking. Splenic preservation would reduce short-term morbidity and is essential for emerging oncological adjunctive therapies, including immunotherapy and personalized cancer vaccines. This study reviewed the incidence of splenic hilum nodal involvement (SHNI) in left-sided PDAC. METHODS: A systematic review of the PubMe…

Systematic Review and Pooled Analysis of 1,021 Children With Pancreatic Tumors.

The Journal of surgical research · 2026 · PMID 42335633

INTRODUCTION: Although relatively rare, pediatric pancreatic tumors have been increasingly reported in the literature. Our aim was to systematically review the literature on the clinical characteristics, management, and outcomes of pediatric pancreatic tumors. METHODS: We performed a systematic review of the MEDLINE, Scopus, Web of Science, and Cochrane Library databases (end-of-search date: June 2022) according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. RESULTS: Sixty-four…

Sampling performance of EUS-Guided fine-needle biopsy in pancreatic neuroendocrine tumors: A systematic review and meta-analysis.

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026 · PMID 42509099

BACKGROUND/OBJECTIVES: Pancreatic neuroendocrine tumors (PNETs) account for a growing proportion of pancreatic lesions. Adequate tissue acquisition is essential for accurate diagnosis, tumor grading, and treatment planning. Fine-needle biopsy (FNB) has emerged as a promising alternative to fine-needle aspiration (FNA) for obtaining diagnostic samples. METHODS: We conducted a systematic review and meta-analysis of clinical trials and cohort studies evaluating the sampling performance of FNB in patients with suspecte…

Feasibility, efficacy and safety of pressurized intraperitoneal aerosol chemotherapy (PIPAC) for hepatobiliary and pancreatic cancers with peritoneal metastases: A systematic review.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026 · PMID 42430883

BACKGROUND: Hepato-pancreato-biliary (HPB) cancers frequently develop peritoneal metastases, signalling a poor prognosis and severely limiting the efficacy of systemic treatments. This review evaluates the feasibility, efficacy, and safety of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for these malignancies. METHODS: We conducted a systematic review in accordance with the PRISMA guidelines. A comprehensive, structured search strategy was applied to PubMed, Scopus, and Web of Science to identify eligib…

The outcomes of surgical resection versus ablation of liver metastases from neuroendocrine tumors: A systematic review.

Hepatobiliary & pancreatic diseases international : HBPD INT · 2026 · PMID 42177126

BACKGROUND: Neuroendocrine liver metastases (NLMs) from gastroenteropancreatic neuroendocrine tumors (GEP-NETs) significantly impact morbidity and mortality. While surgical resection remains the standard treatment, radiofrequency ablation (RFA) has emerged as an alternative for unresectable cases. This systematic review compared the oncological outcomes of surgical resection and RFA. DATA SOURCES: A systematic search of PubMed, Web of Science, and Scopus identified studies published between 2014 and 2025. Eligible …

Defining textbook outcome for distal pancreatectomy by systematic review. Is it clinically relevant?

Surgery · 2026 · PMID 42134067

BACKGROUND: A textbook outcome is a composite score of individual metrics that report an ideal outcome for a given surgery. The objectives of this study were to develop and validate a textbook outcome definition for distal pancreatectomy. METHODS: PubMed, Embase, and Web of Science databases were searched until October 1, 2024 for this systematic review, and studies that evaluated textbook outcome for distal pancreatectomy were selected. Textbook outcome metrics were chosen by data strength and validated by reviewi…

EUS-Guided Choledochoduodenostomy Versus Hepaticogastrostomy in Case of Concomitant Gastric Outlet Obstruction Treated by EUS-Guided Gastroenterostomy: A Systematic Review and Meta-Analysis.

United European gastroenterology journal · 2026 · PMID 42713827

BACKGROUND: Biliary (BO) and gastric outlet obstruction (GOO) frequently complicate pancreatic cancer, often delaying treatment. While EUS-guided gastroenterostomy (EUS-GE) is preferred over duodenal stenting for GOO, the optimal approach for biliary drainage (BD) between EUS-guided choledochoduodenostomy (EUS-CDS) and hepaticogastrostomy (EUS-HGS) remains undefined. This systematic review and meta-analysis aimed to identify the preferred BD strategy in patients undergoing EUS-GE for concurrent GOO and BO. METHODS:…

Effects of Glucagon-Like Peptide-1 Receptor Agonists as Weight Loss Drugs on Pancreatitis and Pancreatic Cancer: A Meta-Analysis.

Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme · 2026 · PMID 42600634

This meta-analysis aimed to clarify the association between glucagon-like peptide-1 receptor agonists, used for weight management in obesity, and the risks of pancreatitis and pancreatic cancer. We systematically searched PubMed, Web of Science, Embase, the Cochrane Library, and Scopus through June 15, 2026, for clinical studies conducted in obese populations. Peto odds ratios with 95% confidence intervals were calculated. Heterogeneity was assessed using I² statistic, and random-effects models were applied when I²…

Automated glucose control systems in post-pancreatectomy diabetes: systematic review of clinical efficacy and nursing care implications.

Minerva gastroenterology · 2026 · PMID 41801256

INTRODUCTION: Post-pancreatectomy diabetes (type 3c diabetes) is a frequent consequence of pancreatic cancer surgery and is characterized by extreme glycemic variability, high risk of severe hypoglycemia, and a substantial impact on quality of life and nursing workload. Technological solutions such as continuous glucose monitoring (CGM) and closed-loop insulin delivery may help address these challenges. EVIDENCE ACQUISITION: We conducted a systematic review according to the Cochrane Handbook 6.5 and PRISMA 2020 gui…

Mediterranean Diet and Risk of Pancreatic Cancer-Is It Worth Investigating More? An Updated Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies.

Cancer medicine · 2026 · PMID 42608885

BACKGROUND: Despite previous meta-analysis studies on the association between adherence to the Mediterranean diet and risk of pancreatic cancer, there has not been a comprehensive and updated study reviewing all studies with inclusion criteria. Despite advances in cancer treatment and control, pancreatic cancer is still one of the deadliest malignancies, and the mortality rate is consistent with its prevalence. Therefore, this updated systematic review and dose-response meta-analysis study was conducted to examine …

Photon-counting CT in gastrointestinal malignancies: a scoping review.

European journal of radiology · 2026 · PMID 42102569

BACKGROUND: Photon-Counting computed tomography(PCCT) offers superior spatial resolution, improved contrast-to-noise ratio and reduced radiation dose compared with conventional CT. This scoping review maps and synthesizes clinical evidence on PCCT applications in gastrointestinal (GI) oncology following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines METHODS: A systematic search of PubMed, Embase, Web of Science and Cochrane Library (January 2017-December 2025) identified studies evaluating PCCT in…

Adjuvant Chemotherapy ± Chemoradiotherapy for Adenocarcinoma of the Pancreatic Head: Results of the Radiotherapy Random Assignment of NRG Oncology/RTOG 0848.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026 · PMID 42456089

PURPOSE: To assess whether adding fluoropyrimidine sensitized radiotherapy (CXRT) to adjuvant chemotherapy improves overall survival (OS) after curative intent resection of the pancreatic head. METHODS: This was a multicenter, randomized phase III, two step trial. Step 1: gemcitabine versus gemcitabine + erlotinib (previously reported). Step 2: random assignment to sixth chemotherapy cycle ± CXRT after five cycles of step 1 chemotherapy without progression. Outcomes of step 2 random assignment are reported here. As…

Treatment Strategies and Outcomes for Single-Site Recurrent Pancreatic Ductal Adenocarcinoma After Curative-Intent Surgery: Local Therapies are Associated with Longer Survival in Selected Cases: A Systematic Review and Meta-analysis.

Annals of surgical oncology · 2026 · PMID 42303818

BACKGROUND: After curative-intent pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), disease recurrence occurs almost invariably. Evidence guiding treatment of recurrence remains limited and may differ across single-site recurrence patterns. METHODS: Scopus, MEDLINE, and the Cochrane Library were systematically searched for observational studies of adults with recurrent PDAC reporting liver-only, lung-only, or locoregional recurrence and post-recurrence treatments. Hazard ratio (HR) meta-analyses were perf…

Agonistic anti-CD40 antibodies in patients with solid tumors: a systematic review and evidence map of clinical safety, with exploratory proportional synthesis.

Frontiers in immunology · 2026 · PMID 42723988

BACKGROUND: Agonistic anti-CD40 antibodies and related CD40 agonist biologics are being developed across multiple solid tumors using diverse biologic formats, delivery routes, and combination regimens. Safety is central to their clinical development but remains difficult to interpret because high-grade adverse events in combination settings may reflect partner therapies, and safety outcomes are reported inconsistently. METHODS: We conducted a systematic review and evidence map of the clinical safety of CD40 agonist…

Is there a role for early SSTR-targeting PRRT in GEP-NET?

European journal of nuclear medicine and molecular imaging · 2026 · PMID 42234009

PURPOSE: Peptide receptor radionuclide therapy (PRRT) with radiolabelled somatostatin analogues, such as [¹⁷⁷Lu]Lu-DOTATATE, is approved as a second-line treatment for progressive, gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, emerging evidence suggests potential earlier roles for PRRT. MATERIALS AND METHODS: A systematic review was conducted in accordance with the PRISMA guidelines, including case reports, original papers, and clinical trial protocols evaluating neoadjuvant, adjuvant, or first-…

Validation of magnetic resonance imaging for quantification of intrapancreatic fat deposition using phantom and histologic comparators: a systematic review and meta-analysis.

European radiology · 2026 · PMID 41872343

OBJECTIVES: Recent insights into understanding intrapancreatic fat deposition (IPFD) and its relationship with common pancreatic diseases have opened new opportunities for their prevention and treatment. This progress underscores the need for an accurate and universally applicable non-invasive imaging modality tailored for IPFD quantification. Chemical shift-encoded magnetic resonance imaging (CSE-MRI) is a non-ionising, time-efficient technique thought to be naturally fit for IPFD quantification because of its exc…

Radiation Therapy for Pancreatic Cancer: An ASTRO Clinical Practice Guideline.

Practical radiation oncology · 2026 · PMID 42580553

PURPOSE: This guideline provides evidence-based recommendations on the use of radiation therapy (RT) for the treatment of pancreatic cancer in a variety of clinical settings including patients with resectable, borderline resectable, locally advanced, metastatic, and symptomatic disease. METHODS: The American Society for Radiation Oncology convened a multidisciplinary task force to address 4 key questions: (1) indications for and timing of RT for patients with nonmetastatic pancreatic cancer; (2) appropriate RT dose…

Association between glucose to lymphocyte ratio and prognosis in patients with solid tumors.

Frontiers in immunology · 2024 · PMID 39712026

BACKGROUND: Glucose-to-lymphocyte ratio (GLR) plays an important role in the prognosis of various tumors. The aim of this study was to comprehensively evaluate the prognostic value of GLR in solid tumors through the meta-analysis. METHODS: A comprehensive search of eligible studies was performed by scrutinizing the Pubmed, Embase and Web of science databases until May 30, 2024. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate overall survival (OS), disease-free survival…

Efficacy of nab-paclitaxel combined with immune checkpoint inhibitors in solid tumors: a systematic review and meta-analysis of randomized controlled trials.

Translational cancer research · 2026 · PMID 42591455

BACKGROUND: Nab-paclitaxel combined with immune checkpoint inhibitors (ICIs) is a promising strategy across solid tumors, but its overall efficacy across cancer types and treatment settings remains to be comprehensively quantified. We therefore aimed to evaluate the efficacy of nab-paclitaxel plus ICIs versus nab-paclitaxel-based regimens without immunotherapy across multiple solid tumor types and treatment settings. METHODS: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Scien…

Survival benefit of particle chemoradiotherapy in locally advanced unresectable pancreatic cancer: a systematic review and meta-analysis.

Therapeutic advances in gastroenterology · 2026 · PMID 42544125

BACKGROUND: The pros and cons of incorporating radiotherapy (RT) into chemotherapy (CT) for locally advanced unresectable pancreatic cancer (LAPC) have been debated for decades. Recently, particle (proton and carbon-ion) therapy has emerged as a new radiotherapy modality. Given the unclear benefits of this approach, we summarized clinical outcomes of LAPC treated with concurrent chemoradiotherapy (CRT) using particle therapy to compare outcomes with current treatments. OBJECTIVES: To evaluate the efficacy and safet…

Neoadjuvant Chemoradiotherapy Versus Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-analysis of Randomised Controlled Trials.

Annals of surgical oncology · 2026 · PMID 42545416

PURPOSE: This study was designed to evaluate the comparative outcomes of neoadjuvant chemoradiotherapy (NACR) and neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: Systematic search of electronic data sources was conducted, and all randomised controlled trials (RCTs) investigating outcomes of NACR and NAC in patients with PDAC were considered. Surgical resection rate, R0 resection, radiological response to treatment, and 1-5 years and overall survival were the evaluat…

Vitamin C as an Adjunctive Therapy in Cancer: A Systematic Review and Meta-Analysis of Outcomes in Solid and Hematologic Malignancies.

American journal of clinical oncology · 2026 · PMID 42507830

OBJECTIVES: Vitamin C has gained interest as an adjunctive treatment in oncology due to its antioxidant effects, potential to enhance cancer therapy, and ability to improve quality of life. This systematic review and meta-analysis aimed to assess the therapeutic impact of vitamin C in patients with solid and hematologic malignancies. METHODS: A comprehensive search was conducted in PubMed, Cochrane, Embase, ClinicalTrials.gov, and Google Scholar from inception to August 2025, in accordance with PRISMA guidelines. A…

The molecular mechanism of cuproptosis and research progress in pancreatic diseases.

Annals of medicine · 2026 · PMID 41454639

PURPOSE: Cuproptosis has been proven to be a novel mode of cell death, distinct from other types of cell death such as necrosis, ferroptosis, pyroptosis, and apoptosis. This study aims to systematically review the molecular mechanisms of cuproptosis in recent years and its research progress in pancreatic diseases. METHODS: By searching PubMed and Web of Science databases, 113 key literatures were included for thematic analysis, covering the molecular mechanism of cuproptosis and its role in the occurrence and devel…

Global landscape and knowledge structure of research on pancreatitis and gut microbiota: a bibliometric analysis based on WoSCC and Scopus (2006 - 2025).

Frontiers in cellular and infection microbiology · 2026 · PMID 42568357

BACKGROUND: The research on pancreatitis and gut microbiota has expanded rapidly in recent years. Growing evidence suggests that gut dysbiosis may play an important role in pancreatic inflammation, intestinal barrier dysfunction and disease progression, but global research landscape, major contributors, knowledge structure and hotspots have not been fully defined. MATERIALS AND METHODS: Publications related to pancreatitis and gut microbiota were retrieved from the Web of Science Core Collection and Scopus. The sea…

Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA): Are We Getting Evidence-Based Results? A Systematic Review According to the Levels of Evidence.

Medicina (Kaunas, Lithuania) · 2026 · PMID 42512924

Background and Objectives: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an emerging minimally invasive therapeutic option for pancreatic and selected extra-pancreatic lesions. However, its clinical adoption is limited by heterogeneous indications, non-standardized techniques, and variable quality of evidence. This systematic review assessed the published literature on EUS-RFA and classified available evidence according to the Oxford Centre for Evidence-Based Medicine levels of evidence. Materia…

Validation of magnetic resonance imaging for quantification of intrapancreatic fat deposition using phantom and histologic comparators: a systematic review and meta-analysis.

European radiology · 2026 · PMID 41872343

OBJECTIVES: Recent insights into understanding intrapancreatic fat deposition (IPFD) and its relationship with common pancreatic diseases have opened new opportunities for their prevention and treatment. This progress underscores the need for an accurate and universally applicable non-invasive imaging modality tailored for IPFD quantification. Chemical shift-encoded magnetic resonance imaging (CSE-MRI) is a non-ionising, time-efficient technique thought to be naturally fit for IPFD quantification because of its exc…

Treatment Strategies and Outcomes for Single-Site Recurrent Pancreatic Ductal Adenocarcinoma After Curative-Intent Surgery: Local Therapies are Associated with Longer Survival in Selected Cases: A Systematic Review and Meta-analysis.

Annals of surgical oncology · 2026 · PMID 42303818

BACKGROUND: After curative-intent pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), disease recurrence occurs almost invariably. Evidence guiding treatment of recurrence remains limited and may differ across single-site recurrence patterns. METHODS: Scopus, MEDLINE, and the Cochrane Library were systematically searched for observational studies of adults with recurrent PDAC reporting liver-only, lung-only, or locoregional recurrence and post-recurrence treatments. Hazard ratio (HR) meta-analyses were perf…

Life Course Trajectories of Body Mass Index and Risk of Cancer in Adulthood: Systematic Review and Meta-Analysis.

Obesity reviews : an official journal of the International Association for the Study of Obesity · 2026 · PMID 41787663

OBJECTIVE: This systematic review and meta-analysis aimed to identify common life-course body mass index (BMI) trajectories (childhood/adulthood to adulthood) and their impact on risk of cancer overall and cancer at different sites in adulthood. METHODS: Observational studies were identified that assessed the association of BMI trajectories with cancer risks from databases published in English. The pooled effect sizes were estimated using a random-effects model. FINDINGS: A total of 24 eligible studies were include…

Development of models for predicting the 7-month risk of venous thromboembolism and clinically relevant bleeding in ambulatory patients with cancer: analysis from the apixaban for the prevention of venous thromboembolism in high-risk ambulatory cancer patients trial.

Journal of thrombosis and haemostasis : JTH · 2026 · PMID 42107707

BACKGROUND: Patients with cancer are at elevated risk of venous thromboembolism (VTE). While primary thromboprophylaxis reduces VTE incidence, it also increases bleeding risk, necessitating accurate risk stratification. Existing tools (eg, the Khorana score) have modest predictive value, and bleeding risk models have not been validated in ambulatory patients with cancer. OBJECTIVES: To develop and internally validate prediction models for VTE and clinically relevant bleeding in ambulatory patients with cancer initi…

Preoperative mFOLFIRINOX versus PAXG for stage I-III resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2 × 2 factorial phase 3 trial.

Lancet (London, England) · 2026 · PMID 41275879

BACKGROUND: Perioperative chemotherapy is a standard option for treatment of patients with resectable and borderline resectable pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the superiority of PAXG (cisplatin, nab-paclitaxel, capecitabine, and gemcitabine) over mFOLFIRINOX (modified fluorouracil, leucovorin, irinotecan, and oxaliplatin) in this population. METHODS: CASSANDRA is a randomised, open-label, 2 × 2 factorial phase 3 trial, involving 17 Italian academic hospitals. Eligible patients w…

Pancreatic Steatosis and Survival Outcomes in Pancreatic Ductal Adenocarcinoma: A Systematic Review of the Current Evidence.

Diagnostics (Basel, Switzerland) · 2026 · PMID 42587712

Background: Pancreatic steatosis (PS) has emerged as a potential risk factor for pancreatic ductal adenocarcinoma (PDAC). While increasing evidence supports its role in pancreatic carcinogenesis, its prognostic significance after PDAC diagnosis remains unclear. We performed a systematic review to evaluate the association between PS and survival outcomes in patients with pancreatic cancer. Methods: A systematic search of PubMed and Scopus was conducted in May 2026 according to PRISMA guidelines. Observational studie…

A SUZ12-marked epithelial dedifferentiation state with immune co-expression in pancreatic ductal adenocarcinoma.

Computational biology and chemistry · 2026 · PMID 42361510

BACKGROUND: Polycomb repressive complex 2 (PRC2) silences MHC class I antigen presentation across cancer types, yet the role of its core scaffolding subunit SUZ12 in pancreatic ductal adenocarcinoma (PDAC) immune phenotypes remains poorly characterized. METHODS: We integrated bulk transcriptomics from three cohorts, scRNA-seq (137,976 cells), mouse spatial transcriptomics (5980 spots), Mendelian randomization, colocalization, DepMap CRISPR dependency, tissue microarray immunofluorescence, and siRNA knockdown. RESUL…

Research advances on tumor-associated macrophages in pancreatic cancer.

Biochemistry and biophysics reports · 2026 · PMID 42519576

Pancreatic cancer, as a highly malignant tumor, is often regarded as one of the cancers with the poorest prognosis due to its insidious early symptoms, aggressive nature, and extremely poor clinical outcomes. Within the immune microenvironment of pancreatic cancer, tumor-associated macrophages (TAMs) constitute the predominant and central type of immune cell. They play a crucial regulatory role in key processes such as tumor initiation, progression, angiogenesis, and immune evasion. Furthermore, TAMs are deeply inv…

Pain response after palliative-intent radiotherapy for pancreatic cancer: a systematic review.

International journal of clinical oncology · 2026 · PMID 42566091

BACKGROUND: To date, no review has specifically focused on palliative-intent radiotherapy (RT) for pancreatic cancer (PC)-related pain. This study aimed to evaluate the pain response after palliative-intent RT for PC-related pain. METHODS: A comprehensive literature search was conducted using PubMed, Ichushi-Web, and the Cochrane Library for studies published between 1971 and 2024. Studies in which palliative-intent RT was administered for PC-related pain were included. Extracted Data were independently assessed by…

Vertical distribution of accessory canals in different tooth types: A systematic review and meta-analysis.

Journal of dentistry · 2026 · PMID 42492648

OBJECTIVE: To systematically analyze the vertical distribution of accessory canals and propose potential root-end resection levels in different tooth types. DATA: Proportional distribution of accessory canals (PD-AC) in 1 mm intervals, cumulative proportions within 2 mm and 3 mm (CP-AC0-2 and CP-AC0-3), mean distance from accessory foramen to root apex or main foramen (MD-AF), and prevalence of accessory canals in 2D cross-sections (PR-AC-2D). SOURCES: A systematic search of electronic databases was conducted throu…

Five-phase high-resolution contrast-enhanced CT is associated with higher report-level concordance with pathology for pancreatic diseases.

European journal of radiology · 2026 · PMID 42580078

BACKGROUND: This study aimed to investigate the diagnostic value of five-phase high-resolution contrast-enhanced CT (HR-CT) for pancreatic diseases. METHODS: A retrospective study involving 1886 patients with pathologically confirmed pancreatic disorders was performed with non-randomized protocol allocation according to clinical indications. All patients underwent preoperative contrast-enhanced CT scans, which were divided into two protocols: conventional four-phase CT (C-CT, including plain, pancreatic parenchymal…

Dosimetry Results from the Phase 1b/3 ACTION-1 Trial of [225Ac]Ac-DOTATATE (RYZ101) in Patients with Somatostatin Receptor-Expressing, Well-Differentiated GEP-NETs.

Journal of nuclear medicine : official publication, Society of Nuclear Medicine · 2026 · PMID 42242867

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are biologically and clinically heterogeneous tumors, most of which overexpress somatostatin receptors (SSTRs). The presence of SSTRs enables staging and allows patient selection for treatment with radiolabeled somatostatin analogs (SSAs), such as DOTATATE. [225Ac]Ac-DOTATATE is an α-emitting radiopharmaceutical in development for the treatment of patients with SSTR2-expressing solid tumors. α particles have a shorter path length and higher linear energy trans…

A multicenter randomized controlled trial comparing 10-mm versus 14-mm metallic stents for distal biliary obstruction caused by unresectable pancreatic carcinoma.

Gastrointestinal endoscopy · 2026 · PMID 42349763

BACKGROUND AND AIMS: ERCP with metal stent (MS) placement is the standard treatment for biliary drainage in patients with unresectable pancreatic cancer. A 10-mm diameter MS is generally used; however, a larger stent may provide longer patency. This study aimed to compare the outcomes of an uncovered 14-mm MS with those of an uncovered 10-mm MS. METHODS: This multicenter randomized controlled trial enrolled patients with unresectable pancreatic cancer who required biliary drainage. After 1:1 randomization, either a…

Semaglutide and Risk of Pancreatic Cancer: A Meta-Analysis of Randomised Trials.

Diabetes, obesity & metabolism · 2026 · PMID 42297743

Co-Clinical Evaluation of Synthetic Vitamin D and Chemotherapy in Pancreatic Cancer by Integrated Imaging and Molecular Analyses.

Cancer research communications · 2026 · PMID 42574460

PURPOSE: A pilot clinical trial (NCT03519308) was conducted to evaluate perioperative chemotherapy [nab-paclitaxel, gemcitabine, and cisplatin (NGC)] plus nivolumab, with or without synthetic vitamin D (paricalcitol) in resectable pancreatic ductal adenocarcinoma (PDAC). Preclinical studies were designed with statistical power to match the experimental regimen and compare NGC only with NGC plus synthetic vitamin D [calcipotriol (Cal)] or losartan (Losa; an antihypertensive medication). MATERIALS AND METHODS: Molecu…

Maximal Ablative Irradiation Because of Encasement for Patients With Locally Advanced Pancreatic Cancer: A Nonrandomized Clinical Trial.

JAMA surgery · 2026 · PMID 42525419

IMPORTANCE: The best local therapy approach for patients with locally advanced pancreatic cancer (LAPC) remains undefined. OBJECTIVE: To evaluate hypofractionated ablative radiation therapy (A-RT) followed by evaluation for surgery in patients with LAPC whose cancer remained unresectable after induction chemotherapy. DESIGN, SETTING, AND PARTICIPANTS: This was a phase 2 single-arm nonrandomized clinical trial conducted at the Memorial Sloan Kettering Cancer Center, New York, New York, from June 2018 to April 2024. …

Elraglusib and chemotherapy in metastatic pancreatic ductal adenocarcinoma: a randomized controlled phase 2 trial.

Nature medicine · 2026 · PMID 41981308

Metastatic pancreatic ductal adenocarcinoma (mPDAC) is one of the leading causes of cancer-related mortality, but advances in therapeutic treatments remain limited. Elraglusib (9-ING-41), an inhibitor of GSK-3β, exhibits a multimodal mechanism of action based on antitumor activity in preclinical models of cancer, including pancreatic. The efficacy and safety of elraglusib with gemcitabine plus nab-paclitaxel (GnP) were assessed in patients with previously untreated mPDAC. In an open-label, international, multicente…

Metabolic regulation and immunosuppressive functions of lipid-associated macrophages in pancreatic ductal adenocarcinoma.

Frontiers in immunology · 2026 · PMID 42421974

INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) exhibits a profoundly immunosuppressive tumor microenvironment, with tumor-associated macrophages (TAMs) being the most abundant immune infiltrate. Among them, lipid-associated macrophages (LAMs) have emerged as a distinct subpopulation driving immune evasion through metabolic reprogramming. METHODS: We conducted a narrative review by systematically searching PubMed, Web of Science, and Scopus for articles on LAMs in PDAC up to December 2023. Key themes were syn…

Chemoprophylaxis effect of EGCG on various digestive system diseases: a systematic review and meta-analysis.

Frontiers in medicine · 2026 · PMID 42359071

BACKGROUND: Epigallocatechin-3-gallate (EGCG) constitutes the main component of tea polyphenols found in tea leaves and has been found to have a positive therapeutic effect on various digestive system diseases. However, no systematic review has been conducted on the research progress and mechanisms of EGCG in relation to digestive system diseases, an its toxicity. METHODS: We conducted a comprehensive literature search for preclinical studies from the inception of each database to 28th September 2025, including Emb…

Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA): Are We Getting Evidence-Based Results? A Systematic Review According to the Levels of Evidence.

Medicina (Kaunas, Lithuania) · 2026 · PMID 42512924

Background and Objectives: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an emerging minimally invasive therapeutic option for pancreatic and selected extra-pancreatic lesions. However, its clinical adoption is limited by heterogeneous indications, non-standardized techniques, and variable quality of evidence. This systematic review assessed the published literature on EUS-RFA and classified available evidence according to the Oxford Centre for Evidence-Based Medicine levels of evidence. Materia…

The antitumoral effect of statins in pancreatic ductal adenocarcinoma: a scoping review.

Frontiers in pharmacology · 2026 · PMID 42147338

INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive and invasive malignancies, with limited response to the currently available systemic therapy options. Having a 5-year survival of 12%, there is a serious need for novel therapeutic options, including drug repurposing for the treatment of PDAC. In recent years, 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) inhibitors, also known as statins, have been identified as potential candidates for PDAC therapy repurposing. METH…

The Influence of Vitamin C on Stromal and Epithelial Cells of the Pancreas in Malignant and Benign/Inflammatory Pancreatic Diseases: Protocol for a Scoping Review.

JMIR research protocols · 2026 · PMID 42330555

BACKGROUND: With a 5-year survival rate of less than 10% in most regions worldwide, pancreatic ductal adenocarcinoma (PDAC) has been considered as one of the deadliest tumor diseases. In addition, the incidence of acute and chronic pancreatitis is also increasing worldwide. Both diseases-tumorous and inflammatory-involve pronounced stromal changes, including stellate cell activation, fibrosis, immune cell recruitment, and a proinflammatory microenvironment that is able to drive malignant progression. Vitamin C is i…

Research advances on tumor-associated macrophages in pancreatic cancer.

Biochemistry and biophysics reports · 2026 · PMID 42519576

Pancreatic cancer, as a highly malignant tumor, is often regarded as one of the cancers with the poorest prognosis due to its insidious early symptoms, aggressive nature, and extremely poor clinical outcomes. Within the immune microenvironment of pancreatic cancer, tumor-associated macrophages (TAMs) constitute the predominant and central type of immune cell. They play a crucial regulatory role in key processes such as tumor initiation, progression, angiogenesis, and immune evasion. Furthermore, TAMs are deeply inv…

Gemcitabine and nab-paclitaxel with or without the VDR agonist paricalcitol for metastatic pancreatic cancer: a randomized, multiarm, run-in phase trial.

Nature cancer · 2026 · PMID 42185478

Vitamin D receptor (VDR) agonists promote quiescence of cancer-associated fibroblasts and improve efficacy of chemotherapy in preclinical models of pancreatic cancer. We conducted a run-in phase trial with primary endpoint of safety when the VDR agonist paricalcitol is given with first-line gemcitabine and albumin-bound paclitaxel (GA) in patients with metastatic pancreatic cancer. Secondary endpoints included pharmacodynamic analyses. Thirty-six patients were randomized to GA plus placebo, GA plus intravenous pari…

High E2F7 Expression Indicates Pancreatic Cancer Aggressiveness and Downregulation of E2F7 Enhances Sensitivity to S-1.

Annals of surgical oncology · 2026 · PMID 41454190

BACKGROUND: Pancreatic cancer (PC) remains a highly lethal disease with few reliable biomarkers to guide chemotherapy choices. New biomarkers for selecting anticancer drugs are needed to enhance the effectiveness of current multimodal treatment approaches. This study aimed to find a new biomarker by using clinical data and specimens collected for a Japanese randomized controlled trial (RCT). METHODS: Gene expression array analysis was performed using PC tissues collected for the ancillary research of JASPAC01, a na…

Co-Clinical Evaluation of Synthetic Vitamin D and Chemotherapy in Pancreatic Cancer by Integrated Imaging and Molecular Analyses.

Cancer research communications · 2026 · PMID 42574460

PURPOSE: A pilot clinical trial (NCT03519308) was conducted to evaluate perioperative chemotherapy [nab-paclitaxel, gemcitabine, and cisplatin (NGC)] plus nivolumab, with or without synthetic vitamin D (paricalcitol) in resectable pancreatic ductal adenocarcinoma (PDAC). Preclinical studies were designed with statistical power to match the experimental regimen and compare NGC only with NGC plus synthetic vitamin D [calcipotriol (Cal)] or losartan (Losa; an antihypertensive medication). MATERIALS AND METHODS: Molecu…

The efficacy of brachytherapy with radioactive 125I therapy in pancreatic cancer.

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026 · PMID 42420074

OBJECTIVE: To evaluate the therapeutic efficacy and prognosis of 125I brachytherapy in advanced pancreatic cancer and to investigate its effects on the malignant phenotype of pancreatic cancer in vitro and in vivo. METHODS: Forty patients with advanced, unresectable pancreatic cancer were enrolled, including 18 in the chemotherapy group and 22 in the 125I combined with the chemotherapy group. The present study represents a non-randomized, retrospective cohort study with patients allocated to treatment groups based …

Genomic Biomarkers for First-Line Treatment Selection in Metastatic Pancreatic Ductal Adenocarcinoma: A Narrative Review.

Cancers · 2026 · PMID 42193022

Metastatic pancreatic ductal adenocarcinoma (PDAC) is typically treated with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) or gemcitabine plus nab-paclitaxel (GnP), but the choice between regimens remains largely empirical. This narrative review summarizes biomarkers with potential to inform first-line selection in metastatic PDAC, emphasizing genomic and transcriptomic correlates of differential benefit. Recent head-to-head trials, particularly Pancreatic Adenocarcinoma Signature Stratificatio…

Ketogenic Diet Prevents Obesity-Associated Pancreatic Cancer Independent of Weight Loss and Induces Pancreatic Metabolic Reprogramming.

Cancer research · 2026 · PMID 42153914

UNLABELLED: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with poor outcomes. Obesity increases the risk of PDAC through metabolic dysregulation and inflammation. Ketogenic diet (KD) can alter metabolism and has been evaluated for its effects on tumor progression in nonobese PDAC using genetically engineered mouse models (GEMM). We hypothesized that KD may also prevent obesity-associated PDAC progression by altering body composition and cancer metabolism. Therefore, male PDAC GEMMs were subjected …

Acquired resistance to the RAS(ON) multi-selective inhibitor daraxonrasib guides rational combination therapy strategies in pancreatic cancer.

Nature medicine · 2026 · PMID 42581230

Daraxonrasib is an orally bioavailable RAS(ON) multi-selective tri-complex inhibitor of the oncogenic mutant and wild-type variants of N, H and KRAS. We previously reported encouraging efficacy in a phase 1/2 clinical trial evaluating daraxonrasib monotherapy at clinically active dose levels in patients with previously treated, RAS mutant metastatic pancreatic adenocarcinoma (PDAC), providing the basis for confirmatory evaluation in the randomized phase 3 RASolute 302 clinical trial. Here we report mechanisms of ac…

Netrin1 blockade alleviates resistance to chemotherapy in pancreatic cancer.

Nature · 2026 · PMID 42020751

Netrin1, a developmental cue, is a master regulator of tumour epithelial-to-mesenchymal transition (EMT)1, a mechanism that is known to drive resistance to chemotherapy2. A netrin1 antibody (NP137)3 has been shown to inhibit tumour EMT in preclinical1 and clinical4 settings. In animal models of pancreatic cancer, netrin1 and its receptor neogenin have been shown to promote tumour progression5, EMT5 and metastasis6. Here we report the results of a phase 1b study that assesses the combination of NP137 with modified F…

Preclinical Characterization and Clinical Activity of RNK08954, a Highly Selective and Orally Bioavailable KRASG12D Inhibitor.

Cancer discovery · 2026 · PMID 41557983

UNLABELLED: KRAS G12D is the most prevalent subtype of KRAS mutation across solid tumors, but no drug is available in the clinic. RNK08954 is a potent and selective KRASG12D inhibitor that inhibits proliferation of KRASG12D-mutant cells and demonstrates significant tumor regressions in mouse xenograft models while inhibiting KRAS-mediated signaling. The in vivo effects of RNK08954 are explained by its unique pharmacokinetic (PK) profile and significantly prolonged retention time in tumor tissues. RNK08954 shows syn…

REG4 serves as a prognostic biomarker for pancreatic cancer with long-standing diabetes mellitus by modulating chemoresistance.

Translational oncology · 2026 · PMID 42398462

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) in patients with diabetes mellitus (DM) represents a clinically heterogeneous subgroup, yet biomarkers that reflect diabetes-associated tumor biology and chemotherapy response remain limited. In particular, the influence of diabetes duration on treatment resistance in PDAC is poorly understood. METHODS: We performed an integrated translational analysis combining reanalysis of public single-cell RNA sequencing (scRNA-seq) datasets, clinical serum biomarker profilin…

Next-generation AI for visually occult pancreatic cancer detection in a low-prevalence setting with longitudinal stability and multi-institutional generalisability.

Gut · 2026 · PMID 42049489

BACKGROUND: Failure of conventional imaging to detect pancreatic ductal adenocarcinoma (PDA) at its visually occult pre-diagnostic stage is a primary barrier to improving its otherwise poor rate of survival. OBJECTIVE: To develop and validate the Radiomics-based Early Detection MODel (REDMOD), an AI framework to identify subvisual radiomic signatures of pre-diagnostic PDA on standard-of-care CT. DESIGNS: REDMOD was trained on a multi-institutional cohort (n=969; 156 pre-diagnostic, 813 control) and tested on an ind…

Oncogenic KRAS-driven type I interferon signalling primes pancreatic cancer for necroptosis.

Nature communications · 2026 · PMID 42297776

Pancreatic ductal adenocarcinoma (PDAC) is projected to become the second leading cause of cancer-related death within this decade. Here, we show that its major driver oncogene KRAS activates the cGAS-STING-TBK1 axis, inducing a type I interferon (IFN) response that primes PDAC cells for necroptosis. Using genetically engineered mouse models, we find that cancer cell-specific deletion of caspase-8 is sufficient to trigger necroptotic cell death, eliminating most pancreatic precursor lesions. Mechanistically, KRAS-d…

IGF2BP3-mediated regulation of the RNA isoform and modification landscape in pancreatic cancer.

Oncogene · 2026 · PMID 42567885

The incidence of pancreatic ductal adenocarcinoma (PDAC) is increasing but clinical outcomes remain poor and new treatments are required. IGF2BP3 is an oncofetal m6A-reading RNA regulatory protein whose expression is commonly observed in PDAC and which may represent an important therapeutic target. IGF2BP3 protein is expressed in >95% of primary tumours whilst RNA expression ranges from 3 to 3000-fold above normal epithelium. siRNA knockdown reveals IGF2BP3 to strongly support expression of gene programs related to…

Targeting stroma-mediated T-cell exclusion and functional exhaustion in pancreatic ductal adenocarcinoma through CXCR4 and PD-1 blockade.

Frontiers in immunology · 2026 · PMID 42553398

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest malignancies to date and characterized by a unique immunosuppressive and highly desmoplastic tumor microenvironment (TME). These features drive profound T-cell dysfunction and maintain high resistance to current immunotherapy. By recapitulating the complex 3D architecture of human PDAC, we demonstrate the key immunosuppressive mechanisms that drive T-cell dysfunction within the tumor microenvironment. METHOD: 3D PDAC spheroids-generated fro…

Human pancreatic progenitor organoids define genetic and epigenetic barriers to early PDAC transformation.

Developmental cell · 2026 · PMID 42161274

The lack of accurate human models that recapitulate pancreatic ductal adenocarcinoma (PDAC) initiation has hindered therapeutic development. Using pluripotent stem cell-derived pancreatic progenitor organoids, we established a human PDAC model that faithfully reproduces the genetic, epigenetic, and transcriptomic trajectories of tumor initiation and progression, validated against clinical datasets and tumor histopathology. We demonstrate that CDKN2A loss, which is nearly universal in patients but dispensable in mou…

Antibody subclass deficiency accelerates tumorigenesis in genetically engineered mouse models of pancreatic cancer.

JCI insight · 2026 · PMID 42113908

Antibody production by B cells has emerged as an important factor in regulating antitumor immunity with both suppressive and promotive roles in cancer. However, the specific effect of antibody deficiency during development of pancreatic ductal adenocarcinoma (PDAC) has not been explored. To address this question, we crossed the well-established KPC mouse model to mice lacking all circulating immunoglobulin (Ig) due to genetic ablation of both Ig secretion and Ig class switching (KPC-μSAID mice). KPC-μSAID mice exhi…

Tumor organoids modeling reveals timed responses and interplay of radiotherapy and chemotherapy in pancreatic cancer.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2026 · PMID 41786221

PURPOSE: Model the therapeutic effects of chemotherapy, radiotherapy, and chemoradiotherapy to study the heterogeneous responses of patient-derived tumor organoids (PDTOs). METHODS: We proposed novel mathematical forecasting frameworks based on logistic growth ordinary differential equations (ODEs) and the characteristics of tumor responses to model the therapeutic effects of chemo- and radiation-induced killing. To validate the models, we cultured PDTOs from different patients and treated them with radiation (4 Gy…

Wnt-deficient and hypoxic environment orchestrates squamous reprogramming of human pancreatic ductal adenocarcinoma.

Nature cell biology · 2024 · PMID 39232216

Human pancreatic cancer is characterized by the molecular diversity encompassing native duct-like and squamous cell-like identities, but mechanisms underlying squamous transdifferentiation have remained elusive. To comprehensively capture the molecular diversity of human pancreatic cancer, we here profiled 65 patient-derived pancreatic cancer organoid lines, including six adenosquamous carcinoma lines. H3K27me3-mediated erasure of the ductal lineage specifiers and hijacking of the TP63-driven squamous-cell programm…

Elraglusib and chemotherapy in metastatic pancreatic ductal adenocarcinoma: a randomized controlled phase 2 trial.

Nature medicine · 2026 · PMID 41981308

Metastatic pancreatic ductal adenocarcinoma (mPDAC) is one of the leading causes of cancer-related mortality, but advances in therapeutic treatments remain limited. Elraglusib (9-ING-41), an inhibitor of GSK-3β, exhibits a multimodal mechanism of action based on antitumor activity in preclinical models of cancer, including pancreatic. The efficacy and safety of elraglusib with gemcitabine plus nab-paclitaxel (GnP) were assessed in patients with previously untreated mPDAC. In an open-label, international, multicente…

Evaluation of translational potential of mRNA vaccine candidate antigens for pancreatic cancer: a systematic review based on clinical evidence and stratified prioritization strategies.

Frontiers in immunology · 2026 · PMID 42131338

Pancreatic cancer is a highly aggressive malignancy with a 5-year relative survival rate of only 13%. Current treatment options have limited efficacy, and mRNA vaccines offer a new direction for its treatment. However, how to accurately identify antigen targets that possess tumor specificity, functional relevance, and immunogenicity remains the key bottleneck restricting the clinical translation of mRNA vaccines for pancreatic cancer. Recent clinical studies have advanced KRAS mutant vaccines and personalized neoan…

[177Lu]Lu-DOTATATE PRRT and CAPTEM chemotherapy for pancreas and small bowel neuroendocrine tumours: The AGITG CONTROL NETS Multi-centre randomized trial.

European journal of cancer (Oxford, England : 1990) · 2026 · PMID 42142431

BACKGROUND/AIM: To evaluate the efficacy of [177Lu]Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) plus capecitabine and temozolomide (CAPTEM) in participants(pts) with progressive WHO Grade 1-2 neuroendocrine tumours: pancreas(pNETs) and small bowel(SBNETs). METHODS: Non-comparative randomized open label parallel group phase II trial, 2:1 randomization to PRRT/CAPTEM (experimental arm) vs PRRT (SBNETs control) and CAPTEM (pNETs control). PRRT/CAPTEM: 7.8 GBq [177Lu]Lu-DOTATATE i.v. Day 10, 8 weekly x 4, c…

Second-line liposomal irinotecan plus S-1 vs. liposomal irinotecan plus 5-fluorouracil in metastatic pancreatic cancer: The phase I/II randomized NAPAN trial.

European journal of cancer (Oxford, England : 1990) · 2026 · PMID 41921365

BACKGROUND: This study aimed to determine the optimal second-line treatment strategy in patients with metastatic pancreatic cancer, hypothesizing that liposomal irinotecan (nal-IRI) combined with S-1 would be superior to nal-IRI with 5-fluorouracil (5-FU)/leucovorin (LV). METHODS: This was an international, multi-center, open-label, randomized phase I/II superiority trial. Patients with pancreatic adenocarcinoma, previously treated with gemcitabine-based treatment, were enrolled. Patients were randomly allocated to…

Failure to Undergo Resection Following Neoadjuvant Therapy for Resectable Pancreatic Cancer: A Secondary Analysis of SWOG S1505.

Journal of the National Comprehensive Cancer Network : JNCCN · 2024 · PMID 38688309

BACKGROUND: Neoadjuvant therapy (NT) is increasingly used for patients with pancreatic ductal adenocarcinoma (PDAC), and yet reasons for not undergoing subsequent pancreatectomy are poorly understood. Given the importance of completing multimodality therapy, we investigated factors associated with failure to undergo surgical resection following NT for PDAC. METHODS: SWOG S1505 was a multicenter phase II randomized trial of preoperative mFOLFIRINOX or gemcitabine/nab-paclitaxel prior to planned pancreatectomy for pa…

Nivolumab ± Ipilimumab in Patients With Pretreated Advanced Neuroendocrine Carcinoma: The GCO-001 NIPINEC Randomized Phase II Trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026 · PMID 41774886

PURPOSE: There is no standard second-line therapy for gastroenteropancreatic (GEP) and lung large-cell neuroendocrine carcinoma (NEC) after the failure of platinum-based chemotherapy. This study aimed to investigate the efficacy of nivolumab ± ipilimumab. METHODS: The GCO-001-NIPINEC (ClinicalTrials.gov identifier: NCT03591731) trial was a noncomparative, open-label, phase II trial. The main inclusion criteria were age ≥18 years, performance status (PS) ≤2, advanced large- and small-cell GEP-NEC and large-cell lung…

NALIRIFOX versus gemcitabine plus nab-paclitaxel in Chinese patients with advanced pancreatic adenocarcinoma: a randomized, open-label phase II trial.

Nature communications · 2026 · PMID 41545349

In this phase 2 study (NCT05047991), patients with unresectable metastatic pancreatic adenocarcinoma were randomized to receive NALIRIFOX (liposomal irinotecan, 5-FU, leucovorin, and oxaliplatin) or gemcitabine plus nab-paclitaxel. The primary endpoint was progression free survival (PFS). Secondary endpoints included other efficacy outcomes (overall survival, objective response rate, disease control rate, and duration of response), as well as safety, pharmacokinetic parameters, and evaluation of the relationship be…

A Randomized Trial of Nutrition and Exercise Treatment in Patients With Pancreatic and Non-Small Cell Lung Cancer (NEXTAC-TWO).

Journal of cachexia, sarcopenia and muscle · 2025 · PMID 40522817

BACKGROUND: In our previous study (NEXTAC-ONE), the Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) program (including home-based exercise and branched-chain amino acid-containing supplements combined with nutritional counselling) was shown to potentially prevent low muscle mass-related disability in elderly cancer patients. This randomized controlled trial (NEXTAC-TWO) was conducted to elucidate whether the NEXTAC program prolongs disability-free survival in elderly patients with advanced pancreatic …

Quemliclustat and chemotherapy with or without zimberelimab in metastatic pancreatic adenocarcinoma: a randomized phase 1 trial.

Nature medicine · 2026 · PMID 41912809

Quemliclustat potently inhibits CD73, a key enzyme producing immunosuppressive adenosine. In a phase 1b trial (ARC-8), we evaluated safety and efficacy of quemliclustat combined with gemcitabine/nab-paclitaxel (G/nP) with or without zimberelimab (anti-programmed cell death protein 1 (PD-1)) in first-line metastatic pancreatic ductal adenocarcinoma (PDAC). During the dose-escalation phase, 22 patients were enrolled across five dose levels of quemliclustat (25 mg, 50 mg, 75 mg, 100 mg or 125 mg) with G/nP + zimbereli…

Comparison of chemoradiotherapy and gemcitabine plus nab-paclitaxel for locally advanced pancreatic cancer: an integrated analysis of two randomized phase II trials (JCOG2408A).

BMC cancer · 2026 · PMID 41668051

BACKGROUND: Two main therapeutic approaches are currently used for locally advanced pancreatic cancer (LAPC): chemoradiotherapy and systemic chemotherapy. It remains unclear which approach may be more promising, or whether these strategies should be considered alternative or complementary therapeutic options in the management of LAPC. Clinical outcomes and safety were assessed for S-1 plus concurrent radiotherapy (S-1 + RT) and gemcitabine plus nab-paclitaxel (GnP) in patients with LAPC. METHODS: We conducted a poo…

Modified FOLFIRINOX with or Without Stereotactic Body Radiation in Locally Advanced Unresectable Pancreatic Cancer (SABER): A Randomized Open-Label Phase 2 Trial.

Annals of surgical oncology · 2026 · PMID 42098550

BACKGROUND: Prospective data on stereotactic body radiation therapy (SBRT) combined with modified 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) in patients with locally advanced unresectable pancreatic adenocarcinoma (PDAC) are limited. PATIENTS AND METHODS: The SABER trial was an open-label, randomized, phase 2 study. Patients with locally advanced, unresectable PDAC were eligible if they were suitable for SBRT with adherence to organ-at-risk constraints. Participants were randomized (1:1) …

[177Lu]Lu-dota-tate versus sunitinib in patients with metastatic progressive neuroendocrine tumours of the pancreas (OCLURANDOM): a randomised, controlled, phase 2 trial.

The Lancet. Oncology · 2026 · PMID 42225102

BACKGROUND: To our knowledge, no randomised trial with peptide receptor radionuclide therapy has been done in patients with metastatic pancreatic neuroendocrine tumours. We aimed to evaluate the antitumour activity and safety of [177Lu]Lu-dota-tate in this setting. METHODS: OCLURANDOM is a randomised, open-label, non-comparative, phase 2 trial conducted in ten academic centres in France. Patients aged 18 years and older with pretreated, progressive, somatostatin receptor-positive, metastatic pancreatic neuroendocri…

Atezolizumab and motixafortide, cobimetinib or simlukafusp alfa in pretreated advanced pancreatic cancer: phase I/IIb MORPHEUS-PDAC umbrella study.

The oncologist · 2026 · PMID 41741368

BACKGROUND: The MORPHEUS platform comprised multiple open-label, randomized, phase Ib/II trials to identify early signals with different treatment combinations across multiple cancers. MORPHEUS-PDAC (NCT03193190) evaluated atezolizumab combinations in pancreatic ductal adenocarcinoma (PDAC). We describe outcomes with atezolizumab plus either motixafortide, cobimetinib, or two simlukafusp alfa regimens. METHODS: Eligible patients with advanced, pretreated PDAC were randomized to receive second-line (2 L) atezolizuma…

Dosimetry Results from the Phase 1b/3 ACTION-1 Trial of [225Ac]Ac-DOTATATE (RYZ101) in Patients with Somatostatin Receptor-Expressing, Well-Differentiated GEP-NETs.

Journal of nuclear medicine : official publication, Society of Nuclear Medicine · 2026 · PMID 42242867

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are biologically and clinically heterogeneous tumors, most of which overexpress somatostatin receptors (SSTRs). The presence of SSTRs enables staging and allows patient selection for treatment with radiolabeled somatostatin analogs (SSAs), such as DOTATATE. [225Ac]Ac-DOTATATE is an α-emitting radiopharmaceutical in development for the treatment of patients with SSTR2-expressing solid tumors. α particles have a shorter path length and higher linear energy trans…

A randomized phase II trial of gemcitabine, nab-paclitaxel, cisplatin with or without a medically supervised ketogenic diet for patients with metastatic pancreatic cancer.

Cancer · 2026 · PMID 41817106

BACKGROUND: A randomized phase II screening trial of gemcitabine, nab-paclitaxel, and cisplatin with a medically supervised ketogenic diet (MSKD) versus usual diet (non-MSKD) was conducted in patients with treatment-naive metastatic pancreatic ductal adenocarcinoma (PDAC). METHODS: Patients with untreated metastatic PDAC were randomized 1:1 to MSKD or non-MSKD while receiving gemcitabine, nab-paclitaxel, and cisplatin on days 1 and 8 of a 21-day cycle. The MSKD was guided by a remote health care team and daily keto…

Serplulimab combined with gemcitabine, nab-paclitaxel, and stereotactic body radiotherapy versus gemcitabine and nab-paclitaxel as first-line treatment for recurrent or metastatic pancreatic ductal adenocarcinoma: a randomized, open-label, multicenter, phase III clinical trial (WGOG-PAN 006/ICSBR-2).

Frontiers in immunology · 2026 · PMID 42212134

BACKGROUND: Pancreatic ductal adenocarcinoma remains a malignancy with a dismal prognosis, characterized by a median overall survival of less than one year in the metastatic setting despite standard-of-care chemotherapy regimens like gemcitabine plus nab-paclitaxel. The PDAC tumor microenvironment is notoriously immunosuppressive, rendering single-agent immune checkpoint inhibitors largely ineffective. Stereotactic Body Radiotherapy has emerged as a potential strategy to induce immunogenic cell death and remodel th…

Metastatic tropism of molecularly defined clear-cell renal cell carcinoma clusters.

The Journal of clinical investigation · 2026 · PMID 42138077

BACKGROUNDThe relationship between molecular subgroups in clear-cell renal cell carcinoma (ccRCC) and metastatic tropism is poorly understood.METHODSWe analyzed over 5,000 metastatic sites from 305 treatment-naive ccRCC patients in the IMmotion150 phase II clinical trial, where patients were randomized to atezolizumab, atezolizumab/bevacizumab, or sunitinib.RESULTSAngiogenic tumors (clusters 1 and 2) had a higher rate of pancreatic (21% vs. 6.9%; P = 0.002) and lower absolute number of lymph node (2.5 vs. 4.2; P = …

DNA Repair gene alterations and efficacy from gemcitabine and nab-paclitaxel with/without durvalumab and tremelimumab in metastatic pancreatic ductal adenocarcinoma.

Nature communications · 2026 · PMID 41794844

The CCTG PA.7 study was a randomized phase II trial comparing chemotherapy with and without dual immune checkpoint inhibition in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC). In follow-up to the published primary results of the trial, the analysis herein focused on long-term survival and exploratory analysis.Plasma sequencing analysis identified concurrent mutations in DNA damage repair genes BRCA1, POLE, ATM and FANCA in 18/173 (10.40%) of patients, and presence of two or more mutations in the…

Open-Label, Phase II Trial of Extracellular Regulated Kinase Inhibition Alone and in Combination With Autophagy Inhibition in Patients With Metastatic Pancreatic Cancer.

JCO precision oncology · 2025 · PMID 40893054

PURPOSE: Oncogenic mutations in Kirsten rat sarcoma virus are present in over 90% of pancreatic ductal adenocarcinomas (PDACs). Preclinical data suggest that PDAC cells treated with inhibitors of the mitogen-activated protein kinase pathway demonstrate elevated autophagic flux. In this study, we evaluate the clinical efficacy of combining LY3214996 (extracellular regulated kinase inhibitor) with hydroxychloroquine (HCQ; autophagy inhibitor) in patients with metastatic PDAC. METHODS: Eligible patients had metastatic…

Fibroblast Activation Protein-Targeted Radiopharmaceutical Therapy Using 177Lu-, 90Y-, and 225Ac-Labeled 3BP-3940: First Experience in 21 Different Advanced Malignancies.

Journal of nuclear medicine : official publication, Society of Nuclear Medicine · 2026 · PMID 42225357

Fibroblast activation protein (FAP) is an attractive target for molecular precision imaging and therapy, given its specific tumor expression across various cancer types. We report first-in-human results using a FAP-targeted cyclic peptide, 3BP-3940, labeled with 177Lu, 90Y, and 225Ac for FAP-targeted radiopharmaceutical therapy (FRT) in patients with end-stage cancer. Methods: Eighty-eight patients with 21 distinct advanced metastatic solid tumor types received 227 cycles of 177Lu-, 90Y-, 225Ac-labeled 3BP-3940, ei…

Nab-paclitaxel plus S-1 induction chemotherapy for patients with locally advanced pancreatic cancer: a multicenter, open-label phase 2 study.

Signal transduction and targeted therapy · 2026 · PMID 42324245

Locally advanced pancreatic cancer (LAPC) is associated with a poor prognosis and limited therapeutic options. This study aimed to evaluate the efficacy and safety of nab-paclitaxel plus S-1 (SnP) as a first-line treatment in patients with previously untreated LAPC. In this multicenter, single-arm phase 2 trial conducted across four centers in China, eligible patients received up to eight cycles of nab-paclitaxel combined with S-1, followed by investigator-selected continuation strategies in the absence of disease …

A Phase II Trial of an Extended-Release siRNA Implant Targeting KRASG12D/V in Locally Advanced Pancreatic Cancer.

Clinical cancer research : an official journal of the American Association for Cancer Research · 2026 · PMID 41528981

PURPOSE: Locally advanced pancreatic cancer (LAPC) accounts for 30% of pancreatic cancers. We assessed the efficacy and safety of a novel extended-release siRNA targeting KRASG12D/V mutations (siG12D-LODER) combined with chemotherapy in LAPC. PATIENTS AND METHODS: This two-cohort, phase II multicenter, open-label study (NCT01676259) evaluated siG12D-LODER with chemotherapy in patients with LAPC, regardless of KRAS status. In cohort 1, patients were randomized to siG12D-LODER plus gemcitabine/nab-paclitaxel (arm 1) …

Adjuvant 5-fluorouracil and portal vein infusion chemotherapy followed by gemcitabine for pancreatic cancer.

Cancer medicine · 2024 · PMID 39030993

BACKGROUND: Although adjuvant gemcitabine (GEM) monotherapy improves the overall survival (OS) of patients with resected pancreatic cancer, its efficacy requires further improvement. This multicenter, phase II study investigated the efficacy of adjuvant portal vein infusion (PVI) chemotherapy followed by GEM therapy in patients with resected pancreatic cancer. METHODS: 5-fluorouracil (250 mg/day) and heparin (2000 IU/day) PVI chemotherapy were combined with systemic administration of mitomycin C (4 mg; days 6, 13, …

A Phase II Trial of Niraparib in Patients with Advanced Pancreatic Cancer Harboring Pathogenic Variants in ATM, BRCA1, BRCA2, PALB2, and CHEK2.

Clinical cancer research : an official journal of the American Association for Cancer Research · 2026 · PMID 41686836

PURPOSE: PARP inhibition has demonstrated efficacy in patients with platinum-sensitive pancreatic cancer with germline BRCA1/2 pathogenic variants (PV). Whether PARP inhibitors might be effective in a broader population of patients with pancreatic cancer remains under investigation. PATIENTS AND METHODS: This multicenter, open-label phase II trial (NCT03601923) enrolled patients with advanced pancreatic cancers who harbored germline or somatic BRCA1, BRCA2, PALB2, ATM, and/or CHEK2 PVs. Patients with prior progress…

Daraxonrasib in Previously Treated Advanced RAS-Mutated Pancreatic Cancer.

The New England journal of medicine · 2026 · PMID 42090791

BACKGROUND: Current therapies for patients with pancreatic ductal adenocarcinoma (PDAC) provide modest benefit. Activating RAS mutations occur in more than 90% of PDAC tumors. Daraxonrasib (RMC-6236) is an oral RAS(ON) multiselective inhibitor that targets guanosine triphosphate-bound mutant and wild-type RAS. METHODS: In this phase 1-2 study, we evaluated daraxonrasib in patients with advanced solid tumors with activating RAS mutations. Patients received 10 to 400 mg of daraxonrasib orally once daily; 300 mg was s…

pRECIST: Guidelines for Response Criteria for Use in Trials Testing Therapeutics in Pancreatic Cancer.

Pancreas · 2026 · PMID 41941588

IMPORTANCE: Pancreatic tumor response to treatment remains challenging and varies greatly. In order to establish a standardized approach to measuring and evaluating pancreatic tumor metabolic activity (MA), a consensus guideline called Pancreatic RECIST (pRECIST) was developed. This guideline is based on modified Response Evaluation Criteria in Solid Tumors (RECIST version 1.1), incorporating concurrent CT/PET scan quantitative assessments. OBJECTIVE: The aims were to ensure consistent design, data collection, and …

Association of dietary intake and serum levels of unsaturated fatty acids and risk of pancreatic cancer: A GRADE-assessed systematic review and dose-response meta-analysis of prospective cohort studies.

Cancer epidemiology · 2026 · PMID 42235418

Lifestyle and dietary factors contribute to about one-third of cancer deaths. The fatty acid composition in diets may be related to pancreatic cancer. A prior meta-analysis examining the connection between mono- and polyunsaturated fatty acid intake and pancreatic cancer risk has not investigated the dose-response relationship. This systematic review and dose-response meta-analysis aims to explore the association between dietary intake and serum levels of unsaturated fatty acids and the risk of pancreatic cancer in…

Prognostic and predictive values of transcriptomic signatures in metastatic pancreatic cancer: A biomarker analysis of three French multicenter prospective randomized controlled phase 2 trials (Prodige35, Prodige37 and AFUGEM).

Cancer letters · 2026 · PMID 42521075

To evaluate the clinical applicability of previously established transcriptomic signatures (molecular subtypes, components and GemPred status) in metastatic pancreatic cancer, we conducted a retrospective pooled analysis of 178 patients from three phase 2 trials (PRODIGE35/37, AFUGEM; 2013-2016) testing first-line regimens (FOLFIRINOX, GemNab, FuNab, FOLFIRI3). RNA sequencing was performed on primary/metastatic tumors across French centers, with blinded assessment of subtypes (immune classical, pure basal-like, str…

Reverse-Bevel (ProCore) EUS-Guided Fine-Needle Biopsy for Solid Pancreatic Mass Lesions: a GRADE-Assessed Systematic Review and Meta-Analysis of Prospective Randomized Trials.

Journal of gastrointestinal cancer · 2026 · PMID 42406286

BACKGROUND AND AIMS: Endoscopic ultrasound-guided tissue acquisition is used to diagnose pancreatic mass lesions, but optimal needle selection remains uncertain. Reverse bevel ProCore fine needle biopsy (FNB) needles aim to enhance histologic procurement and reduce sampling burden; randomized evidence versus standard fine needle aspiration (FNA) is limited. We synthesized randomized trials to compare diagnostic performance, efficiency, and safety. METHODS: We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, Sco…

Mediterranean Diet and Risk of Pancreatic Cancer-Is It Worth Investigating More? An Updated Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies.

Cancer medicine · 2026 · PMID 42608885

BACKGROUND: Despite previous meta-analysis studies on the association between adherence to the Mediterranean diet and risk of pancreatic cancer, there has not been a comprehensive and updated study reviewing all studies with inclusion criteria. Despite advances in cancer treatment and control, pancreatic cancer is still one of the deadliest malignancies, and the mortality rate is consistent with its prevalence. Therefore, this updated systematic review and dose-response meta-analysis study was conducted to examine …

Covered self-expandable metal stents in benign biliary strictures caused by chronic pancreatitis: a randomized controlled trial of 6 versus 12 months of stenting.

Surgical endoscopy · 2026 · PMID 42151467

BACKGROUND: In chronic pancreatitis (CP), a symptomatic benign biliary stricture (BBS) evolves as an adverse event in 3-30%. Treatment by ERCP with a single plastic biliary stent has been disappointing. Multiple plastic stents are more successful but make the procedure more time consuming than treatment with a fully covered self-expandable metal stent (fcSEMS). The most efficient stenting duration of BBS caused by CP is not known. The aim of this multicenter prospective randomized study was to compare the safety an…

Precipitation-based versus filtration-based liquid-based cytology in endoscopic ultrasound-guided fine-needle biopsy specimens of solid pancreatic masses: a prospective, randomized trial (with video).

Gastrointestinal endoscopy · 2026 · PMID 41223974

BACKGROUND AND AIMS: EUS-guided fine-needle biopsy (FNB) is the standard technique for diagnosing solid pancreatic masses, offering high histologic accuracy. However, adequate tissue acquisition can still be difficult in small or technically demanding lesions. Liquid-based cytology (LBC) may serve as a complementary tool to improve diagnostic yield. This study compared the diagnostic efficacy and cytomorphologic features of 2 LBC techniques-precipitation-based SurePath and filtration-based ThinPrep-using cytologic …

Modified FOLFIRINOX with or Without Stereotactic Body Radiation in Locally Advanced Unresectable Pancreatic Cancer (SABER): A Randomized Open-Label Phase 2 Trial.

Annals of surgical oncology · 2026 · PMID 42098550

BACKGROUND: Prospective data on stereotactic body radiation therapy (SBRT) combined with modified 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) in patients with locally advanced unresectable pancreatic adenocarcinoma (PDAC) are limited. PATIENTS AND METHODS: The SABER trial was an open-label, randomized, phase 2 study. Patients with locally advanced, unresectable PDAC were eligible if they were suitable for SBRT with adherence to organ-at-risk constraints. Participants were randomized (1:1) …

Mesopancreas excision in pancreatic ductal adenocarcinoma: recurrence patterns - a single-arm descriptive study.

World journal of surgical oncology · 2026 · PMID 42324571

BACKGROUND: Mesopancreas excision has emerged as a critical component of pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), potentially improving oncological outcomes. However, comprehensive data on recurrence patterns following mesopancreas excision remain limited. OBJECTIVE: To analyze recurrence patterns in patients with PDAC who underwent pancreaticoduodenectomy with mesopancreas excision at a tertiary care center in Egypt. METHODS: This single-arm, single-center, retrospective descriptive coh…

Intraoperative esketamine for postoperative analgesia and depression in pancreatic cancer surgery: protocol for a multicenter randomized controlled trial.

Annals of medicine · 2026 · PMID 42657795

INTRODUCTION: Patients undergoing pancreatic cancer surgery frequently experience severe postoperative pain and a high prevalence of depression. Esketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, offers rapid-onset analgesic and antidepressant properties, yet its efficacy in this high-risk population remains unknown. We hypothesize that intraoperative esketamine infusion improves multidimensional analgesic benefit and reduces postoperative depression compared with placebo. PATIENTS AND METHODS: This pr…

Laparoscopic versus open pancreaticoduodenectomy for non-pancreatic periampullary adenocarcinomas: study protocol for a multicentre randomised controlled trial in China.

BMJ open · 2026 · PMID 42409398

INTRODUCTION: Pancreaticoduodenectomy (PD) is the preferred surgical approach for resectable periampullary carcinomas. Non-pancreatic periampullary carcinomas (NPPC) demonstrate distinct biological behaviours and are generally less aggressive than pancreatic cancer. Despite over three decades of advancements, the role of laparoscopic PD (LPD) remains debated. Few studies have directly compared LPD and open PD (OPD) while accounting for tumour invasiveness, and the data specifically evaluating LPD vs OPD for NPPC ar…

The Concept of Biological Resectability in Pancreatic Ductal Adenocarcinoma - An Updated Narrative Review.

Annali italiani di chirurgia · 2026 · PMID 42610296

Resectability in pancreatic ductal adenocarcinoma (PDAC) has traditionally been defined according to tumor-vessel relationship on cross-sectional imaging. However, anatomical criteria alone fail to identify occult systemic disease and do not reliably predict early postoperative recurrence or the likelihood of meaningful oncological benefit from surgery. This structured narrative review evaluated contemporary evidence regarding biological resectability and the emerging role of biomarkers in perioperative decision-ma…

Impact of Hypertrophy-Oriented Resistance Training on Muscle Mass and Quality of Life in Patients with Unresectable Pancreatic Cancer (HY-PANC): Study Protocol for a Randomized Controlled Trial.

Current protocols · 2026 · PMID 42461827

BACKGROUND: Unresectable pancreatic cancer (PC) is characterized by a high prevalence of sarcopenia and cachexia, which negatively impact survival, treatment toxicity, and quality of life (QoL). Currently, evidence evaluating exercise programs in this vulnerable population is limited. METHODS: This prospective, two-arm randomized controlled trial (RCT) will recruit patients with unresectable PC undergoing chemotherapy. Participants will be randomized (1:1) to an intervention group (hypertrophy-oriented resistance t…

Deep learning-based CT model for non-invasive prediction of tertiary lymphoid structures in pancreatic cancer: a multicenter study with prospective validation in an immunochemotherapy cohort.

Journal for immunotherapy of cancer · 2026 · PMID 42731878

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies. Tertiary lymphoid structures (TLS) have emerged as key components of the tumor immune microenvironment, associated with improved survival and enhanced immunotherapy response. However, non-invasive detection of TLS remains a significant clinical challenge. OBJECTIVE: This multicenter study aimed to develop and validate a deep learning-based CT model to noninvasively predict TLS status and evaluate its prognostic and pred…

Prospective Phase II Trial of Biweekly Gemcitabine Plus Nab-Paclitaxel as First-Line Therapy in Patients Aged 75 Years and Older With Unresectable Pancreatic Cancer.

Cancer reports (Hoboken, N.J.) · 2026 · PMID 42735912

BACKGROUND: Although older adults (≥ 75 years) constitute a large proportion of patients with unresectable pancreatic cancer (PC), they remain underrepresented in clinical trials. Biweekly gemcitabine plus nab-paclitaxel (GnP) has been evaluated in retrospective studies as an alternative dosing schedule, whereas prospective evidence remains limited. AIMS: This single-center, prospective Phase II trial aimed to evaluate the efficacy and safety of biweekly GnP as a first-line therapy in older adults with unresectable…

PancDS in Real-World Practice: A Prospective Multicenter Validation of a Clinical Decision-Support System Bridging Experience Gaps in Pancreatic Lesion Diagnosis.

Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026 · PMID 42153997

Distinguishing pancreatic ductal adenocarcinoma (PDAC) from mass-forming pancreatitis (MFP) is challenging due to imaging mimicry and reader-dependent variability. PancDS is developed as a biomimetic pancreatic decision-support system that integrates clinical predictors, a radiomics signature, and self-developed deep features (PANet). PancDS is enabled by TriFusionNet, an adaptive fusion strategy designed to emulate expert reasoning by dynamically reweighting modalities according to diagnostic relevance. In a retro…

Semiannual surveillance facilitates detection of surgically treatable intraductal papillary mucinous neoplasm-derived and concomitant carcinoma: a multicenter prospective observational study.

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026 · PMID 42399187

BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN) is a well-recognized precursor of pancreatic cancer; however, the optimal surveillance strategy for IPMN remains controversial. This study aimed to evaluate the clinical impact of semiannual surveillance using endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) for the detection of malignant transformation, including IPMN-derived and concomitant carcinoma. METHODS: This multicenter prospective observational study included 360 patients with…

Development and internal validation of a clinical risk prediction model for pancreatic ductal adenocarcinoma in the UK Biobank.

European journal of cancer (Oxford, England : 1990) · 2026 · PMID 42068760

INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal cancers. Earlier identification through improved risk prediction modelling represents a promising strategy for improving PDAC outcomes. We developed a PDAC risk prediction model using routinely available clinical risk factors, including modifiable factors, to enable targeted screening. METHODS: Data from the UK Biobank, a prospective cohort of adults aged 40-69 years recruited between 2006 and 2010, were used to develop a PDAC risk…

Diagnostic yield of endoscopic ultrasound-guided fine-needle biopsy of solid pancreatic lesions with tissue sent directly in formalin for histopathologic evaluation compared with cytology: a multicenter prospective pilot study.

Gastrointestinal endoscopy · 2026 · PMID 41412424

BACKGROUND AND AIMS: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is widely used to evaluate solid pancreatic lesions (SPLs). Although, traditionally, samples are sent for cytopathologic evaluation in cytology media, histopathologic analysis may offer advantages in centers without on-site cytopathologists. METHODS: We conducted a multicenter, prospective study of EUS-FNB samples from patients with SPLs, submitted for histopathologic evaluation with macroscopic on-site evaluation (MOSE). Diagnostic accu…

Non-thermal focused ultrasound with FOLFIRINOX for borderline resectable or locally advanced pancreatic cancer: An explorative phase II trial.

European journal of cancer (Oxford, England : 1990) · 2026 · PMID 42335570

INTRODUCTION: FOLFIRINOX is standard chemotherapy for borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC), but response rates remain suboptimal. Mechanical effect-dominant non-thermal focused ultrasound (FUS) may enhance drug delivery. This study prospectively evaluated the safety and efficacy of FUS plus FOLFIRINOX in patients with BRPC or LAPC. METHODOLOGY: In this exploratory phase II trial (NCT05262452), participants with BRPC or LAPC received FUS plus FOLFIRINOX chemotherapy during the fi…

Quality of life and care experiences in a US multi-institutional neuroendocrine tumor cohort.

Journal of the National Cancer Institute · 2026 · PMID 41808486

BACKGROUND: Neuroendocrine tumors (NETs) are rare, heterogeneous neoplasms associated with prolonged survival and substantial symptom burden. However, patient-reported outcomes across NET subtypes remain poorly characterized, particularly in real-world settings. This study describes baseline health-related quality of life (HRQoL) and care experiences among patients with gastroenteropancreatic and lung NETs, examining differences by tumor site and time since diagnosis. METHODS: The Neuroendocrine Tumors-Patient Repo…

DNA/RNA-Based Next-Generation Sequencing Improves the Early Diagnosis and Management of Neoplastic Bile Duct Strictures: A 6-Year, Prospective, Multi-Institutional, Real-Time Study.

Gastroenterology · 2026 · PMID 41905432

BACKGROUND & AIMS: The distinction between benign and neoplastic bile duct strictures remains challenging. Pathologic assessment of endoscopic retrograde cholangiopancreatography (ERCP)-obtained specimens has limited sensitivity, particularly among patients with primary sclerosing cholangitis (PSC). Next-generation sequencing of bile duct specimens provides a promising diagnostic approach, but a prospective, multi-institutional, and comprehensive DNA/RNA analysis is lacking. METHODS: A 6-year, prospective, multi-in…

Surgical outcomes from nationwide implementation of the international best practice for locally advanced pancreatic cancer (PREOPANC-4) study.

The British journal of surgery · 2026 · PMID 42329186

BACKGROUND: In expert centres, surgical resection rates for patients with locally advanced pancreatic cancer (LAPC) after induction chemotherapy have increased beyond 20% with subsequent 25% 5-year overall survival (OS). In the Netherlands, however, the historical low 8% LAPC resection rate compared with 23% in international expert centres reflects a relative reluctance to perform resections. Thereby, opportunities to achieve long-term survival in appropriately selected patients may be missed. The aim of this study…

Cardiovascular-Kidney-Metabolic Syndrome Severity and Risk of Pancreatic Cancer in a Large Prospective Cohort.

Diabetes/metabolism research and reviews · 2026 · PMID 42549759

AIMS: Pancreatic cancer remains one of the most lethal malignancies due to late diagnosis and limited opportunities for prevention. Cardiovascular-kidney-metabolic (CKM) syndrome reflects the cumulative burden of metabolic, renal, and cardiovascular dysfunction, but its association with pancreatic cancer risk has not been well established. We investigated this relationship in a large prospective cohort from the UK Biobank. MATERIALS AND METHODS: Participants without pancreatic cancer at baseline (2006-2010) were fo…

Higher Daytime Light Exposure Predicts Lower Risk of Gastrointestinal Cancer Incidence and Mortality.

International journal of cancer · 2026 · PMID 42071269

Daytime light exposure is essential for health, primarily by synchronizing tissue and cellular-level clocks with the external light/dark cycle. Insufficient exposure may disrupt circadian alignment and contribute to adverse outcomes, including cancer. Given the high prevalence of gastrointestinal cancer, we conducted a prospective cohort study of 89,069 participants with objectively measured daytime light intensity and duration. Cox proportional hazards models were used to evaluate associations with gastrointestina…

Vitamin C as an Adjunctive Therapy in Cancer: A Systematic Review and Meta-Analysis of Outcomes in Solid and Hematologic Malignancies.

American journal of clinical oncology · 2026 · PMID 42507830

OBJECTIVES: Vitamin C has gained interest as an adjunctive treatment in oncology due to its antioxidant effects, potential to enhance cancer therapy, and ability to improve quality of life. This systematic review and meta-analysis aimed to assess the therapeutic impact of vitamin C in patients with solid and hematologic malignancies. METHODS: A comprehensive search was conducted in PubMed, Cochrane, Embase, ClinicalTrials.gov, and Google Scholar from inception to August 2025, in accordance with PRISMA guidelines. A…

Mistletoe extract in patients with advanced pancreatic cancer: Health-related quality of life in a double-blind, randomized, placebo-controlled trial (MISTRAL).

Palliative medicine · 2026 · PMID 42059487

BACKGROUND: Mistletoe extract is a widespread complementary therapy mainly used for quality-of-life improvement in cancer patients. Advanced pancreatic cancer is associated with poor quality of life and better therapies for symptomatic relief are highly needed. AIM: MISTRAL aimed to assess the impact of mistletoe extract on quality of life, body weight, observed costs and blood biomarkers in patients with advanced pancreatic cancer. DESIGN: MISTRAL was an investigator-initiated, phase III, randomized, double-blind,…

Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer.

The New England journal of medicine · 2026 · PMID 42223072

BACKGROUND: Current therapies offer limited benefit for patients with previously treated metastatic pancreatic ductal adenocarcinoma (mPDAC). Aberrant activation of the RAS pathway is the key driver of PDAC, with oncogenic RAS mutations present in more than 90% of cases. Daraxonrasib is an oral RAS(ON) multiselective, tri-complex inhibitor of the active guanosine triphosphate-bound state of mutant and wild-type RAS. METHODS: In this phase 3, international, open-label, randomized trial, we randomly assigned patients…

The Epidemiology of PRSS1 Hereditary Pancreatitis and Its Clinical Implications: A Systematic Review.

Pancreas · 2026 · PMID 42132515

OBJECTIVES: PRSS1-associated hereditary pancreatitis (HP) is a rare autosomal dominant disorder characterized by early disease onset. Although PRSS1 variants are recognized as pathogenic factors, the epidemiology and clinical phenotype of PRSS1 hereditary pancreatitis remain inconsistently reported. This systematic review consolidates current evidence to define the genetic landscape, clinical profile, and implications for diagnosis and management. METHODS: Following PRISMA guidelines, MEDLINE, EMBASE, and Cochrane …

Radiofrequency Ablation and Chemotherapy vs Chemotherapy Only in Locally Advanced Pancreatic Cancer: The PELICAN Randomized Clinical Trial.

JAMA network open · 2026 · PMID 41915391

IMPORTANCE: The poor prognosis and limited treatment options in patients with locally advanced pancreatic cancer (LAPC) highlight the need for novel therapies to increase survival. OBJECTIVE: To assess whether the addition of radiofrequency ablation (RFA) to chemotherapy improves survival when compared with chemotherapy only in patients with nonprogressive LAPC. DESIGN, SETTING, AND PARTICIPANTS: This international randomized clinical trial was performed from April 7, 2015, through December 6, 2022, in patients wit…

Second-line liposomal irinotecan plus S-1 vs. liposomal irinotecan plus 5-fluorouracil in metastatic pancreatic cancer: The phase I/II randomized NAPAN trial.

European journal of cancer (Oxford, England : 1990) · 2026 · PMID 41921365

BACKGROUND: This study aimed to determine the optimal second-line treatment strategy in patients with metastatic pancreatic cancer, hypothesizing that liposomal irinotecan (nal-IRI) combined with S-1 would be superior to nal-IRI with 5-fluorouracil (5-FU)/leucovorin (LV). METHODS: This was an international, multi-center, open-label, randomized phase I/II superiority trial. Patients with pancreatic adenocarcinoma, previously treated with gemcitabine-based treatment, were enrolled. Patients were randomly allocated to…

Depression as a potential early indicator of pancreatic cancer: a systematic review of prevalence, mechanisms, and temporal associations.

Journal of psychosocial oncology · 2026 · PMID 42246226

BACKGROUND: Pancreatic cancer (PC) remains one of the most lethal malignancies, with a five-year survival rate of only 12%, largely due to late diagnosis. Depression is frequently reported in PC and may precede its onset, yet underlying mechanisms remain unclear. AIMS: This systematic review examined (1) the prevalence of depression in PC, (2) potential psychological, clinical, and biological mechanisms, and (3) the temporality of depressive symptoms relative to PC diagnosis. METHODS: Following PRISMA guidelines, E…

[177Lu]Lu-dota-tate versus sunitinib in patients with metastatic progressive neuroendocrine tumours of the pancreas (OCLURANDOM): a randomised, controlled, phase 2 trial.

The Lancet. Oncology · 2026 · PMID 42225102

BACKGROUND: To our knowledge, no randomised trial with peptide receptor radionuclide therapy has been done in patients with metastatic pancreatic neuroendocrine tumours. We aimed to evaluate the antitumour activity and safety of [177Lu]Lu-dota-tate in this setting. METHODS: OCLURANDOM is a randomised, open-label, non-comparative, phase 2 trial conducted in ten academic centres in France. Patients aged 18 years and older with pretreated, progressive, somatostatin receptor-positive, metastatic pancreatic neuroendocri…

A randomized phase II trial of gemcitabine, nab-paclitaxel, cisplatin with or without a medically supervised ketogenic diet for patients with metastatic pancreatic cancer.

Cancer · 2026 · PMID 41817106

BACKGROUND: A randomized phase II screening trial of gemcitabine, nab-paclitaxel, and cisplatin with a medically supervised ketogenic diet (MSKD) versus usual diet (non-MSKD) was conducted in patients with treatment-naive metastatic pancreatic ductal adenocarcinoma (PDAC). METHODS: Patients with untreated metastatic PDAC were randomized 1:1 to MSKD or non-MSKD while receiving gemcitabine, nab-paclitaxel, and cisplatin on days 1 and 8 of a 21-day cycle. The MSKD was guided by a remote health care team and daily keto…

Robot-assisted versus open pancreatoduodenectomy for cancer in the pancreatic head (DIPLOMA-2x2): study protocol for an international multicentre patient- and assessor-blinded randomized controlled non-inferiority trial.

Trials · 2026 · PMID 42464359

BACKGROUND: Robot-assisted pancreatoduodenectomy (RPD) is increasingly performed for cancer in the pancreatic head. Randomised evidence confirming its oncological safety and efficacy is lacking. The DIPLOMA-2x2 trial aims to compare the oncological safety of RPD versus OPD in terms of radicality (microscopically radical resection [R0] resection). We hypothesise that RPD is non-inferior to OPD in terms of radicality and superior regarding time to functional recovery. METHODS: The DIPLOMA-2x2 trial is an investigator…

Trimodal Prehabilitation with Supervised Exercise during Neoadjuvant Chemotherapy in Localized Pancreatic Cancer.

Medicine and science in sports and exercise · 2026 · PMID 41430738

BACKGROUND: Pancreatic cancer (PC) is highly lethal, with surgery as the only curative option, but significant postoperative morbidity. Prehabilitation shows promise in other cancers, yet no trials have examined supervised exercise during neoadjuvant chemotherapy in PC. OBJECTIVES: The primary objective was to evaluate recruitment and adherence to a trimodal prehabilitation program during neoadjuvant chemotherapy in patients with nonmetastatic PC. Secondary aims included assessing changes in physical condition, fat…

Sequential alternation of nal-IRI/5-FU and gemcitabine/nab-paclitaxel versus nal-IRI/5-FU versus gemcitabine/nab-paclitaxel in first-line metastatic pancreatic cancer: results of the randomized phase II PRODIGE 61-FUNGEMAX trial (France).

EClinicalMedicine · 2026 · PMID 42256682

BACKGROUND: New chemotherapeutic approaches are still needed to improve survival and quality of life in metastatic pancreatic ductal adenocarcinoma (mPDAC). In the absence of validated predictive biomarkers, first-line sequential treatment strategies may allow to delay chemoresistance and reduce cumulative side effects. METHODS: PRODIGE 61-FUNGEMAX was an open-label, multicentre, randomised phase II trial conducted in 31 centres in France. Between November 2018 and January 2024, chemotherapy-naive patients aged 18-…

Digital cognitive-behavioral therapy for pain management in individuals with recurrent acute and chronic pancreatitis (IMPACT-2): study protocol for a hybrid effectiveness-implementation trial.

Trials · 2026 · PMID 41664170

BACKGROUND: Abdominal pain is a cardinal symptom of pancreatitis, present in up to 90% of patients with recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). Increases in pain severity and constancy are associated with significant morbidity including depression and anxiety symptoms, low physical functioning, sleep disturbance, and low quality of life, as well as high economic and societal burden. Our pilot study of digital cognitive-behavioral therapy (CBT) demonstrated preliminary efficacy in improving…

Multimodal Prehabilitation In Pancreatic cancer Patients undergoing surgery (PIPS): study protocol for a randomized controlled trial.

Trials · 2026 · PMID 41618415

BACKGROUND: Pancreatic cancer surgery is challenging and associated with up to a 70% complication rate, which translates to poor postoperative recovery and patient health-related quality of life (HRQoL). Previous studies showed that preoperative low functional capacity and malnutrition have been associated with inferior postoperative outcomes. Considering the high frequency of older and frail patients, often deconditioned by long-course neoadjuvant chemotherapy, the preoperative period, including the time window af…

Radical antegrade modular pancreatosplenectomy versus conventional left pancreatectomy for pancreatic cancer: study protocol for the multicentre randomized clinical RAMPS trial.

BJS open · 2025 · PMID 41649934

BACKGROUND: Complete surgical resection (R0 resection) is crucial for overall and disease-free survival in patients with pancreatic cancer undergoing curative surgery. The radical antegrade modular pancreatosplenectomy (RAMPS) procedure was developed to increase achievement of R0 resection margins for tumour resections of the pancreatic body and tail. By extending the posterior dissection plane, a more radical surgical resection can be achieved, as this is the most frequent site of positive margins in conventional …

Living With Advanced Pancreatic Cancer: Patients' Experiences of Daily Life.

Psycho-oncology · 2025 · PMID 40903211

BACKGROUND: Pancreatic cancer is often diagnosed in late stages of the disease with only a 10% 5-year survival. The disease is associated with complex symptoms and psychological distress. AIMS: The specific objective of this qualitative study was to explore patients' experiences of what symptoms and distress that had impact on their everyday life. METHODS: We interviewed 31 patients with advanced pancreatic cancer nested within a randomized controlled study, called MISTRAL, about their everyday life using a semi st…

Laparoscopic versus open pancreaticoduodenectomy for non-pancreatic periampullary adenocarcinomas: study protocol for a multicentre randomised controlled trial in China.

BMJ open · 2026 · PMID 42409398

INTRODUCTION: Pancreaticoduodenectomy (PD) is the preferred surgical approach for resectable periampullary carcinomas. Non-pancreatic periampullary carcinomas (NPPC) demonstrate distinct biological behaviours and are generally less aggressive than pancreatic cancer. Despite over three decades of advancements, the role of laparoscopic PD (LPD) remains debated. Few studies have directly compared LPD and open PD (OPD) while accounting for tumour invasiveness, and the data specifically evaluating LPD vs OPD for NPPC ar…

Pathogenesis, Diagnostic Pathways, and New Therapeutic and Nutritional Strategies for Pancreatic Cancer-Associated Cachexia.

Cancers · 2026 · PMID 41976282

Background/Objectives: Pancreatic cancer-associated cachexia (CAC) is a complex, multifactorial and multi-organ metabolic syndrome affecting approximately 80% of patients with pancreatic ductal adenocarcinoma (PDAC). Recent epidemiological data show that cachexia is a primary cause of mortality in PDAC, directly accounting for approximately 30% of cancer-related deaths and significantly limiting the tolerability of cancer therapy and is associated with adverse effects of treatment. It is defined by systemic weight …

Efficacy of intra-arterial [ 177 Lu]Lu-DOTATATE vs. continuation intravenous [ 177 Lu]Lu-DOTATATE peptide receptor radionuclide therapy in nonresponding locally advanced inoperable or liver-dominant metastatic gastroenteropancreatic neuroendocrine tumors.

Nuclear medicine communications · 2026 · PMID 42169550

BACKGROUND: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) demonstrating liver-dominant inoperable metastatic diseases or locally advanced inoperable tumors may at times show reduced efficacy for intravenous peptide receptor radionuclide therapy (PRRT). AIMS AND OBJECTIVES: To determine and compare the outcome of intra-arterial [ 177 Lu]Lu-DOTATATE PRRT in GEP-NET with locally advanced inoperable primary or liver-dominant metastases who had shown no response after at least two cycles of intravenous [ 177 L…

Nutritional Therapy in Pancreatic Cancer: Mechanisms, Clinical Applications, and Future Perspectives.

Nutrition and cancer · 2026 · PMID 42411702

BACKGROUND: Pancreatic cancer is frequently complicated by malnutrition, cancer cachexia, pancreatic exocrine insufficiency (PEI), and sarcopenia, all of which adversely affect treatment tolerance, quality of life, and survival. OBJECTIVE: To review the pathophysiology, assessment, and contemporary nutritional management of pancreatic cancer, with a focus on cachexia, PEI, body composition, and personalized nutritional care. METHODS: This narrative review summarizes evidence from clinical guidelines, randomized tri…

Impact of Hypertrophy-Oriented Resistance Training on Muscle Mass and Quality of Life in Patients with Unresectable Pancreatic Cancer (HY-PANC): Study Protocol for a Randomized Controlled Trial.

Current protocols · 2026 · PMID 42461827

BACKGROUND: Unresectable pancreatic cancer (PC) is characterized by a high prevalence of sarcopenia and cachexia, which negatively impact survival, treatment toxicity, and quality of life (QoL). Currently, evidence evaluating exercise programs in this vulnerable population is limited. METHODS: This prospective, two-arm randomized controlled trial (RCT) will recruit patients with unresectable PC undergoing chemotherapy. Participants will be randomized (1:1) to an intervention group (hypertrophy-oriented resistance t…

Use of liposomal irinotecan with 5-FU and oxaliplatin (NALIRIFOX) in neoadjuvant pancreatic adenocarcinoma: NEO-Nal-IRI trial.

The oncologist · 2026 · PMID 42371783

BACKGROUND: While neoadjuvant FOLFIRINOX is an effective regimen for pancreatic ductal adenocarcinoma (PDAC), toxicity frequently limits its use. Nanoliposomal irinotecan (nal-IRI) offers improved pharmacokinetic properties and may mitigate some of the side effects. We conducted a multi-institutional, phase II study to evaluate the safety and clinical activity of neoadjuvant NALIRIFOX (nal-IRI, 5-fluorouracil, leucovorin, and oxaliplatin) in patients with resectable and borderline resectable (R/BR) PDAC. METHODS: P…

High-Intensity Interval Training Boosts Immune Cells in Advanced Cancer Patients and Healthy Controls: Implications for Cancer Care.

Cancer medicine · 2026 · PMID 42233178

BACKGROUND: Regular exercise improves quality of life (QoL) and reduces fatigue in advanced cancer patients (ACP), but acute immune responses are underexplored. This study investigated the effects of a single high-intensity interval training (HIIT) session on natural killer (NK) cells and circulating innate lymphoid cells (cILCs) in ACP. METHODS: An ACP group undergoing chemotherapy (PG, n = 20, 59.8 ± 10.3 years, 70% pancreatic cancer) was compared with age-matched healthy controls (HG, n = 19, 60.7 ± 10.6 years).…

Correction: Impact of Hypertrophy-Oriented Resistance Training on Muscle Mass and Quality of Life in Patients with Unresectable Pancreatic Cancer (HY-PANC): Study Protocol for a Randomized Controlled Trial.

Current protocols · 2026 · PMID 42519871

Quality of life and care experiences in a US multi-institutional neuroendocrine tumor cohort.

Journal of the National Cancer Institute · 2026 · PMID 41808486

BACKGROUND: Neuroendocrine tumors (NETs) are rare, heterogeneous neoplasms associated with prolonged survival and substantial symptom burden. However, patient-reported outcomes across NET subtypes remain poorly characterized, particularly in real-world settings. This study describes baseline health-related quality of life (HRQoL) and care experiences among patients with gastroenteropancreatic and lung NETs, examining differences by tumor site and time since diagnosis. METHODS: The Neuroendocrine Tumors-Patient Repo…

Glucagon-like Peptide-1 receptor agonists are not associated with increased risk of pancreatic cancer: A systematic review and meta-analysis.

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026 · PMID 41991368

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for glucose control and weight management. Concerns have arisen regarding a potential association with pancreatic ductal adenocarcinoma (PDAC), though evidence remains conflicting. We performed a systematic review and meta-analysis to evaluate PDAC risk in GLP-1 RA users. METHODS: We included studies with ≥24 weeks of follow-up assessing PDAC incidence in patients treated with GLP-1 RAs. Eligible studies included adults with typ…

Prognostic and predictive values of transcriptomic signatures in metastatic pancreatic cancer: A biomarker analysis of three French multicenter prospective randomized controlled phase 2 trials (Prodige35, Prodige37 and AFUGEM).

Cancer letters · 2026 · PMID 42521075

To evaluate the clinical applicability of previously established transcriptomic signatures (molecular subtypes, components and GemPred status) in metastatic pancreatic cancer, we conducted a retrospective pooled analysis of 178 patients from three phase 2 trials (PRODIGE35/37, AFUGEM; 2013-2016) testing first-line regimens (FOLFIRINOX, GemNab, FuNab, FOLFIRI3). RNA sequencing was performed on primary/metastatic tumors across French centers, with blinded assessment of subtypes (immune classical, pure basal-like, str…

Reverse-Bevel (ProCore) EUS-Guided Fine-Needle Biopsy for Solid Pancreatic Mass Lesions: a GRADE-Assessed Systematic Review and Meta-Analysis of Prospective Randomized Trials.

Journal of gastrointestinal cancer · 2026 · PMID 42406286

BACKGROUND AND AIMS: Endoscopic ultrasound-guided tissue acquisition is used to diagnose pancreatic mass lesions, but optimal needle selection remains uncertain. Reverse bevel ProCore fine needle biopsy (FNB) needles aim to enhance histologic procurement and reduce sampling burden; randomized evidence versus standard fine needle aspiration (FNA) is limited. We synthesized randomized trials to compare diagnostic performance, efficiency, and safety. METHODS: We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, Sco…

Advancing precision immunotherapy in advanced pancreatic cancer: a systematic review and meta-analysis of first-line ICI-based combinations.

Frontiers in immunology · 2026 · PMID 42500667

OBJECTIVE: Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis. Immune checkpoint inhibitor (ICI) monotherapy has shown limited efficacy in PDAC, whereas the potential clinical value of first-line ICI-based combination regimens remains unclear. Through a systematic review and meta-analysis, this study aimed to evaluate the efficacy and safety of first-line ICI-based combination regimens in advanced PDAC. METHODS: PubMed, Embase, The Cochrane Library, Scopus, Web of Science, CNKI, Wanfang Data, V…

The outcomes of surgical resection versus ablation of liver metastases from neuroendocrine tumors: A systematic review.

Hepatobiliary & pancreatic diseases international : HBPD INT · 2026 · PMID 42177126

BACKGROUND: Neuroendocrine liver metastases (NLMs) from gastroenteropancreatic neuroendocrine tumors (GEP-NETs) significantly impact morbidity and mortality. While surgical resection remains the standard treatment, radiofrequency ablation (RFA) has emerged as an alternative for unresectable cases. This systematic review compared the oncological outcomes of surgical resection and RFA. DATA SOURCES: A systematic search of PubMed, Web of Science, and Scopus identified studies published between 2014 and 2025. Eligible …

Automated glucose control systems in post-pancreatectomy diabetes: systematic review of clinical efficacy and nursing care implications.

Minerva gastroenterology · 2026 · PMID 41801256

INTRODUCTION: Post-pancreatectomy diabetes (type 3c diabetes) is a frequent consequence of pancreatic cancer surgery and is characterized by extreme glycemic variability, high risk of severe hypoglycemia, and a substantial impact on quality of life and nursing workload. Technological solutions such as continuous glucose monitoring (CGM) and closed-loop insulin delivery may help address these challenges. EVIDENCE ACQUISITION: We conducted a systematic review according to the Cochrane Handbook 6.5 and PRISMA 2020 gui…

Activity and Physiological Stress Within 90 Days After Minimally Invasive and Open Pancreatoduodenectomy: A Predefined Analysis of the DIPLOMA-2 Randomized Clinical Trial.

JAMA surgery · 2026 · PMID 42160093

IMPORTANCE: Minimally invasive pancreatoduodenectomy (MIPD) aims to improve postoperative recovery compared with open pancreatoduodenectomy (OPD). However, it is unclear whether the benefits of MIPD extend beyond the initial hospital stay. OBJECTIVE: To assess postoperative recovery after hospital discharge-using activity tracking-in patients with upfront resectable neoplasm in the pancreatic head or periampullary region, comparing MIPD with OPD. DESIGN, SETTING, AND PARTICIPANTS: The patient-blinded DIPLOMA-2 rand…

Adjuvant Chemotherapy ± Chemoradiotherapy for Adenocarcinoma of the Pancreatic Head: Results of the Radiotherapy Random Assignment of NRG Oncology/RTOG 0848.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026 · PMID 42456089

PURPOSE: To assess whether adding fluoropyrimidine sensitized radiotherapy (CXRT) to adjuvant chemotherapy improves overall survival (OS) after curative intent resection of the pancreatic head. METHODS: This was a multicenter, randomized phase III, two step trial. Step 1: gemcitabine versus gemcitabine + erlotinib (previously reported). Step 2: random assignment to sixth chemotherapy cycle ± CXRT after five cycles of step 1 chemotherapy without progression. Outcomes of step 2 random assignment are reported here. As…

Impact of cytoreductive surgery with HIPEC in the treatment of pancreatic cancer with peritoneal carcinomatosis: A systematic review.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026 · PMID 42229165

Pancreatic cancer with peritoneal metastases is associated with a particularly poor prognosis under standard systemic therapy. This systematic review evaluates the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in this patient population, focusing on survival, recurrence, and treatment-related morbidity and mortality. Following PRISMA guidelines, a systematic search was conducted across MEDLINE, Web of Science, and SCOPUS. Study quality was assessed using the Methodologica…

Is there a role for early SSTR-targeting PRRT in GEP-NET?

European journal of nuclear medicine and molecular imaging · 2026 · PMID 42234009

PURPOSE: Peptide receptor radionuclide therapy (PRRT) with radiolabelled somatostatin analogues, such as [¹⁷⁷Lu]Lu-DOTATATE, is approved as a second-line treatment for progressive, gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, emerging evidence suggests potential earlier roles for PRRT. MATERIALS AND METHODS: A systematic review was conducted in accordance with the PRISMA guidelines, including case reports, original papers, and clinical trial protocols evaluating neoadjuvant, adjuvant, or first-…

Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA): Are We Getting Evidence-Based Results? A Systematic Review According to the Levels of Evidence.

Medicina (Kaunas, Lithuania) · 2026 · PMID 42512924

Background and Objectives: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an emerging minimally invasive therapeutic option for pancreatic and selected extra-pancreatic lesions. However, its clinical adoption is limited by heterogeneous indications, non-standardized techniques, and variable quality of evidence. This systematic review assessed the published literature on EUS-RFA and classified available evidence according to the Oxford Centre for Evidence-Based Medicine levels of evidence. Materia…

Vertical distribution of accessory canals in different tooth types: A systematic review and meta-analysis.

Journal of dentistry · 2026 · PMID 42492648

OBJECTIVE: To systematically analyze the vertical distribution of accessory canals and propose potential root-end resection levels in different tooth types. DATA: Proportional distribution of accessory canals (PD-AC) in 1 mm intervals, cumulative proportions within 2 mm and 3 mm (CP-AC0-2 and CP-AC0-3), mean distance from accessory foramen to root apex or main foramen (MD-AF), and prevalence of accessory canals in 2D cross-sections (PR-AC-2D). SOURCES: A systematic search of electronic databases was conducted throu…

Mistletoe extract in patients with advanced pancreatic cancer: Health-related quality of life in a double-blind, randomized, placebo-controlled trial (MISTRAL).

Palliative medicine · 2026 · PMID 42059487

BACKGROUND: Mistletoe extract is a widespread complementary therapy mainly used for quality-of-life improvement in cancer patients. Advanced pancreatic cancer is associated with poor quality of life and better therapies for symptomatic relief are highly needed. AIM: MISTRAL aimed to assess the impact of mistletoe extract on quality of life, body weight, observed costs and blood biomarkers in patients with advanced pancreatic cancer. DESIGN: MISTRAL was an investigator-initiated, phase III, randomized, double-blind,…

Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer.

The New England journal of medicine · 2026 · PMID 42223072

BACKGROUND: Current therapies offer limited benefit for patients with previously treated metastatic pancreatic ductal adenocarcinoma (mPDAC). Aberrant activation of the RAS pathway is the key driver of PDAC, with oncogenic RAS mutations present in more than 90% of cases. Daraxonrasib is an oral RAS(ON) multiselective, tri-complex inhibitor of the active guanosine triphosphate-bound state of mutant and wild-type RAS. METHODS: In this phase 3, international, open-label, randomized trial, we randomly assigned patients…

Impact of reinforced pancreaticojejunostomy with or without tissue adhesive glue modified cyanoacrylate following pancreaticoduodenectomy: a randomized controlled clinical trial.

World journal of surgical oncology · 2026 · PMID 42381068

BACKGROUND: Postoperative pancreatic fistula (POPF) remains the most significant complication following pancreaticoduodenectomy (PD). This randomized controlled trial evaluated the efficacy of reinforcing the pancreaticojejunostomy (PJ) with Glubran®2, a modified N-butyl-2-cyanoacrylate adhesive, in reducing the rate of clinically relevant POPF. METHODS: This single-center randomized controlled trial with blinded patients and blinded outcome assessors enrolled 100 consecutive patients undergoing open PD for pancrea…

[177Lu]Lu-DOTATATE PRRT and CAPTEM chemotherapy for pancreas and small bowel neuroendocrine tumours: The AGITG CONTROL NETS Multi-centre randomized trial.

European journal of cancer (Oxford, England : 1990) · 2026 · PMID 42142431

BACKGROUND/AIM: To evaluate the efficacy of [177Lu]Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) plus capecitabine and temozolomide (CAPTEM) in participants(pts) with progressive WHO Grade 1-2 neuroendocrine tumours: pancreas(pNETs) and small bowel(SBNETs). METHODS: Non-comparative randomized open label parallel group phase II trial, 2:1 randomization to PRRT/CAPTEM (experimental arm) vs PRRT (SBNETs control) and CAPTEM (pNETs control). PRRT/CAPTEM: 7.8 GBq [177Lu]Lu-DOTATATE i.v. Day 10, 8 weekly x 4, c…

Covered self-expandable metal stents in benign biliary strictures caused by chronic pancreatitis: a randomized controlled trial of 6 versus 12 months of stenting.

Surgical endoscopy · 2026 · PMID 42151467

BACKGROUND: In chronic pancreatitis (CP), a symptomatic benign biliary stricture (BBS) evolves as an adverse event in 3-30%. Treatment by ERCP with a single plastic biliary stent has been disappointing. Multiple plastic stents are more successful but make the procedure more time consuming than treatment with a fully covered self-expandable metal stent (fcSEMS). The most efficient stenting duration of BBS caused by CP is not known. The aim of this multicenter prospective randomized study was to compare the safety an…

Randomized phase III trial of gemcitabine plus nab-paclitaxel versus gemcitabine plus S-1 as neoadjuvant chemotherapy for resectable pancreatic cancer in geriatric patients: JCOG2101C (PRESTIGE study).

Japanese journal of clinical oncology · 2026 · PMID 41968990

Neoadjuvant gemcitabine plus S-1 (GS) followed by surgery and adjuvant S-1 is the standard of care for resectable pancreatic cancer. Since ~73% of newly diagnosed pancreatic cancer patients are aged ≥70, effective treatments are strongly needed in this geriatric population. In unresectable pancreatic cancer, gemcitabine plus nab-paclitaxel (GnP) is widely used, even among geriatric patients. To evaluate the survival advantage of neoadjuvant GnP over GS for geriatric patients with resectable pancreatic cancer, an op…

[177Lu]Lu-edotreotide versus everolimus for gastroenteropancreatic neuroendocrine tumours (COMPETE): a phase 3, multicentre, randomised, open-label, superiority trial.

Lancet (London, England) · 2026 · PMID 42392118

BACKGROUND: Peptide receptor radionuclide and targeted therapy are both approved treatment options for patients with metastatic gastroenteropancreatic neuroendocrine tumours (GEP NETs), but clinical evidence for preferred sequencing is scarce. The COMPETE trial evaluated the efficacy and harms of peptide receptor radionuclide therapy ([177Lu]Lu-edotreotide) versus targeted molecular therapy (everolimus) in patients with advanced, progressive, somatostatin receptor-positive GEP NETs. METHODS: This phase 3, open-labe…

Robotic versus Open Pancreatoduodenectomy (PORTAL): multicentre, single masked, phase 3, non-inferiority randomised controlled trial.

BMJ (Clinical research ed.) · 2026 · PMID 42386316

OBJECTIVE: To determine whether robotic pancreatoduodenectomy (RPD) is non-inferior to open pancreatoduodenectomy (OPD) in terms of postoperative functional recovery, without compromising safety or oncological quality. DESIGN: Multicentre, single masked, phase 3, non-inferiority randomised controlled trial. SETTING: Seven tertiary high volume pancreatic centres in China, 15 June 2020 to 28 November 2024. PARTICIPANTS: 268 adults with resectable pancreatic or periampullary disease. INTERVENTIONS: Participants were r…

Preoperative Biliary Drainage with Metal Stent Versus Early Surgery in Patients with Pancreatic Cancer: A Randomized Clinical Trial.

Annals of surgical oncology · 2026 · PMID 41951900

BACKGROUND: Among patients with pancreatic cancer and biliary obstruction planned for pancreaticoduodenectomy, preoperative biliary drainage (PBD) may be considered during surgical delays. Higher complication rates have been reported for PBD using plastic stents versus early surgery. PBD with a self-expanding metal stent (SEMS) has not been compared with early surgery in a randomized controlled trial (RCT). PATIENTS AND METHODS: We conducted a noninferiority RCT comparing PBD using a SEMS versus early surgery at 11…

Preoperative mFOLFIRINOX versus PAXG for stage I-III resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2 × 2 factorial phase 3 trial.

Lancet (London, England) · 2026 · PMID 41275879

BACKGROUND: Perioperative chemotherapy is a standard option for treatment of patients with resectable and borderline resectable pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the superiority of PAXG (cisplatin, nab-paclitaxel, capecitabine, and gemcitabine) over mFOLFIRINOX (modified fluorouracil, leucovorin, irinotecan, and oxaliplatin) in this population. METHODS: CASSANDRA is a randomised, open-label, 2 × 2 factorial phase 3 trial, involving 17 Italian academic hospitals. Eligible patients w…

Timing of Adjuvant S-1 Chemotherapy and Survival After Pancreatectomy for Pancreatic Cancer: An Ancillary Analysis of the JASPAC 01 Trial.

Journal of hepato-biliary-pancreatic sciences · 2026 · PMID 41999030

BACKGROUND: Relationship between timing of initiating adjuvant chemotherapy (AC) and clinical outcomes after surgery for pancreatic cancer remains controversial. METHODS: In this ancillary analysis of the JASPAC 01 trial, 187 patients were classified according to the interval between surgery and chemotherapy initiation to Early (< 6 weeks, n = 45), Standard (6-8 weeks, n = 70), and Delayed (> 8 weeks, n = 72). Overall survival (OS) and relapse-free survival (RFS) were analyzed. RESULTS: Baseline characteristics wer…

Co-Clinical Evaluation of Synthetic Vitamin D and Chemotherapy in Pancreatic Cancer by Integrated Imaging and Molecular Analyses.

Cancer research communications · 2026 · PMID 42574460

PURPOSE: A pilot clinical trial (NCT03519308) was conducted to evaluate perioperative chemotherapy [nab-paclitaxel, gemcitabine, and cisplatin (NGC)] plus nivolumab, with or without synthetic vitamin D (paricalcitol) in resectable pancreatic ductal adenocarcinoma (PDAC). Preclinical studies were designed with statistical power to match the experimental regimen and compare NGC only with NGC plus synthetic vitamin D [calcipotriol (Cal)] or losartan (Losa; an antihypertensive medication). MATERIALS AND METHODS: Molecu…

Development and Crossover Evaluation of an Artificial Intelligence-Assisted System for Solid Pancreatic Lesion Detection and Pancreatic Parenchyma Recognition in Endoscopic Ultrasonography (With Video).

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2026 · PMID 42720264

BACKGROUND AND STUDY AIMS: Pancreatobiliary endoscopic ultrasonography (EUS) is technically demanding, and supervised training opportunities are limited. We developed an artificial intelligence (AI) overlay system for detecting solid pancreatic lesions (SPL) and recognizing pancreatic parenchyma (PP) and evaluated its effect on reader performance. PATIENTS AND METHODS: Across six centers, two deep learning-based models were trained using expert-annotated EUS frames. We then conducted a randomized, two-sequence, two…

Endoscopic Sphincterotomy Prior to Biliary Stenting for Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Journal of gastroenterology and hepatology · 2026 · PMID 42694002

BACKGROUND AND AIMS: ERCP-guided biliary stenting is the usual palliative treatment for patients with unresectable malignant biliary obstruction (MBO). Previous studies suggested that ES prior to biliary stenting may not reduce the post-ERCP pancreatitis (PEP) risk and may increase bleeding risk. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of ES prior to biliary stenting in patients with MBO, with a particular focus on the impact of MBO etiology and stent type. METHODS: W…

Endoscopic Ultrasound-Guided Franseen Fine-Needle Biopsy for Solid Pancreatic Lesions: A Systematic Review and Meta-Analysis.

Digestive diseases and sciences · 2026 · PMID 42156629

INTRODUCTION: Accurate tissue acquisition (TA) of solid pancreatic lesions is essential for guiding treatment with endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) being the preferred method. Among FNB designs, the three-pronged Franseen-tip needle demonstrates strong diagnostic performance, though direct head-to-head comparisons with other FNB designs remain limited. METHODOLOGY: This meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251123856). Eligible studies enrolled pa…

Preoperative mFOLFIRINOX versus PAXG for stage I-III resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results of the first randomisation analysis of a randomised, open-label, 2 × 2 factorial phase 3 trial.

Lancet (London, England) · 2026 · PMID 41275879

BACKGROUND: Perioperative chemotherapy is a standard option for treatment of patients with resectable and borderline resectable pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the superiority of PAXG (cisplatin, nab-paclitaxel, capecitabine, and gemcitabine) over mFOLFIRINOX (modified fluorouracil, leucovorin, irinotecan, and oxaliplatin) in this population. METHODS: CASSANDRA is a randomised, open-label, 2 × 2 factorial phase 3 trial, involving 17 Italian academic hospitals. Eligible patients w…

Biomarker Analysis from Patients with Metastatic PDAC Treated with TGFβ Antibody NIS793 plus Abraxane + Gemcitabine versus Abraxane + Gemcitabine Alone in a Phase II, Open-Label, Randomized Study.

Clinical cancer research : an official journal of the American Association for Cancer Research · 2026 · PMID 42347868

PURPOSE: Transforming growth factor β (TGFβ) plays a dual role in cancer, acting as a tumor suppressor early in the disease but promoting progression and immune evasion when dysregulated. In pancreatic ductal adenocarcinoma (PDAC), TGFβ-driven desmoplasia fosters chemoresistance and immunosuppression, limiting therapeutic efficacy. NIS793, a fully human mAb targeting TGFβ, demonstrated antifibrotic and immunomodulatory activity in preclinical models and early-phase trials. PATIENTS AND METHODS: We conducted a rando…

Short-term versus long-course neoadjuvant chemotherapy for resectable and borderline resectable pancreatic ductal adenocarcinoma (PACT-21 CASSANDRA): results from the second randomisation analysis of a randomised, open-label, 2 × 2 factorial phase 3 trial.

EClinicalMedicine · 2026 · PMID 42733563

BACKGROUND: The first randomisation results from the PACT-21/CASSANDRA trial demonstrated that cisplatin, nab-paclitaxel, capecitabine, and gemcitabine (PAXG) is a standard neoadjuvant treatment option for resectable/borderline resectable (R/BR) pancreatic adenocarcinoma (PDAC). Here, we report the results of the second randomisation comparing long versus short pre-operative chemotherapy. METHODS: PACT-21/CASSANDRA was a 2 × 2 factorial phase 3 trial involving 17 academic hospitals across 10 regions in Italy. Eligi…

Intraoperative esketamine for postoperative analgesia and depression in pancreatic cancer surgery: protocol for a multicenter randomized controlled trial.

Annals of medicine · 2026 · PMID 42657795

INTRODUCTION: Patients undergoing pancreatic cancer surgery frequently experience severe postoperative pain and a high prevalence of depression. Esketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, offers rapid-onset analgesic and antidepressant properties, yet its efficacy in this high-risk population remains unknown. We hypothesize that intraoperative esketamine infusion improves multidimensional analgesic benefit and reduces postoperative depression compared with placebo. PATIENTS AND METHODS: This pr…

Efficacy and safety of a novel oral anti-vasculogenic mimicry agent, CVM-1118, in advanced well-differentiated neuroendocrine tumors: a Phase IIa trial.

British journal of cancer · 2026 · PMID 42393461

BACKGROUND: Highly vascularised neuroendocrine tumours (NETs) are attractive targets for foslinanib (CVM-1118), which disrupts vasculogenic mimicry and induces apoptosis via tumour necrosis factor receptor-associated protein 1. We evaluated the efficacy and safety of CVM-1118 in advanced NETs. METHODS: Patients with grades 1-2, well-differentiated lung, gastrointestinal, or pancreatic NETs, refractory or intolerant to one or more standard therapies and progressing within 6 months, received CVM-1118 (200-300 mg oral…

Prospective Phase II Trial of Biweekly Gemcitabine Plus Nab-Paclitaxel as First-Line Therapy in Patients Aged 75 Years and Older With Unresectable Pancreatic Cancer.

Cancer reports (Hoboken, N.J.) · 2026 · PMID 42735912

BACKGROUND: Although older adults (≥ 75 years) constitute a large proportion of patients with unresectable pancreatic cancer (PC), they remain underrepresented in clinical trials. Biweekly gemcitabine plus nab-paclitaxel (GnP) has been evaluated in retrospective studies as an alternative dosing schedule, whereas prospective evidence remains limited. AIMS: This single-center, prospective Phase II trial aimed to evaluate the efficacy and safety of biweekly GnP as a first-line therapy in older adults with unresectable…

Impact of GLP-1 receptor agonists on patients with intraductal papillary mucinous neoplasms: Study protocol for a multicentric cohort study.

PloS one · 2026 · PMID 42715243

AIM OF THE STUDY: Intraductal papillary mucinous neoplasms (IPMNs) are among the most common cystic pancreatic neoplasms, with a potential to progress to malignancy. The increasing prevalence of IPMNs, coupled with the widespread use of GLP-1 receptor agonists (GLP-1 RAs) for diabetes and obesity management, raises concerns about the safety of these medications in patients with preexisting pancreatic conditions. Despite their proven metabolic benefits, questions remain about their impact on pancreatic pathology. Th…

Surgical outcomes after robot-assisted versus laparoscopic pancreatoduodenectomy: multicentre propensity-matched comparison from the Italian Group of Minimally Invasive Pancreatic Surgery.

BJS open · 2026 · PMID 42742083

BACKGROUND: Minimally invasive approaches to pancreatoduodenectomy (PD) are increasingly being adopted worldwide. However, direct comparisons between laparoscopic PD (LPD) and robot-assisted PD (RPD) remain limited and inconclusive. This study aimed to compare perioperative outcomes between LPD and RPD within a national multicentre cohort. METHODS: This retrospective multicentre study included patients who underwent LPD or RPD at participating Italian centres within the Italian Group of Minimally Invasive Pancreas …

Oral KRAS G12D inhibitor GFH375 for previously treated advanced solid tumors with KRASG12D mutations: a phase 1 trial.

Nature medicine · 2026 · PMID 42745055

Kirsten rat sarcoma viral oncogene homolog (KRAS)G12D is the most prevalent RAS mutation in solid tumors, associated with poor prognosis, and occurs mainly in pancreatic ductal adenocarcinoma (PDAC), colorectal cancer (CRC) and non-small cell lung cancer (NSCLC). Here we evaluated GFH375, a compound that targets both 'ON' (GTP-bound) and 'OFF' (GDP-bound) states of KRASG12D proteins, in a phase 1 dose-escalation trial in patients with advanced solid tumors harboring the KRASG12D mutation. The primary endpoints were…

Synthetic long peptide and DNA personalized cancer vaccines induce robust neoantigen-specific T cell responses in pancreatic cancer.

Science advances · 2026 · PMID 42696575

Pancreatic ductal adenocarcinoma (PDAC) is unresponsive to standard immunotherapies despite harboring cancer neoantigens capable of eliciting T cell responses. We completed two phase 1 clinical trials (NCT03956056 and NCT03122106) evaluating safety and immunogenicity of synthetic long peptide (SLP) and DNA personalized cancer vaccines (PCVs). PCVs were administered after resection and adjuvant chemotherapy. Tumor/normal whole-exome sequencing, RNA sequencing, and pVACtools were used to identify and prioritize candi…

Impact of Neoadjuvant Approach and Tumor Response on Survival in Pancreatic Adenocarcinoma.

Journal of surgical oncology · 2026 · PMID 42693621

INTRODUCTION: Neoadjuvant therapy for pancreatic adenocarcinoma (PDAC) has evolved from single-agent to multi-agent approaches, largely informed by metastatic disease studies demonstrating improved survival; albeit at the price of increased toxicity. It remains unclear how response to varied neoadjuvant regimens impact survival. We hypothesized that tumor response to different neoadjuvant approaches reflects underlying tumor biology, and achieving a pathologic complete response (pCR) with single-agent neoadjuvant m…

Triplet chemotherapy with Gemcitabine, Nab-paclitaxel, and S-1 achieves high response and conversion rates in advanced pancreatic cancer: A multicenter phase II study (GeNeS1S trial).

European journal of cancer (Oxford, England : 1990) · 2026 · PMID 42748587

BACKGROUND: S-1 has demonstrated non-inferiority to gemcitabine (GEM) in overall survival (OS) in advanced pancreatic cancer and superiority in the adjuvant setting for resectable disease. This study evaluated the efficacy and safety of S-1 combined with GEM plus nab-paclitaxel (nPTX) in advanced pancreatic cancer. METHODS: This multicenter, single-arm, phase II study enrolled patients with previously untreated locally advanced, recurrent, or metastatic pancreatic cancer. Treatment consisted of GEM (600 mg/m²) and …

Early postoperative serum IL-6 may contribute to risk stratification for pancreas-specific complications after pancreatic resection.

Langenbeck's archives of surgery · 2026 · PMID 42742801

PURPOSE: IL-6 level in serum has been shown to have predictive value for postoperative infectious complications and prognostic value in acute pancreatitis. Evidence on its role after pancreatic resection is limited. The aim of the study was to analyse the predictive role of early postoperative serum IL-6 regarding complications after pancreatic resection. METHODS: A retrospective analysis of patients with pancreatic resection at a tertiary German centre was performed. All IL-6 values per patient within 48 h after r…

Parenchyma-sparing pancreatectomy for solid pseudopapillary neoplasm of the pancreas: A propensity-matched analysis.

Surgery · 2026 · PMID 42561640

BACKGROUND: The oncological equivalence of parenchyma-sparing pancreatectomy versus conventional resection for solid pseudopapillary neoplasm of the pancreas remains debated. This study compares perioperative and long-term outcomes between these approaches. MATERIALS AND METHODS: A retrospective study was conducted on patients undergoing solid pseudopapillary neoplasm resection at a high-volume center between June 2002 and August 2024. Propensity score matching (1:1) balanced baseline characteristics between groups…

Percutaneous abdominal lavage cytology screening reduces non-therapeutic laparotomy in patients with pancreatic cancer considered for curative-intent resection: A single-institutional retrospective study.

Surgery · 2026 · PMID 42551279

BACKGROUND: Assessing peritoneal cytology status is essential for determining the optimal treatment strategy in patients with pancreatic cancer. This study aimed to evaluate the safety and technical feasibility of percutaneous abdominal lavage cytology screening and its clinical utility in identifying patients unlikely to benefit from resection, thereby reducing nontherapeutic laparotomy. METHODS: We retrospectively analyzed 225 consecutive patients with pancreatic cancer referred for potential curative-intent rese…

Adjuvant FOLFIRINOX versus S-1 monotherapy for resected PDAC: retrospective real-world data.

Therapeutic advances in medical oncology · 2026 · PMID 42719505

BACKGROUND: Although modified FOLFIRINOX (mFOLFIRINOX) has improved survival in patients with resected pancreatic ductal adenocarcinoma (PDAC) in clinical studies, S-1 is also a treatment option with desirable efficacy and limited toxicity. We aimed to compare the efficacy and safety of adjuvant mFOLFIRINOX with those of S-1 monotherapy for PDAC. OBJECTIVES: This study aimed to compare the efficacy and safety of adjuvant mFOLFIRINOX versus S-1 monotherapy in resected PDAC. DESIGN: A retrospective real-world study. …

Safety and Diagnostic Performance of Pancreatic Duct Brushings for Detecting Pancreatic Cancer.

Pancreas · 2026 · PMID 42720991

OBJECTIVES: Pancreatic duct (PD) brush cytology (BC) and fluorescence in-situ hybridization (FISH) are viable techniques but underutilized due to limited data on their diagnostic accuracy for pancreatic malignancy and associated risks. This study evaluates the safety and diagnostic performance of BC, FISH, and their combination for detecting pancreatic malignancy. METHODS: A retrospective analysis was conducted on subjects undergoing endoscopic retrograde cholangiopancreatography (ERCP) PD brushings at a tertiary h…

Risk Factors for Peritonitis Associated With Endoscopic Ultrasound-guided Hepaticogastrostomy.

DEN open · 2027 · PMID 42602637

BACKGROUND AND OBJECTIVES: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative therapeutic option for unsuccessful endoscopic retrograde cholangiopancreatography in patients with malignant biliary obstruction. Procedure-related adverse events (AEs), such as bile leakage and peritonitis, can lead to prolonged hospitalization and delay the initiation of chemotherapy for underlying malignancies. This study aimed to identify factors associated with the development of peritonitis following EUS-H…

Portomesenteric Venous Thrombosis After Pancreatic Cancer Surgery With Venous Resection and Reconstruction: Timing, Incidence, and Risk Factors.

Annals of surgery · 2026 · PMID 39676646

OBJECTIVE: To investigate the incidence and risk factors of portomesenteric venous thrombosis (PVT) after pancreatic cancer surgery with portomesenteric venous resection (PVR). BACKGROUND: Pancreatic cancer surgery with PVR can be complicated by PVT, but the long-term associations, risk factors, and consequences of PVT have not been clearly elucidated. METHODS: This study included pancreatic cancer patients undergoing any type of pancreatic resection with PVR at the University of Colorado Hospital between January 2…

Clinical Outcomes of Reintervention After Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a Partially Covered Self-Expandable Metal Stent.

Digestive diseases and sciences · 2026 · PMID 42223542

BACKGROUND: Partially covered self-expandable metallic stents (PCSEMSs) used for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) provide favorable patency and low migration risk; however, reintervention (RI) remains challenging. OBJECTIVES AND METHODS: We retrospectively evaluated the outcomes of RI after EUS-HGS with PCSEMS placement in 108 patients with malignant biliary obstruction treated between January 2016 and December 2024. Causes of recurrent biliary obstruction (RBO), RI techniques, and post-RI…

Clinical efficacy of 2-week and 3-week albumin-bound paclitaxel therapy for advanced pancreatic cancer.

Future science OA · 2026 · PMID 41588563

OBJECTIVE: We aim to compare the clinical efficacy and safety of albumin-bound paclitaxel (nab-PTX) (125 mg/m2, q2w) for two weeks and (125 mg/m2, d1, d8, q3w) for three weeks in the first-line treatment of advanced pancreatic cancer. METHODS: The medical records of patients with advanced pancreatic cancer who received nab-PTX for 2 weeks and 3 weeks, combined with gemcitabine, from July 2018 to January 2023, were retrospectively analyzed. The efficacy and adverse reactions of the two groups of patients were compar…

Arteriography- and portography-guided vascular mapping for clustered electrode placement in pancreatic irreversible electroporation.

Diagnostic and interventional radiology (Ankara, Turkey) · 2026 · PMID 42740689

PURPOSE: To assess the feasibility, safety, and early imaging outcomes of an intraprocedural vascular mapping workflow integrating selective arteriography and/or portography to guide clustered electrode irreversible electroporation (IRE) for locally advanced pancreatic cancer (LAPC). METHODS: In this single-center retrospective study, 48 patients with LAPC underwent percutaneous IRE (August 2024-December 2025). Selective arteriography (97.9%) and portography (75.0%) delineated the peripancreatic vascular anatomy. C…

Chemotherapy-free phase 1/2 trial of HRS-4642 plus adebrelimab in previously treated metastatic KRAS G12D-mutant pancreatic cancer.

Cancer cell · 2026 · PMID 42748921

KRAS G12D mutations drive approximately 40% of pancreatic ductal adenocarcinoma (PDAC) cases and foster an immunosuppressive tumor microenvironment. This phase 1/2 trial (NCT06427239) evaluated HRS-4642, a selective KRAS G12D inhibitor, combined with the PD-L1 blockade adebrelimab in 48 pretreated patients with metastatic KRAS G12D-mutant PDAC. Dose escalation revealed no dose-limiting toxicities, establishing the recommended phase 2 dose (RP2D), and no treatment-related deaths occurred; hypercholesterolemia and an…

Thoracic Epidural Analgesia Is Not Associated With Improved Survival After Pancreatic Surgery: Long-Term Follow-Up of the Randomized Controlled PAKMAN Trial.

Anesthesia and analgesia · 2025 · PMID 38335141

BACKGROUND: Perioperative thoracic epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) are common forms of analgesia after pancreatic surgery. Current guidelines recommend EDA over PCIA, and evidence suggests that EDA may improve long-term survival after surgery, especially in cancer patients. The aim of this study was to determine whether perioperative EDA is associated with an improved patient prognosis compared to PCIA in pancreatic surgery. METHODS: The PAKMAN trial was an adaptive, pra…

Mistletoe extract in patients with advanced pancreatic cancer: Health-related quality of life in a double-blind, randomized, placebo-controlled trial (MISTRAL).

Palliative medicine · 2026 · PMID 42059487

BACKGROUND: Mistletoe extract is a widespread complementary therapy mainly used for quality-of-life improvement in cancer patients. Advanced pancreatic cancer is associated with poor quality of life and better therapies for symptomatic relief are highly needed. AIM: MISTRAL aimed to assess the impact of mistletoe extract on quality of life, body weight, observed costs and blood biomarkers in patients with advanced pancreatic cancer. DESIGN: MISTRAL was an investigator-initiated, phase III, randomized, double-blind,…

SLOG versus modified FOLFIRINOX as first-line treatment for advanced pancreatic cancer: A randomized phase II trial (TCOG T5217).

European journal of cancer (Oxford, England : 1990) · 2026 · PMID 41576645

OBJECTIVE: A multicenter, randomized phase II trial to compare two first-line triplet treatments for advanced pancreatic ductal adenocarcinoma (PDAC). METHODS: Patients with histologically confirmed advanced PDAC were randomized 1:1 to receive S-1/leucovorin plus oxaliplatin, and gemcitabine (SLOG) or modified FOLFIRINOX (mFOLFIRINOX). Tumor response was assessed every eight weeks. The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS), objective response rate (ORR)…

Comparison of clinical/histological outcomes according to puncture sites in endoscopic ultrasound-guided fine needle biopsy for large pancreatic masses: Multicenter randomized prospective pilot study.

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2025 · PMID 39090983

OBJECTIVES: There are no recommendations regarding the optimal puncture site in endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). This multicenter randomized prospective study compared the diagnostic accuracy and histological findings according to the sampling site for pancreatic masses larger than 3 cm. METHODS: Consecutive patients with pancreatic masses larger than 3 cm indicated for EUS-FNB were included in the study. Patients were randomly assigned to two groups for the initial puncture site (central …

Long-term oncological outcomes following algorithm-based care versus usual care for the early recognition and management of complications after pancreatic resection: a post-hoc analysis of a nationwide, stepped-wedge cluster-randomised trial.

The lancet. Gastroenterology & hepatology · 2026 · PMID 41662856

BACKGROUND: Studies have shown that severe postoperative complications after resection of pancreatic and periampullary cancer might have a negative effect on long-term oncological outcomes. The PORSCH trial showed that an algorithm for early recognition and minimally invasive management of complications after pancreatic resection significantly improved short-term clinical outcomes. The algorithm's effect on long-term survival remains to be determined. METHODS: Long-term oncological outcomes were evaluated post hoc …

Somatostatin Versus Octreotide for Prevention of Postoperative Pancreatic Fistula: The PREFIPS Randomized Clinical Trial: A FRENCH 007-ACHBT Study.

Annals of surgery · 2024 · PMID 38662619

OBJECTIVE: Pharmacological prevention of postoperative pancreatic fistula (POPF) after pancreatectomy is open to debate. The present study compares clinically significant POPF rates in patients randomized between somatostatin versus octreotide as prophylactic treatment. METHODS: Multicentric randomized controlled open study in patient's candidate for pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) comparing somatostatin continuous intravenous infusion for 7 days versus octreotid 100 μg, every 8 hours sub…

Effect of Laparoscopic and Open Pancreaticoduodenectomy for Pancreatic or Periampullary Tumors: Three-year Follow-up of a Randomized Clinical Trial.

Annals of surgery · 2024 · PMID 37965767

OBJECTIVE: This study aimed to estimate whether the potential short-term advantages of laparoscopic pancreaticoduodenectomy (LPD) could allow patients to recover in a more timely manner and achieve better long-term survival than with open pancreaticoduodenectomy (OPD) in patients with pancreatic or periampullary tumors. BACKGROUND: LPD has been demonstrated to be feasible and may have several potential advantages over OPD in terms of shorter hospital stay and accelerated recovery than OPD. METHODS: This noninferior…

Modified Fluorouracil, Leucovorin, Irinotecan, and Oxaliplatin or S-1, Irinotecan, and Oxaliplatin Versus Nab-Paclitaxel + Gemcitabine in Metastatic or Recurrent Pancreatic Cancer (GENERATE, JCOG1611): A Randomized, Open-Label, Phase II/III Trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2025 · PMID 40720715

PURPOSE: Modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) and nab-paclitaxel + gemcitabine are recommended as first-line treatments for metastatic pancreatic cancer. S-1, irinotecan, and oxaliplatin (S-IROX) demonstrated activity in a phase Ib trial in this population. Therefore, these three regimens were directly compared. METHODS: This randomized phase II/III trial was performed at 45 centers in Japan. Eligible patients age 20-75 years with an Eastern Cooperative Oncology Group perform…

Video Education Is an Acceptable Alternative to Pretest Genetic Counseling for Patients With Breast, Ovarian, Pancreatic, and Metastatic Prostate Cancer: Results From a Randomized Study.

JCO oncology practice · 2025 · PMID 40209136

PURPOSE: With increased demand for cancer genetic testing (GT), providers are exploring alternative service delivery models such as video education (VE). We compare the uptake of GT among 250 patients with breast, ovarian, pancreatic, or metastatic prostate cancer randomly assigned to receive either pretest VE or a pretest visit with a genetic counselor (GC). MATERIALS AND METHODS: Using a 3:1 ratio, 187 patients were randomly assigned to the VE arm and 63 patients to the GC arm. GT was arranged after participants …

Comparation of 5 ml and 10 ml Negative Pressures with Wet-suction Techniques for EUS-FNA of Solid Lesions: A Single-center Randomized Controlled Trial.

Journal of clinical gastroenterology · 2025 · PMID 38359147

BACKGROUND AND OBJECTIVES: The negative pressure selectable for the wet-suction technique remains uncertain. The aim was to investigate the quality of sampling and diagnostic accuracy with solid lesions by 5 mL and 10 mL negative pressure with wet-suction techniques. METHODS: This is a single-center, crossover, randomized controlled trial conducted with a random sampling technique. In all, 160 patients consecutively undergoing EUS-FNA for solid lesions were randomized in a ratio of 1:1 into 2 groups, the 5 mL and 1…

Outcome following pylorus resecting pancreaticoduodenectomy versus classical Whipple's pancreaticoduodenectomy: a randomised controlled trial.

HPB : the official journal of the International Hepato Pancreato Biliary Association · 2025 · PMID 39757070

OBJECTIVE: To compare pylorus resecting pancreaticoduodenectomy (PRPD) with classical pancreaticoduodenectomy (classical PD) in terms of short term outcomes. BACKGROUND: There is some evidence that Pylorus resecting PD (PRPD) is associated with lesser incidence of DGE when compared to pylorus preserving PD (PPPD). However, no study has previously compared PRPD with classical PD. METHODS: Patients requiring PD were randomly assigned to either PRPD or classical PD after intraoperative assessment to rule out metastase…

A Randomized Trial of Nutrition and Exercise Treatment in Patients With Pancreatic and Non-Small Cell Lung Cancer (NEXTAC-TWO).

Journal of cachexia, sarcopenia and muscle · 2025 · PMID 40522817

BACKGROUND: In our previous study (NEXTAC-ONE), the Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) program (including home-based exercise and branched-chain amino acid-containing supplements combined with nutritional counselling) was shown to potentially prevent low muscle mass-related disability in elderly cancer patients. This randomized controlled trial (NEXTAC-TWO) was conducted to elucidate whether the NEXTAC program prolongs disability-free survival in elderly patients with advanced pancreatic …

Early tumor shrinkage as a prognostic predictor in chemotherapy-naïve patients with locally advanced pancreatic cancer treated with modified FOLFIRINOX or gemcitabine plus nab-paclitaxel combination therapy: An exploratory analysis of JCOG1407.

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2024 · PMID 39060124

BACKGROUND: Early tumor shrinkage (ETS) is a prognostic predictor for patients treated with chemotherapy in colorectal cancer, although scarce studies evaluated its potential in locally advanced pancreatic cancer (LAPC). In this exploratory analysis of JCOG1407, a randomized phase II study comparing modified 5-fluorouracil, levofolinate, irinotecan, and oxaliplatin (mFOLFIRINOX) and gemcitabine plus nab-paclitaxel (GnP), we evaluated whether ETS can predict prognosis of patients with LAPC. METHODS: Of the 126 patie…

Trajectories of perioperative nutritional status in patients with pancreatic tumor after surgery in six months.

European journal of oncology nursing : the official journal of European Oncology Nursing Society · 2024 · PMID 39288676

PURPOSE: To characterize subgroups with similar nutritional status trajectories during the 6-month period after pancreatectomy and to identify demographic and clinical characteristics influencing changes in nutritional status in each subgroup. METHODS: This longitudinal prospective study recruited 112 patients with newly diagnosed pancreatic tumor from an outpatient pancreatic surgical department of a medical center in northern Taiwan between September 2016 and April 2019. Patients completed a demographic and clini…

Effects of the superior mesenteric artery approach versus the no-touch approach during pancreatoduodenectomy on the mobilization of circulating tumour cells and clusters in pancreatic cancer (CETUPANC): randomized clinical trial.

BJS open · 2024 · PMID 39485887

BACKGROUND: Patients with pancreatic ductal adenocarcinoma present early postoperative systemic metastases, despite complete oncological resection. The aim of this study was to assess two pancreatoduodenectomy approaches with regard to intraoperative circulating tumour cells and cluster mobilization and their potential association with the development of distant metastasis. METHODS: Patients with periampullary tumours who underwent open pancreatoduodenectomy were randomly allocated to either the no-touch approach o…

Sequential nutrition intervention guided by nutritional risk screening improves outcomes following CyberKnife radiotherapy for pancreatic cancer: A randomized controlled trial.

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2025 · PMID 40783360

INTRODUCTION: Nutritional status may determine the outcomes of patients with pancreatic cancer. This study aimed to investigate the value of sequential nutrition intervention guided by nutritional risk screening for patients undergoing CyberKnife radiotherapy for pancreatic cancer. METHODS: A total of 100 patients with pancreatic cancer were enrolled and randomly divided into a control group (n = 50) and a nutrition intervention group (n = 50). Nutritional status, immunity, QoL, and postoperative complications were…

MRI-guided stereotactic ablative body radiotherapy versus CT-guided percutaneous irreversible electroporation for locally advanced pancreatic cancer (CROSSFIRE): a single-centre, open-label, randomised phase 2 trial.

The lancet. Gastroenterology & hepatology · 2024 · PMID 38513683

BACKGROUND: Pancreatic ductal adenocarcinoma is an aggressive disease with a dismal prognosis. Stage III locally advanced pancreatic cancer is considered unresectable and current palliative chemotherapy regimens only modestly improve survival. Guidelines suggest chemoradiation or stereotactic ablative body radiotherapy (SABR) could be beneficial in certain circumstances. Other local treatments such as irreversible electroporation could enhance patient outcomes by extending survival while preserving quality of life.…

Long-term outcomes of prophylactic right-half dissection of the superior mesenteric artery nerve plexus in pancreatoduodenectomy for pancreatic ductal adenocarcinoma: five-year results from a randomized phase II trial.

Surgery today · 2025 · PMID 40380996

PURPOSES: In pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), Prophylactic right-half dissection of the superior mesenteric artery (SMA) nerve plexus has been attempted in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. In this study, we evaluated the significance of prophylactic right-half dissection of the SMA nerve plexus by extending the observation period to 5 years. METHODS: From April 2014 to June 2018, 74 patients with PDAC in the pancreatic head were randomly assigned to e…

A Randomized Controlled Trial of Mindfulness Meditation Combined With BrainLink Intelligent Biofeedback Instrument on Pancreatic Cancer Patients Under Chemotherapy.

Brain and behavior · 2024 · PMID 39711061

BACKGROUND: Adjuvant chemotherapy can promote the 5-year overall survival rate of pancreatic cancer (PC) patients to 16%-21%. However, the negative emotions of patients, such as anxiety, are usually omitted. Moreover, their disease burden concentrates on pain symptoms, seriously affecting the quality of life of patients. How to improve the negative emotions of PC patients, alleviate their pain, and ameliorate their quality of life has become an urgent issue. OBJECTIVE: To explore the effect of mindfulness meditatio…

Endoscopic ultrasound (EUS) elastography-guided fine-needle aspiration cytology (FNAC) versus conventional EUS FNAC for solid pancreatic lesions: A pilot randomized trial.

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2025 · PMID 39230660

BACKGROUND: Endoscopic ultrasound guided fine-needle aspiration (EUS FNA) is the first-line modality to diagnose suspected solid pancreatic malignant lesions. Elastography-guided FNA has been shown to improve the diagnostic yield of EUS FNA but prospective studies are limited. The aim of the study was to compare diagnostic accuracy, sensitivity and specificity of conventional and elastography-guided EUS FNA in patients with suspected malignant pancreatic solid masses. METHODS: Patients with suspected malignant soli…

Digital subtraction angiography-guided pancreatic arterial infusion of GEMOX chemotherapy in advanced pancreatic adenocarcinoma: a phase II, open-label, randomized controlled trial comparing with intravenous chemotherapy.

BMC cancer · 2024 · PMID 39095759

BACKGROUND: Advanced pancreatic adenocarcinoma lacks effective treatment options, and systemic gemcitabine-based chemotherapy offers only marginal survival benefits at the cost of significant toxicities and adverse events. New therapeutic options with better drug availability are warranted. This study aims to evaluate the safety and efficacy of digital subtraction angiography (DSA)-guided pancreatic arterial infusion (PAI) versus intravenous chemotherapy (IVC) using the gemcitabine and oxaliplatin (GEMOX) regimen i…

Splanchnic nerve block via transdiscal and paraspinal approach in the treatment of pain in advanced pancreatic cancer: A randomized controlled trial.

Medicine · 2025 · PMID 40988238

BACKGROUND: This randomized controlled clinical trial aims to assess the clinical effect of splanchnic nerve block through transdiscal and paraspinal approaches in treating pain from advanced pancreatic cancer. METHODS: Patients with progressive pancreatic cancer pain who were treated in the Pain Department of the First Affiliated Hospital of Nanchang University from December 2021 to March 2023 were selected. According to the inclusion and exclusion criteria, 34 patients were randomly divided into a transdiscal gro…

Blumgart Anastomosis Versus Invaginating Pancreatogastrostomy for Reconstruction after Pancreatoduodenectomy: A Randomized Controlled Trial.

Annals of surgery · 2025 · PMID 40747945

OBJECTIVE: To compare postoperative pancreatic fistula (POPF) rates between Blumgart anastomosis (BA) and invaginating pancreatogastrostomy (PG) after pancreatoduodenectomy (PD). BACKGROUND: POPF rates after PD are still high. The only modifiable factor available to improve POPF is the anastomotic technique. BA and PG anastomoses have been previously shown to be feasible and safe, but they have never been compared in a randomized trial. METHODS: A multicenter, randomized, controlled trial was conducted in 13 Univer…

Contrast-enhanced endoscopic ultrasound versus conventional endoscopic ultrasound-guided fine-needle biopsy with macroscopic on-site evaluation for solid pancreatic lesions: a multicenter randomized trial.

Gastrointestinal endoscopy · 2026 · PMID 41135907

BACKGROUND AND AIMS: Although contrast-enhanced EUS (CE-EUS) has been suggested to improve the diagnostic yield of EUS-guided fine-needle aspiration (FNA) of solid pancreatic lesions (SPLs), multicenter data to inform its use in fine-needle biopsy (FNB) remain scarce. This multicenter randomized trial aims to compare the diagnostic performance of CE-EUS and conventional EUS-guided FNB with macroscopic on-site evaluation (MOSE) for SPLs. METHODS: Consecutive patients with SPLs ≥1 cm from 3 referral centers (Hong Kon…

Randomized trial comparing the Franseen needle versus 2 types of sharpened-tip 3-prong needles in EUS-guided tissue acquisition from solid pancreatic lesions.

Gastrointestinal endoscopy · 2025 · PMID 40120866

BACKGROUND AND AIMS: EUS-guided tissue acquisition (EUS-TA) is crucial for diagnosing pancreatic diseases. Recently, 2 novel types of sharpened-tip, 3-prong fine-needle biopsy (FNB) needles, the Trident needle (Micro-Tech Endoscopy, High Wycombe, UK) and the 3-point needle (TopGain; MediGlobe, London, UK), were developed to improve puncture performance. In this study, these novel needles were compared with the conventional Franseen needle in EUS-TA from solid pancreatic lesions (SPLs). METHODS: In this prospective,…