Pancreatic Cancer
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Jun 01 – Jun 08, 2026
Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer.
NEW ENGL J MED · Q1 JOURNAL - RANK #2/332TOP-TIER
This phase 3, international, open-label randomized trial evaluated daraxonrasib versus chemotherapy in patients with previously treated metastatic pancreatic ductal adenocarcinoma (mPDAC). A total of 500 participants were randomized, with 91.8% harboring G12 mutations, to receive either daraxonrasib or chemotherapy. Daraxonrasib significantly improved median overall survival (13.2 months vs. 6.6 months in the G12 population, HR: 0.40, P<0.001) and progression-free survival (7.3 months vs. 3.5 months in the G12 population, HR: 0.45, P<0.001). Adverse events occurred in all patients in the daraxonrasib group and 97.7% of the chemotherapy group, with fewer treatment-related discontinuations in the daraxonrasib group (1.2%) compared to the chemotherapy group (11.2%).
10.1056/NEJMoa2605555
May 25 – Jun 01, 2026
Gemcitabine and nab-paclitaxel with or without the VDR agonist paricalcitol for metastatic pancreatic cancer: a randomized, multiarm, run-in phase trial.
NAT CANCER · Q1 JOURNAL - RANK #11/326TOP-TIER
This randomized, multiarm, run-in phase trial evaluated the safety and pharmacodynamic effects of adding the VDR agonist paricalcitol to gemcitabine and nab-paclitaxel (GA) in 36 patients with metastatic pancreatic cancer. Patients were randomized to GA plus placebo, GA plus intravenous paricalcitol, or GA plus oral paricalcitol, with pretreatment and on-treatment tumor biopsies analyzed. Paricalcitol was safely administered, though 42% of oral paricalcitol recipients experienced grade 2-4 hypercalcemia requiring dose reduction. On-treatment biopsies showed decreased αSMA+ fibroblasts, altered fibroblast VDR activation, increased CD8+ T cell density and spatial colocalization with tumor cells, and VDR expression predicted tumor response in paricalcitol arms.
10.1038/s43018-026-01165-8
May 11 – May 18, 2026
Efficacy and safety of surufatinib and sintilimab with or without chemotherapy for advanced high-grade neuroendocrine neoplasms and pancreatic cancer.
NPJ PRECIS ONCOL · Q1 JOURNAL - RANK #39/326
This phase II clinical trial evaluated the efficacy and safety of surufatinib plus the PD-1 inhibitor sintilimab, with or without chemotherapy, in 51 patients with advanced high-grade neuroendocrine carcinoma (NEC), neuroendocrine tumor grade 3 (NET G3), or pancreatic cancer (PC). The primary endpoint was progression-free survival (PFS), while secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety. In the NEC cohort, first-line therapy yielded a median PFS of 7.6 months, median OS of 14.3 months, and an ORR of 65.0%; outcomes were less favorable for NET G3 (mPFS 6.8 months) and PC (mPFS 2.1 months) cohorts. The study concluded that surufatinib plus sintilimab, with or without chemotherapy, demonstrated encouraging efficacy and manageable safety across these malignancies.
10.1038/s41698-026-01478-y
The SHERPA trial: A phase I study combining SHP2 inhibitor RMC-4630 and ERK inhibitor LY3214996 in patients with KRAS-mutant pancreatic, non-small cell lung and colorectal cancer.
EUR J CANCER · Q1 JOURNAL - RANK #45/326
SHP2 inhibitor RMC-4630 plus ERK inhibitor LY3214996 were tested in a phase I 3+3 dose-escalation trial of 24 patients with KRAS-mutant pancreatic, non-small cell lung, or colorectal cancer. The primary objective was determining the recommended phase 2 dose (RP2D), with patients receiving RMC-4630 weekly and LY3214996 daily in 28-day cycles. Dose-limiting toxicities at three of four dose levels included grade 3 thrombocytopenia, grade 2 decreased left ventricular ejection fraction, and grade 3 acute kidney injury and diarrhea. Insufficient drug exposure was reached due to toxicity, no radiological responses were observed, and the trial was discontinued without establishing an RP2D.
10.1016/j.ejca.2026.116782
May 04 – May 11, 2026
Modified FOLFIRINOX with or Without Stereotactic Body Radiation in Locally Advanced Unresectable Pancreatic Cancer (SABER): A Randomized Open-Label Phase 2 Trial.
ANN SURG ONCOL · Q1 JOURNAL - RANK #39/312
This open-label, randomized, phase 2 trial (SABER) assessed modified FOLFIRINOX (mFOLFIRINOX) with or without stereotactic body radiation therapy (SBRT) in patients with locally advanced unresectable pancreatic adenocarcinoma. Thirty-seven of a planned 92 participants were randomized to mFOLFIRINOX+SBRT or mFOLFIRINOX alone; SBRT (35 Gy in five fractions) was given within the first four cycles, and primary endpoint was 1-year progression-free survival (PFS). Median PFS was 14.0 months for mFOLFIRINOX+SBRT versus 11.7 months for mFOLFIRINOX, with 1-year PFS rates of 66.7% vs 45.1%, median OS 28.9 vs 28.1 months, and comparable safety profiles. SBRT was feasible and improved 1-year PFS and local control numerically, though study limitations warrant cautious interpretation.
10.1245/s10434-026-19762-3
Perioperative NALIRIFOX in patients with resectable pancreatic ductal adenocarcinoma: updated analysis of survival and circulating and genetic biomarkers from the phase II nITRO trial.
ESMO OPEN · Q1 JOURNAL - RANK #36/326
The nITRO trial is a prospective, single-arm phase II clinical trial evaluating perioperative NALIRIFOX in patients with resectable pancreatic ductal adenocarcinoma (PDAC). After a median follow-up of 50.2 months, median overall survival (mOS) was 32 months in the intent-to-treat population and 48 months in resected patients. High baseline TNF-α levels were associated with reduced treatment response (P=0.022) and survival (P=0.014), while germline pathogenic variants in DDR/tumor suppressor genes, present in 36.2% of patients, correlated with improved outcomes. This study confirms the activity of perioperative NALIRIFOX and supports biomarker-driven patient stratification for personalized perioperative strategies.
10.1016/j.esmoop.2026.106964
Favorable safety outcomes of a perioperative propranolol and etodolac regimen in cancer patients in four randomized controlled trials.
FRONT PHARMACOL · Q1 JOURNAL - RANK #51/352
This study describes four small prospective, randomized controlled trials of perioperative propranolol and etodolac in 148 breast, colorectal, and pancreatic cancer patients. The regimen started 5 days before surgery and continued up to 30 days postoperatively, with propranolol titrated from 20 mg b.i.d to 80 mg b.i.d on surgery day and similarly adjusted later, while 400 mg b.i.d of etodolac was maintained. The primary endpoints were perioperative safety outcomes (AEs up to 30 days and 16 blood indices), showing manageable side effects such as bradycardia (12% in treated) and some changes in blood markers that did not remain significant after FDR correction. The secondary outcome indicated an improvement in 8-year DFS for CRC patients (2/15 vs. 9/18, p=0.034), suggesting the potential long-term efficacy of this combination therapy.
10.3389/fphar.2026.1823113
First-line nanoparticle polymeric micellar paclitaxel with gemcitabine in metastatic pancreatic cancer: a single-arm, prospective, and exploratory study.
GASTROENTEROL REP · Q1 JOURNAL - RANK #32/147
This single-arm, prospective, exploratory study evaluated the efficacy and safety of nanoparticle polymeric micellar paclitaxel (pm-Pac) combined with gemcitabine as first-line treatment for metastatic pancreatic cancer (mPC) in 21 patients. The primary endpoint was progression-free survival (PFS), with a median PFS of 7.4 months (95% CI: 5.4-9.4 months), while the objective response rate (ORR) and disease control rate (DCR) were 52.4% (95% CI: 29.1%-75.7%) and 95.2% (95% CI: 85.3%-100%), respectively. Grade 3-4 adverse events occurred in 81.0% of patients, with no treatment-related deaths reported. The study concluded that the combination therapy showed favorable tolerability and clinical efficacy, though larger randomized-controlled trials are needed for validation.
10.1093/gastro/goag034
Apr 27 – May 04, 2026
Mistletoe extract in patients with advanced pancreatic cancer: Health-related quality of life in a double-blind, randomized, placebo-controlled trial (MISTRAL).
PALLIATIVE MED · Q1 JOURNAL - RANK #46/332
The MISTRAL study was a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial evaluating whether subcutaneous mistletoe extract added to standard palliative chemotherapy or best supportive care improves outcomes in 290 adults with advanced pancreatic cancer. Patients were randomized to mistletoe extract or placebo and followed for up to nine months; health-related quality of life (EORTC QLQ-C30 and PAN26), body weight, healthcare resource use, and blood biomarkers were measured repeatedly. No statistically significant differences were detected between groups for global or domain-specific quality-of-life scores, body weight, or cost-related parameters; biomarker analyses likewise showed no treatment effect except a rise in eosinophil counts in the mistletoe arm unlinked to clinical benefit. The authors conclude that mistletoe extract confers no measurable clinical advantage and should not be recommended for patients with advanced pancreatic cancer.
10.1177/02692163261437609
Apr 20 – Apr 27, 2026
Netrin1 blockade alleviates resistance to chemotherapy in pancreatic cancer.
NATURE · Q1 JOURNAL - RANK #2/135TOP-TIER
This phase 1b study evaluated the combination of NP137 (a netrin1 antibody) with modified FOLFIRINOX in 43 first-line patients with locally advanced pancreatic cancer. Patients received treatment every other week for up to 12 cycles, with NP137 showing good tolerability. Median progression-free survival was 10.85 months (95% CI: 10.03-15.61) and median overall survival was 16.43 months (95% CI: 12.75-non-reached), with 23% undergoing post-therapy conversion surgery. RNA sequencing confirmed EMT pathway downregulation, and neogenin-high patients had longer PFS (15.65 vs. 10.22 months), supporting netrin1 blockade’s role in alleviating chemotherapy resistance.
10.1038/s41586-026-10436-4
Apr 13 – Apr 20, 2026
Timing of Adjuvant S-1 Chemotherapy and Survival After Pancreatectomy for Pancreatic Cancer: An Ancillary Analysis of the JASPAC 01 Trial.
J HEPATO-BIL-PAN SCI · Q1 JOURNAL - RANK #59/312
This ancillary analysis of the JASPAC 01 trial investigated the impact of timing of adjuvant S-1 chemotherapy initiation on survival outcomes in 187 pancreatic cancer patients post-pancreatectomy, categorizing them into Early (<6 weeks), Standard (6-8 weeks), and Delayed (>8 weeks) groups. The Standard group demonstrated significantly longer overall survival (median 66 vs. 37 months, HR 0.61, 95% CI 0.38-0.99, p=0.041) and relapse-free survival (median 46 vs. 20 months, HR 0.61, 95% CI 0.38-0.99, p=0.040) compared to the Early group, with similar trends against the Delayed group. Multivariate analysis identified nonstandard initiation (<6 or >8 weeks), operative procedure, R1 resection, and lymph node metastasis as independent adverse prognostic factors. The study concluded that initiating S-1 chemotherapy at 6-8 weeks post-surgery yields optimal survival benefits.
10.1002/jhbp.70117
Usefulness of an S-1 dosage formula for predicting adverse events in adjuvant chemotherapy for curatively resected pancreatic cancer: an exploratory analysis of the randomized clinical trial (JASPAC-01).
J GASTROENTEROL · Q1 JOURNAL - RANK #21/147
This exploratory randomized clinical trial investigated the usefulness of an S-1 dosage formula based on renal function and body surface area for adjuvant chemotherapy in 187 patients with resected pancreatic cancer. Patients were categorized into underdose (n=27), equal dose (n=43), and overdose (n=117) groups, and researchers assessed recurrence rates, prognoses, adverse events, and 5-year overall survival. The overdose group had significantly higher all-grade and grade ≥3 anemia rates (94.9%/18.8% vs. 93.0%/4.7% vs. 81.5%/7.4%, p=0.04) and slightly lower 5-year overall survival (41.9% vs. 48.1%/47.6%). The authors concluded that the S-1 dosage formula may help reduce adverse events and avoid unnecessary dose reductions.
10.1007/s00535-026-02413-5
Elraglusib and chemotherapy in metastatic pancreatic ductal adenocarcinoma: a randomized controlled phase 2 trial.
NAT MED · Q1 JOURNAL - RANK #1/195TOP-TIER
The study evaluated the efficacy and safety of elraglusib combined with gemcitabine plus nab-paclitaxel (GnP) versus GnP alone in previously untreated metastatic pancreatic ductal adenocarcinoma (mPDAC) through an open-label, international, multicenter, randomized phase 2 trial. Patients were randomized 2:1 to elraglusib/GnP (n=155) or GnP alone (n=78), with primary endpoints of median overall survival (OS) and 1-year survival rate. Elraglusib/GnP improved median OS by 2.9 months (10.1 vs. 7.2 months; HR 0.62, 95% CI 0.46-0.84, P=0.01) and increased 1-year survival rates (44.1% vs. 22.3%), with manageable safety profiles including grade 3+ neutropenia (52.3% vs. 30.8%). The findings support elraglusib/GnP as a promising first-line treatment for mPDAC, with a phase 3 trial planned based on these results.
10.1038/s41591-026-04327-4
Apr 06 – Apr 13, 2026
Cabozantinib and temozolomide in patients with advanced progressive neuroendocrine tumors: a phase 2 study.
NAT COMMUN · Q1 JOURNAL - RANK #10/135TOP-TIER
This open-label, single-arm, phase 2 clinical trial investigated the safety and efficacy of cabozantinib at 40 mg/day combined with metronomic temozolomide (100 mg/m²/day one week on/one week off) in patients with advanced progressive neuroendocrine tumors. The primary endpoint was overall response rate as evaluated by blinded local review, with secondary endpoints including progression-free survival, overall survival, clinical benefit rate, duration of response, and safety. Among 37 participants, the overall response rate was 15% (95% CI, 5–31%), the clinical benefit rate was 100% (95% CI, 89.5–100%), the median progression-free survival was 28.5 months (95% CI, 16.8–28.5), and the 3-year overall survival rate was 68.5% (±9.1%). Despite not meeting the prespecified ORR target, the trial concluded that the high clinical benefit rate and favorable safety profile warrant further controlled investigation of this combination therapy.
10.1038/s41467-026-71756-7
Preoperative Biliary Drainage with Metal Stent Versus Early Surgery in Patients with Pancreatic Cancer: A Randomized Clinical Trial.
ANN SURG ONCOL · Q1 JOURNAL - RANK #39/312
This randomized clinical trial aimed to compare the safety of preoperative biliary drainage (PBD) using a self-expanding metal stent (SEMS) to early surgery in patients with resectable pancreatic or periampullary cancer experiencing biliary obstruction and scheduled for pancreaticoduodenectomy. The study enrolled 284 patients across 11 centers in 9 countries, randomizing them to either PBD or early surgery; the primary endpoint was the proportion of patients with at least one serious adverse event (SAE) within 120 days post-randomization, and key secondary endpoints included SEMS insertion rate, curative-intent resection rate, and all-cause mortality. Results showed SAE rates of 29.0% (40/138) for PBD and 26.5% (36/136) for early surgery, with a between-group difference of 2.5% (upper 95% confidence limit 11.7%, P = 0.011 for noninferiority); mortality rates were similar between groups (7.9% PBD vs. 8.0% early surgery). The authors concluded that PBD with SEMS is noninferior to early surgery regarding safety in this patient population.
10.1245/s10434-026-19546-9