No screening test can catch pancreatic cancer before symptoms appear. That is the gap the National Cancer Institute is paying several large projects to close.
Looking for it earlier
One known risk is a new diagnosis of diabetes. About 1 in 100 people with new-onset diabetes are diagnosed with pancreatic cancer within three years, and 1 in 4 people who get the cancer had already been diagnosed with diabetes. The NCI-supported New Onset Diabetes Study is enrolling 10,000 people with new-onset diabetes or hyperglycemia. Its aim is a blood test that picks out the few who need further testing.
Other NCI-funded teams, coordinated through the Pancreatic Cancer Detection Consortium, are trying to build a blood test for the general population and sharpen imaging so it can spot tiny deposits of tumor cells. Some evidence suggests regular imaging may help people at high risk. Researchers are also studying vaccines aimed at mutations in the KRAS gene, found in most pancreatic cancers, to prime the immune system.
Treatment
The organ’s location makes surgery hard, and the disease has often spread by the time it is found. Treatment usually means surgery, chemotherapy, radiation or a mix. For metastatic disease, combination chemotherapy remains the mainstay. The newly approved first-line combination NALIRIFOX is similar to the older FOLFIRINOX and more effective than gemcitabine plus nab-paclitaxel.
For tumors that can be removed, chemotherapy may come before surgery to shrink the tumor or after it to kill remaining cells. Researchers are testing whether regimens that extend life in metastatic disease work better in the earlier setting.
Targeted therapy is where much of the excitement lies. More than 90% of pancreatic cancers carry KRAS mutations, so drugs that block the altered proteins are a major focus. On August 26, 2026, the FDA approved daraxonrasib, an oral drug aimed at mutant KRAS, for advanced, previously treated pancreatic cancer, based on research showing it extends survival and improves quality of life. Combining KRAS inhibitors with chemotherapy has shown promise in recent trials. PT886, which marks cells carrying claudin 18.2 for immune destruction, was fast-tracked by the FDA in 2024.
Immunotherapy has had less success. A single drug works for few patients, though tumors with microsatellite instability, about 1% to 3% of cases, can be treated this way. Researchers are testing combinations of immunotherapies, pairings with radiation or other targeted drugs, and cell therapies using altered T cells and natural killer cells. One study suggested a patient’s own tumor DNA and RNA could personalize a vaccine. Early-phase vaccine trials are under way.
Pancreatic tumors are wrapped in unusually dense stroma, the fibrous tissue around them, which can shield cancer cells. The VIRAGE trial is testing chemotherapy combined with the oncolytic virus VCN-01, which replicates in tumor cells and helps break the stroma down.
Patients are generally advised to have genetic testing for inherited mutations and, with advanced disease, biomarker testing of the tumor. Both can suggest treatments and show whether relatives face higher risk. Many experts urge every patient to consider a clinical trial, even at an early stage.
