The phase 3 PANOVA-3 trial showed that treatment with tumor treating fields (TTFields), which use alternating electric fields to disrupt cancer cell proliferation, plus gemcitabine/nab-paclitaxel (GnP) resulted in significantly improved overall survival (OS) and pain-free survival vs GnP alone in patients with unresectable locally advanced pancreatic adenocarcinoma. In this analysis, researchers assessed efficacy and safety of TTFields plus GnP vs GnP alone by tumor location at the head of the pancreas (n=163 and 158, respectively), body of the pancreas (n=81 and 79, respectively), and tail of the pancreas (n=9 and 19, respectively). Median (95% confidence interval [CI]) OS was longer with TTFields plus GnP vs GnP alone in the head and body of the pancreas subgroups (15.8 [12.7–18.0] vs 12.9 [11.5–15.4] months and 18.6 [15.7–22.5] vs 16.4 [13.1–20.1] months, respectively), whereas it was shorter in the tail of the pancreas subgroup (13.9 [3.0–17.1] vs 14.9 [11.5–18.7]; all P>0.05). Median (95% CI) pain-free survival was significantly longer with TTFields plus GnP in the body of the pancreas subgroup at 18.7 (11.0–not evaluable [NE]) vs 9.3 (6.6–16.3) months (P=0.041), with no significant differences in the head (10.2 [6.6–16.5) vs 7.6 [5.9–9.5] months) or tail (5.4 [1.2–NE) vs NE [4.5–NE] months) of the pancreas subgroups (both P>0.05). Type and incidence of device-related adverse events were comparable.
https://www.asco.org/abstracts-presentations/264806
Researchers conducted a retrospective review to determine the incidence and management of cachexia in patients with pancreatic adenocarcinoma. Sixty-six adult patients treated at a safety-net hospital from 2015 to 2025 were included for analysis. Cachexia was defined as body max index (BMI) <20 kg/m2 and/or weight loss of ≥5% over 6 months. Median age at diagnosis was 60 years, and 51.5% of patients were male. Most patients were Hispanic (54.5%) or Black (27.3%). A total of 24.2%, 28.8%, 28.8%, and 18% of patients had stage I, II, III, and IV disease, respectively. Patients most commonly received chemotherapeutic treatment with FOLFIRINOX (54.5%) and gemcitabine plus protein-bound paclitaxel (25.8%), and 25.8% of patients received radiation therapy. In total, 42.4% of patients underwent surgery, while 35.7% of original surgical candidates did not receive planned resection. About two-thirds of patients (63.6%) experienced disease progression. Mean BMI decreased from 25.2 kg/m2 at diagnosis to 21.45 kg/m2 at last follow-up. Although 89.4% of patients met the criteria for cachexia, only 16.7% had a documented diagnosis. A total of 48.5% and 45.5% of patients were seen by palliative care and a dietitian, respectively, and 23.7% receive cachexia-directed medications.
In this review and meta-analysis, researchers evaluated the prognostic utility of baseline circulating tumor deoxyribonucleic acid (ctDNA) in pancreatic ductal adenocarcinoma (PDAC). Eight studies with progression-free survival (PFS) and 14 studies with OS data, 7 of which overlapped, including a total of 1,050 patients were included for analysis. Median age was 69.9 years; 482 patients had resectable/localized disease, and 568 had advanced/metastatic disease. Baseline ctDNA was undetectable in 520 patients. Analyzing pooled median PFS data, researchers found that detectable baseline ctDNA was associated with worse PFS (hazard ratio [HR]: 2.11; 95% CI: 1.72–2.60), and heterogeneity was low. Similar results were reported in resectable (HR: 2.11; 95% CI: 1.72–2.60) and advanced disease (HR: 2.11; 95% CI: 1.64–2.72) subgroups. Pooled OS analysis demonstrated that detectable baseline ctDNA was associated with shorter OS as well (HR: 2.23; 95% CI: 1.80–2.77), with low heterogeneity across studies. Comparable results were found in resectable (HR: 2.36; 95% CI: 1.37–4.08) and advanced disease (HR: 2.23; 95% CI: 1.72–2.89) subgroups.
https://www.asco.org/abstracts-presentations/265180
Here, researchers aimed to develop prognostic models utilizing prediagnostic clinical data to identify individuals with a high risk of PDAC. A retrospective cohort of 1,151 patients with PDAC and 3,745 controls was included. Computed tomography imaging, radiology report embeddings, and demographic data were evaluated as unimodal inputs; these inputs were integrated into a multimodal deep learning survival model. The multimodal model had the highest performance, with an internal validation C-index of 0.885 (95% CI: 0.856–0.908) and an external validation C-index of 0.751 (95% CI: 0.719–0.783). Performance varied based on tumor location. Internal and external validation C-indices were highest for tumors of the pancreatic body, at 0.954 (95% CI: 0.897–0.997) and 0.929 (95% CI: 0.897–0.953), respectively. For tumors at the head of the pancreas, the internal C-index was 0.916 (95% CI: 0.841–0.960), and the external C-index was 0.778 (95% CI: 0.730–0.823). Internal and external C-indices for pancreatic tail tumors were 0.903 (95% CI: 0.830–0.974) and 0.789 (95% CI: 0.689–0.874), respectively.
https://www.asco.org/abstracts-presentations/265231
The Housing-Based Socioeconomic Status (HOUSES) index is a validated patient-level tool that geocodes housing features (eg, assessed value, square footage) to measure socioeconomic status. In this study, researchers evaluated the relationship between HOUSES index and OS among patients with metastatic PDAC. A total of 189 patients diagnosed with metastatic PDAC between 2019 and 2024 were included for analysis. Median age was 67 years. A total of 52.9% of patients were male, and 92.1% were non-Hispanic White. Most patients (85.3%) received cancer-directed treatment. Overall, median OS was 10.3 months (interquartile range: 4.9–22.9). Higher socioeconomic status quartile demonstrated a protective effect on OS. HRs were significantly lower for quartile 2 (Q2; HR: 0.58; 95% CI: 0.39–0.85), Q3 (HR: 0.51; 95% CI: 0.35–0.75), and Q4 (HR: 0.64; 95% CI: 0.45–0.89), compared to Q1. Multivariable analysis also showed that Medicare vs commercial insurance (HR: 0.18; 95% CI: 0.10–0.32), age (HR: 1.04; 95% CI: 1.02–1.06), and Eastern Cooperative Oncology Group performance status (HR: 2.14; 95% CI: 1.31–3.50) were associated with OS.
https://www.asco.org/abstracts-presentations/264235
Researchers evaluated retrospective data from patients with early-onset metastatic PDAC to determine sex-based differences in metastasis. Data from January 2015 to December 2025 were analyzed. Among 95 patients, 54.4% of male patients presented with liver metastases at diagnosis vs 44.7% of female patients; absolute risk difference was 9.7%. Male patients had increased unadjusted odds of liver metastasis (odds ratio [OR]: 1.47; 95% CI: 0.60–3.62). Bone metastases were present in 10.5% of female patients compared to 3.5% of male patients. In the context of recurrent disease after resection, a greater percentage of male vs female patients had liver-first recurrence (67% vs 45%; OR: 0.42), though this difference was not significant (P=0.41). Further analysis showed that recent pregnancy had a protective effect on OS (HR: 1.76; 95% CI: 0.60–5.17). Compared to premenopausal status, peri- and postmenopausal status were associated with inferior OS (HR: 0.30; 955 CI: 0.07–1.29).
In this study, researchers characterized the prevalence and prognostic significance of Claudin18.2 (CLDN18.2) expression in pancreatic ductal adenocarcinoma (PDAC). Immunohistochemistry was performed on formalin-fixed paraffin-embedded tissue samples to measure CLDN18.2. Moderate (+2) or strong (+3) staining in ≥75% of tumor cells indicated CLDN18.2 positivity. Among 201 patients, 54 (27%) had CLDN18.2 positivity; positive expression was reported in 14 of 56 patients (25%) with nonmetastatic PDAC and 40 of 145 patients (28%) with metastatic PDAC. For patients with metastatic disease, median (95% confidence interval [CI]) overall survival (OS) was significantly longer in the CLDN18.2-positive group compared to the CLDN18.2-negative group, at 9.9 (6.7–12.8) months vs 6.3 (4.9–8.5) months (P=0.009). Univariate analysis showed a significant association between CLDN18.2 positivity and OS (hazard ratio [HR]: 0.60; 95% CI: 0.41–0.89; P=0.010), but significance was not maintained upon multivariable analysis (HR: 0.69; 95% CI: 0.47–1.02; P=0.064). Progression-free survival (PFS) was also significantly longer among CLDN18.2-positive vs CLDN18.2-negative patients (median [95% CI]: 6.0 [3.6–7.6] vs 4.1 [3.4–5.3] months; P=0.036). Similarly to OS, the association between CLDN18.2 positivity and prolonged PFS was significant on univariate analysis (HR: 0.67; 95% CI: 0.46–0.98; P=0.037) but not multivariate analysis (HR: 0.67; 95% CI: 0.43–1.03; P=0.066).
https://www.asco.org/abstracts-presentations/264004
In this single-center retrospective cohort study, researchers assessed disparities in molecular testing among patients with early-onset metastatic PDAC. A total of 95 patients diagnosed between January 2015 and December 2025 were included. The rate of molecular testing was lower for Black patients compared to non-Black patients. In total, 20.0% Black patients received germline testing compared to 67.8% of non-Black patients (odds ratio [OR]: 0.12; P=0.048). Somatic tumor testing was completed in 20.0% of Black patients vs 66.7% of non-Black patients (OR: 0.13; P=0.054). Compared to non-Black patients, Black patients had a lower likelihood of receiving any molecular testing (78.9% vs 40.0%; OR: 0.18; P=0.080). No Black patients received both germline and somatic tumor testing, compared to 55.6% of non-Black patients (P=0.021), indicating a significant difference in comprehensive molecular testing between groups.
https://www.asco.org/abstracts-presentations/264482
Mucin 5AC (MUC5AC) has been associated with tumor progression in PDAC, but its impact on the tumor immune microenvironment (TIME) is unclear. In this study, researchers aimed to determine if MUC5AC expression contributed to distinct transcriptional and immunologic subtypes of PDAC. Data from 730 PDAC tumors and 360 normal pancreatic tissues were analyzed. PDAC tumors were divided into MUC5AC-low (≤25th percentile of MUC5AC expression) and MUC5AC-high (>25th percentile) groups. There was clear separation between PDAC tumors and normal tissues in principal component analysis. The TIME of MUC5AC-high tumors (n=544) was immunosuppressive and stromal-remodeled; these tumors showed enrichment of M2 macrophages, regulatory T cells, and activated natural kill cells, and fibroblast-blast signatures. MUC5AC-high tumors had significantly increased immune and stromal scores compared to MUC5AC-low tumors (n=186). Immune-activating populations, such as naïve B cells, resting CD4⁺ memory T cells, CD8⁺ T cells, and dendritic cell subsets, were enriched in MUC5AC-low tumors. There was a significant correlation between MUC5AC expression and CD274 and TGIT, 2 immune checkpoint genes.
https://www.asco.org/abstracts-presentations/267306
Radiology imaging can be utilized to identify the embryological origin (dorsal [Dp] or ventral pancreatic [Vp] buds) of the pancreatic head. In this study, researchers evaluated the impact of embryological origin on survival in resectable pancreatic head adenocarcinoma. A line connecting the portal vein/superior mesenteric vein to the anterior margin of the intrapancreatic bile duct was considered the boundary between Dp and Vp; tumors with ≥80% predominance in Dp or Vp were classified accordingly, and tumors with <80% predominance were classified as mixed pancreatic (Mp) origin. Among 164 patients, tumor origin was Vp in 74 (45.1%), Dp in 63 (38.4%), and Mp in 27 (16.5%). A significantly greater percentage of Mp tumors were grade 3 (48.1%) compared to Vp (21.6%) and Dp (23.8%) tumors (P=0.005). Stage T3 to T4 was also more prevalent in Mp vs Vp and Dp tumors (70.3% vs 32.4% and 47.6%, respectively; P=0.009). Median (95% CI) PFS was longest in Vp tumors (13.0 [9.3–16.7] months), followed by Mp (11.2 [10.5–11.9] months) and Dp (9.8 [7.6–11.9] months) tumors (P=0.032). In recurrent cases, distant metastases occurred in 100% and 85.7% of Dp and Mp tumors, respectively, and local recurrence was reported in 33.3% of Vp tumors (P<0.001). Patients with Vp tumors exhibited the longest median (95% CI) OS, at 25.3 (11.8–37.8) months vs 16.7 (8.9–27.4) and 16.7 (13.2–20.3) months in patients with Mp and Dp tumors, respectively (P=0.006).
https://www.asco.org/abstracts-presentations/264046
Here, researchers analyzed data from the Healthcare Integrated Research Database to assess treatment patterns and real-world survival outcomes of patients with metastatic PDAC. Patients diagnosed between January 1, 2020, and November 29, 2024, who initiated chemotherapy within 90 days of diagnosis were eligible for inclusion. A total of 1,911 patients with a median follow-up of 6.3 months were included for analysis. Mean age was 65 years, and 57% of patients were male. Most patients (68%) had commercial insurance. Mean Charlon Comorbidity Index score was 3.6. A total of 820 patients (43%) received FOLFIRINOX as first-line chemotherapy; 495 patients (26%) received gemcitabine plus nab-paclitaxel, and 174 (9%) received FOLFOX. Median OS was 6.3 months. Second-line chemotherapy was initiated by 52% of patients, most commonly with gemcitabine plus nab-paclitaxel (27%), followed by FOLFIRI (14%) and FOLFIRINOX (11%). Among those who received second-line treatment, 53% received third-line chemotherapy. The most common third-line treatment was gemcitabine plus nab-paclitaxel (24%).
https://www.asco.org/abstracts-presentations/264826
Researchers evaluated the utility of plasma small extracellular vesicle (sEV) microribonucleic acid (miRNA) to enable diagnosis of PDAC. Small RNA sequencing was utilized to detect miRNA expression in sEVs from plasma samples (n=208). Researchers then developed a diagnostic model to discriminate between PDAC and nonmalignant controls. Thirty-two differentially expressed plasma sEV miRNAs were detected between patients with PDAC and controls. A diagnostic model constructed using 17 sEV miRNAs showed the best performance. In the training cohort (n=140), area under the curve (AUC) was 0.939, and sensitivity and specificity were 93% and 90%, respectively. In the test cohort (n=68), AUC and sensitivity increased to 0.951 and 95%, respectively, and specificity was 83%. Researchers found distinct characteristics of sEV miRNAs in patients with PDAC compared to controls. Additionally, 9 negative miRNAs and 1 positive miRNA were significantly associated with mortality risk in PDAC (all P<0.05). These findings indicate that plasma sEV miRNA is a discriminative biomarker for the diagnosis of PDAC.
In this retrospective cohort study, researchers evaluated the impact of cachexia staging on treatment receipt and survival in patients with pancreatic ductal adenocarcinoma (PDAC). Sixty-six patients diagnosed with PDAC from 2022 to 2024 were included for analysis. Cachexia was measured with the University of Texas Cancer Cachexia Staging System (UT CCSS). Fifty patients (75%) received systemic chemotherapy, and 16 (25%) did not receive treatment. Most treated patients had UT CCSS stage I (n=20) or II (n=27), with only 3 having stage III. Among untreated patients, 3 had UT CCSS stage I, 9 had stage II, and 4 had stage III. TNM stage III/IV and UT CCSS stage II/III were more common in treated patients. Patients with UT CCSS stage I were more likely to have TNM stage I/II. Metastatic disease was more common in the untreated group vs the treated group (62.5% vs 34%). The percentage of weight loss was 88% in the treated group. Lower UT CCSS stage was associated with improved survival; 85% of patients with UT CCSS stage I were alive at 10.9-month median follow-up compared to 73% of those with UT CCSS stage II/III at 11.7-month median follow-up (hazard ratio [HR]: 0.52; 95% confidence interval [CI]: 0.16–1.73).
https://www.asco.org/abstracts-presentations/265069
Here, researchers aimed to determine disparities in comprehensive genomic profiling among patients with PDAC being treated at academic and community medical centers. A total of 9,273 PDAC samples from the American Association for Cancer Research Project GENIE database were included for analysis. Most samples (88.1%) were from academic centers, with only 11.9% from community centers. While the median size of the panels was significantly smaller in the community vs academic settings (82 vs 328 genes; P<0.001), 93% of community samples were from a single network using comprehensive panels that included 613 genes; as such, there was an average of 543 genes per patient in the community setting compared to 690 genes per patient in the academic setting, which was a 1.3-fold difference. There was a significant difference in mutation detection across all categories, which included homologous recombination deficiency (HRD) genes (individual), HRD genes combined, oncogenic drivers, and fusion targets (all P<0.001). The difference was greatest in fusion targets, with a 41-fold difference in NTRK1/2/3 detection between settings (community: 0.09%; academic: 3.69%), followed by PALB2 (community: 0.09%; academic: 1.29%; 14-fold difference) and BRCA1/2 (community: 0.45%; academic: 5.96%; 13-fold difference). Based on academic detection rates, a large percentage of genetic alterations might have gone undetected in the community setting, including 98% of NRTK fusions and 92% of BRCA1/2 mutations.
https://www.asco.org/abstracts-presentations/265160
Few patients with PDAC receive palliative care, despite its association with improved quality of life and decreased symptom burden. Thus, researchers investigated the feasibility and efficacy of a 12-week community health worker (CHW)–led intervention to deliver stepped palliative care to these patients. Included patients were diagnosed with PDAC within 2 weeks of enrollment. The intervention included targeted escalation of care (eg, expedited palliative care visits, care navigation, access to financial resources) for patients with untreated symptoms. A total of 48 patients with a median age of 69 years were included; 29 patients (60%) were Hispanic. At diagnosis, 25 patients (52%) had metastatic disease, 14 (29.1%) had borderline resectable disease, and 9 (18.8%) had resectable disease. Four patients died before intervention completion. The majority of patients (94%) strongly agreed that the intervention was acceptable. Patients identified the importance of the CHW, highlighting their critical role in appointment scheduling as symptoms worsened. Median symptom burden score, as determined by the Edmonton Symptom Assessment Scale, significantly decreased from 68 at baseline to 55 at Week 12 (P=0.02). Rates of financial toxicity, measured by the COST instrument, also significantly decreased from baseline to Week 12 (39% vs 25%; P=0.01). Additionally, 83% of patients completed advanced care planning by Week 12.
https://www.asco.org/abstracts-presentations/258499
Here, researchers aimed to characterize the clinicopathologic and genomic landscape of pancreatic acinar cell carcinoma (PACC) and identify potential actionable alterations. Seven patients with a median age of 64 years were included for analysis. Common symptoms were weight loss and abdominal pain, and jaundice was not reported. All but one tumor were located at the pancreatic head. Lymph node involvement and lymphovascular and perineural invasion varied across patients, and mixed acinar neuroendocrine differentiation was observed in some cases. Three patients underwent next-generation sequencing; 2 patients had 9p21.3 co-deletion (CDKN2A/A and MTAP loss), and all patients were KRAS wildtype. Other actionable alterations included BAP1 mutation, IZKF1 loss, and SEC24D-BRAF fusion. Three patients underwent surgical resection, and receipt of FOLFIRINOX chemotherapy was common. Two patients showed prolonged progression-free survival (>90 and >200 months), with follow-up of <5 years in the remaining patients. Four patients were alive without recurrence at the time of data reporting. Genomic findings showed that PACC is molecularly distinct from PDAC, warranting different treatment approaches for these patients.
https://www.asco.org/abstracts-presentations/264933
In this study, researchers assessed the utility of single-cell circulating tumor cell (CTC) profiling to detect genomic alterations, tumor heterogeneity, and pathway dynamics in metastatic PDAC. Samples form 16 patients with metastatic PDAC receiving standard of care were analyzed. CTC count was highest at baseline (mean: 6.5 per patient). Half of evaluable patients showed decreased CTCs at first on-treatment assessment. Overall, 49 gene alterations were detected, 32 (65%) of which were identified exclusively with single-cell CTC profiling. Fourteen (29%) alterations were detected with both CTC profiling and circulating tumor deoxyribonucleic acid (ctDNA), and 3 (6%) were detected exclusively with ctDNA. Genomic alterations were detected in all patients with CTC-DNA, compared to 75% (n=12) with ctDNA. CTC-DNA detected KRAS alterations in 1 patient (6%), whereas ctDNA identified KRAS alterations in 7 patients (44%), and this difference was observed in longitudinal measurements as well (13–19% vs 59–76%). Features of KRAS-negative CTCs included recurrent alterations in MAPK, DNA damage response, tumor suppressor, and receptor tyrosine kinase pathways. Mutant-allele tumor heterogeneity was significantly higher in CTCs vs ctDNA (50.5 vs 25; P<0.05).
https://www.asco.org/abstracts-presentations/264143
In this study, researchers compared recurrence rate, complete resection, and overall survival (OS) among 56 patients with resectable pancreatic adenocarcinoma with upfront surgery vs neoadjuvant chemotherapy (NAC). The upfront surgery cohort included 25 patients with a mean age of 69.64 years at diagnosis, and the NAC cohort included 31 patients with a mean age of 72.23 years; mean tumor size was not significantly different between groups, at 28.20 mm and 33.48 mm, respectively. OS was similar between groups, at 721.36 days in the upfront surgery cohort and 735.38 days in the NAC cohort. In both cohorts, 23 patients achieved complete resection, which was not significantly different. Additionally, recurrence rates, which excluded patients with residual tumor, did not significantly differ between cohorts.
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