Standard of care: For resectable disease: surgery followed by adjuvant modified FOLFIRINOX (6 months) or gemcitabine + capecitabine. Neoadjuvant chemotherapy increasingly used for borderline resectable. For locally advanced: FOLFIRINOX or gemcitabine/nab-paclitaxel, with radiation in selected cases. For metastatic: FOLFIRINOX (fit patients) or gemcitabine/nab-paclitaxel. Olaparib maintenance for germline BRCA1/2-mutated patients with platinum-stable/responsive disease (POLO trial). Second-line: nanoliposomal irinotecan + 5-FU/leucovorin (NAPOLI-1).
Key Biomarkers for Trial Eligibility
Molecular profiling is essential — over 25% of pancreatic cancer patients have actionable mutations:
KRAS mutation type — present in ~90% of PDAC. The specific variant matters for targeted therapy:
KRAS G12D (~40%) — most common; RMC-9805, HRS-4642 trials
KRAS G12V (~30%) — IX001 TCR-T cell therapy trial
KRAS G12C (~1-2%) — sotorasib (FDA-approved for NSCLC, trials in PDAC)
BRCA1/2 or PALB2 mutation — germline mutations in ~5-7%. Eligible for platinum-based chemo (better response), PARP inhibitors (olaparib), and specific combination trials.
MSI-H / dMMR — rare (~1-2%) but eligible for pembrolizumab (FDA-approved for all MSI-H cancers). Dramatic responses possible.
Claudin 18.2 (CLDN18.2) expression — expressed in ~60% of PDAC. Target for IBI343 ADC (Phase 3) and CAR-T therapy.
NTRK fusion — very rare (<1%) but druggable with larotrectinib or entrectinib (FDA-approved).
HER2 amplification — rare (~2-3%) but eligible for trastuzumab deruxtecan and other HER2 ADC trials.
ctDNA (circulating tumor DNA) — increasingly used to guide adjuvant therapy decisions. Several trials use ctDNA to identify patients who may benefit from additional treatment after surgery.
Know your KRAS variant and BRCA status? Get matched to pancreatic cancer trials in minutes.
How do I find pancreatic cancer clinical trials I'm eligible for?
Enter your pancreatic cancer details into ClinTrialFinder — including KRAS mutation type (G12D, G12V, G12C, G12R), BRCA/PALB2 status, disease stage (resectable, borderline, locally advanced, metastatic), and prior treatments. The AI matches you with trials based on your specific profile in minutes. No login required.
What pancreatic cancer trials are currently recruiting?
There are 666 recruiting interventional trials for pancreatic cancer including KRAS-targeted therapies (61 trials — pan-RAS, G12D-specific, G12V TCR-T, vaccines), immunotherapy combinations (100), BRCA/PALB2-directed treatments (26), Claudin 18.2-targeted ADCs and CAR-T, tumor treating fields, and ctDNA-guided adjuvant therapy.
Should I get molecular profiling for pancreatic cancer?
Yes — comprehensive genomic profiling is strongly recommended for all pancreatic cancer patients. Over 25% have actionable mutations: BRCA1/2 or PALB2 (~5-7%) qualify for PARP inhibitors and platinum-based therapy, MSI-H (~1-2%) responds dramatically to immunotherapy, NTRK fusions are druggable with FDA-approved agents, and knowing your specific KRAS variant (G12D, G12V, G12C) determines which targeted therapy trials you're eligible for.
Are KRAS-mutant pancreatic cancers now treatable with targeted therapy?
KRAS — once considered "undruggable" — is now a therapeutic target. Daraxonrasib (RMC-6236), a pan-RAS inhibitor, is in Phase 3 trials for resected PDAC. RMC-9805 targets KRAS G12D specifically (the most common variant in pancreatic cancer). KRAS G12C can be targeted with sotorasib. KRAS vaccines and TCR-T cell therapy targeting G12V are also in clinical trials. Knowing your specific KRAS variant is essential.
Find Pancreatic Cancer Trials Matched to Your Situation
Enter your KRAS mutation type, BRCA status, and disease stage to get AI-matched trial results in minutes.
