Pancreatic Cancer Treatment Options and Strategies for Patients

Dr. Benjamin Jon Golas of Hackensack Meridian Health discussed pancreatic cancer treatment, focusing on surgery, chemotherapy and radiation.

Surgery removes the tumor if it is technically resectable and the patient is healthy enough. Chemotherapy targets cancer cells systemically, often before or after surgery. Radiation is used in select cases. Advances in chemotherapy, neoadjuvant approaches and emerging targeted therapies offer hope, and care at experienced centers improves outcomes.

CURE: For patients who are newly diagnosed with pancreatic cancer, what are some of the current treatment options that are available that you'd want to highlight, that you think are important to note?

Golas: Yeah, it's a great question. I would say the treatment for pancreatic cancer really has three pillars. One is surgical resection, which is surgery to remove the tumor in the pancreas. The operation is a little different depending on the location of the tumor. The second is systemic chemotherapy — medications designed to kill pancreatic cancer cells, delivered intravenously or sometimes by pill. And then things like radiation, which can be applied in different forms to pancreatic tumors, also play a role in certain cases.

For most patients with tumors that are technically resectable and nonmetastatic, meaning the disease is limited to the pancreas, the majority will receive surgery and chemotherapy. The sequence depends on the patient, but those two treatments are really the hallmark of curative-intent therapy for pancreatic cancer. Radiation plays a role in select cases. These are the major components on which we build our treatment approach for pancreatic cancer.

You mentioned surgery. Can you explain what makes someone a good candidate for surgery with pancreatic cancer?

Yeah, that's a great question. There are a lot of factors. First, disease-related factors: it’s important to have a thorough workup by a team that has expertise in treating pancreatic cancer. The main thing is identifying patients who don’t have metastatic disease — cancer that has spread to distant organs, through the bloodstream, lymphatics, or sometimes directly into the abdominal cavity. Those patients are generally not surgical candidates and are more likely to receive chemotherapy.

For patients without metastatic disease, it’s important to determine whether the tumor can technically be removed surgically at diagnosis. This is a complex decision based on three-dimensional imaging and other assessments to establish the tumor’s relationship to the major blood vessels around the pancreas. From there, patients are categorized as technically resectable, borderline resectable, or locally advanced. Technically resectable means we can safely remove the tumor. Borderline resectable means there is some blood vessel involvement, but with therapy — usually chemotherapy, sometimes radiation — the tumor could potentially be removed. Locally advanced means more extensive blood vessel involvement, unlikely to be converted to surgical removal, though in some patients we are able to convert them to resectable.

The other part is patient-related. Pancreatic surgery is a major operation under general anesthesia, so patients need to be medically fit to tolerate it and the recovery. That includes cardiopulmonary status and overall health. Surgical candidacy is really a convergence of disease-specific and patient-specific factors.

Looking toward the future, is there anything coming down the pipeline that you wanted to note for patients, whether in treatment or other areas?

Historically, pancreatic cancer is still an extraordinarily aggressive disease, and in many cases, it can be lethal. But there is optimism, and there has been progress over the last 10 to 15 years. A lot of that comes from advances in systemic chemotherapy. We now have two regimens known to be effective against pancreatic cancer, which has helped improve survival.

Our understanding of the biology of the disease and the use of chemotherapy in combination with surgery has also evolved. Historically, surgery was offered upfront to everyone who could have it, followed by chemotherapy. Now, we often use a neoadjuvant approach — giving chemotherapy before surgery, then surgery, and sometimes additional therapy afterward.

Immunotherapy has not shown the same success in pancreatic cancer as in other cancers, like gastric, esophageal, or certain colon cancers. The common form of pancreatic cancer, adenocarcinoma, seems more resistant to immune-modulating drugs. That said, there are promising early results from clinical trials of targeted therapies for specific mutations, such as KRAS inhibitors.

Future progress will depend on understanding the genetic drivers of pancreatic cancer, developing targeted treatments, and improving early detection and prevention. Identifying risk factors, whether genetic or environmental, and detecting cancer at an earlier stage could be how we truly improve outcomes for this aggressive disease.

To close out, what is the main takeaway for patients, especially during Pancreatic Cancer Awareness Month?

Be aware of symptoms and seek medical attention if something feels off, such as unintentional weight loss, loss of appetite, or generally not feeling well. The symptoms of pancreatic cancer are often subtle, so early evaluation is important. For patients diagnosed with pancreatic cancer, there is optimism. Treatment options continue to evolve, and long-term survival is possible.

The most important step is seeking care at a center with a multidisciplinary team experienced in pancreatic cancer. This ensures that surgery, chemotherapy, and sometimes radiation are coordinated for the best possible outcome. While pancreatic cancer is serious, effective treatment is available, and patients can benefit from advances in care.

Ultimately, early recognition, expert care, and staying informed about new treatments give patients the best chance for meaningful outcomes. With ongoing research, targeted therapies, and advances in systemic treatment, the outlook for pancreatic cancer is slowly improving, and patients can achieve survival that was once less common.

Transcript has been edited for clarity and conciseness.

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