Moving beyond hope: laying the groundwork for a new era in pancreatic cancer innovation
Stan Jackson of Astellas Pharma Inc (Tokyo, Japan) and Anna Berkenblit, MD, MMSc, of The Pancreatic Cancer Action Network (PanCAN), highlight the importance of mobilizing all parties to prepare for a new era in pancreatic cancer care.
They emphasize the need for collaboration between stakeholders, under a shared ambition to unlock progress and advance innovation in pancreatic cancer.
This article has been developed and funded by Astellas Pharma Inc.
Despite the monumental advances made in cancer outcomes in the past several decades, a simple fact remains – not all cancers are equal.
Although there have been modest improvements, the 5-year survival rate for pancreatic cancer remains extremely low globally, ranging from 2–13% [1]. Yet, worldwide, both incidence and mortality trends are increasing, with pancreatic cancer expected to become the second leading cause of cancer-related deaths in developed countries by 2030 [2, 3, 4]. This inequity with other cancers, coupled with these projections, makes it clear that concerted action is needed now [2, 5].
Pancreatic cancer remains one of the most complex areas for drug development, with the high rate of drug failures making advances heartbreakingly elusive [6]. As a result, there are limited treatment options available and few targeted options [7].
But the resilience of the field is notable. Great R&D continues to take place, and as a community we are hopeful that in the near future, there will be new treatment options available. Between Jan 1, 2000 and Oct 31, 2023, there have been 485 phase I trials, 614 phase II trials and 85 phase III trials in metastatic pancreatic cancer registered [6].
Harnessing this momentum, there is a pressing need to rethink how we plan for innovation in pancreatic cancer. While great uncertainty remains, we need all stakeholders to plan – proactively rather than reactively ─ for new treatments.
We believe that we can learn a great deal from other forms of cancer and from entirely different diseases about how to shape a pathway and reinforce ways of working throughout health systems that benefit patients. At the heart of our efforts, we are committed to prioritizing patients’ needs, with a clear focus on enhancing quality of life. We want to ensure that every patient receives the right treatment at the right time, making a meaningful difference in their healthcare journey.
A collaborative path forward
As a starting point, we have identified three key areas that can help shift the paradigm.
1. Awareness and early detection
Pancreatic cancer is often detected too late, in part because the symptoms of pancreatic cancer are often subtle and difficult to recognize. This is a key driver limiting the options available to patients for treatment, with less than 20% of patients diagnosed early enough for surgical intervention [8].
Our first steps must therefore be rooted in raising awareness of the signs and symptoms of pancreatic cancer among all stakeholders: patients, healthcare professionals and policymakers. We also need consensus on the value of national screening programs. Initiatives that seek to identify high-risk populations based on genetic or early symptom-based biomarkers and develop strategies for follow-up screening that is compatible with national healthcare systems are high priority research efforts.
Biomarker testing
Biomarker testing has the potential to play a crucial role in diagnosing pancreatic cancer and identifying patients who can benefit from targeted personalized therapies – but it is not yet commonplace within clinical pathways. Research, investment and policymaking are required to make progress. We also need to build confidence in science and demonstrate the value of biomarker testing for both treatment options and patient outcomes.
On research, we need to focus on improving the collection of tissue samples for molecular analysis, continue the discovery of predictive biomarkers and accelerate the development of targeted therapies for a precision medicine approach to pancreatic cancer.
On investment and policymaking, we need to ensure health systems allocate the necessary resources to address the stretched pathology infrastructure, improve reimbursement of testing and improve alignment between development and approval processes for biomarker testing and treatment.
2. Reimbursement and access to innovation
We know that ultimately, pancreatic cancer innovation can only be of value if it reaches patients and is reimbursed.
Evolving cancer reimbursement frameworks to improve how we value treatments has been a key focus for the oncology community and spurred international collaboration. This focus includes considering increased flexibility in the consideration of efficacy endpoints [9].
Getting this right, particularly for less survivable cancers such as pancreatic cancer, must be a priority. While specific reimbursement challenges vary from country to country, a common obstacle remains: the current methods of assessing the value of pancreatic cancer treatments can overlook incremental gains in survival and patient quality of life.
We must start now
The scale of the challenge is significant. It will require all parties to work together. We first need to truly understand the barriers faced at each stage in the innovation pathway and build consensus around the solutions required.
What we do know is that there is no time to waste and that patients cannot afford for innovation and the health system it sits within to be out of sync. With potential new innovations on the horizon, health systems should start to prepare now so patients who have long been overlooked are not left waiting.
With collective action, we can look ahead to a new era in pancreatic cancer care.
References
1. Rahnea-Nita G, Rebegea LF, Grigorean VT et al. Long-term survival in metastatic pancreatic adenocarcinoma of intestinal type. J. Clin. Med. 13(17);5034 (2024).
2. Huang J, Lok V, Ngai CH et al. Worldwide burden of risk factors for, and trends in pancreatic cancer Gastroenterology 160(3), 744–754 (2021).
3. Quante A, Ming C, Rottmann M et al. Projections of cancer incidence and cancer-related deaths in Germany by 2020 and 2030. Cancer Med. 5(9) (2016).
4. Rahib L, Wehner M, Matrisian L et al. Estimated projections of US Cancer Incidence and Death to 2040 JAMA Netw. Open. 4(4):e214708 (2021).
5. Ilic I, Ilic M International patterns in incidence and mortality trends of pancreatic cancer in the last three decades: A joinpoint regression analysis. World J. Gastroenterol. 28(32), 4698–4715 (2022).
6. Bishal G, Booth CM Treatment of metastatic pancreatic cancer: 25 years of innovation with little progress for patients. Lancet Oncol. 25(2), 167–170 (2024).
7. Regel I, Mayerle J, Mahajan UM Current strategies and future perspectives for precision medicine in pancreatic cancer. Cancers. 12(4), 1024 (2020).
8. Yau C. Managing inoperable pancreatic cancer: the role of the pancreaticobiliary physician Frontline Gastroenterology 13, 88–93 (2022)
9. Personalised medicine coalition. Advancing access to personalized medicine: a comparative assessment of European reimbursement systems.
Available at: www.personalizedmedicinecoalition.org/Userfiles/PMC-Corporate/file/pmc_bridgehead_issue_brief_european_reimbursement.pdf
(Accessed January 2025)
The opinions expressed in this article are those of the author and do not necessarily reflect the views of Oncology Central or Taylor & Francis Group.
MAT-ABC-NON-2025-00033
April 2025