At the 20th Annual Symposium on Pancreatic Cancer, Dr. Timothy Donahue, Director of the UCLA Agi Hirshberg Center for Pancreatic Diseases, presented the Pancreatic Cancer Progress Report for 2026.
Dr. Donahue’s presentation highlights the amazing amount of progress made over the past year in pancreatic cancer treatment. Outlining the approach of personalized treatment, he emphasized genetic testing, summarized new and emerging treatments in development and early clinical trials, and detailed where he thinks the field is heading.
Genetic Testing for Personalized Treatment
Treatment regimens for pancreatic cancer are not one size fits all and should be guided by a patient’s genetics, the behavior of their tumor(s), and their personal goals. The key to personalized treatment is genetic testing, which is recommended for all patients. There are two types of testing — germline and somatic — and both provide information used in making treatment decisions and identifying clinical trial options.
Germline Testing
Identifies inherited mutations present in all of the patient’s cells, commonly done on blood or a cheek swab.
Inherited mutations in pancreatic cancer include BRCA1/BRCA2, TP53, and genes involved in Lynch Syndrome.
Somatic Testing
Identifies genetic mutations that arise only in the tumor, such as KRAS mutations.
While most patients with untreated, metastatic tumors get chemotherapy, patients with certain germline or somatic mutations may do better on one type of chemotherapy versus another. For patients with KRAS mutations, there are now clinical trials that target specific KRAS mutations they may qualify for. Finally, there are approved treatment options for specific genetic alterations — both germline and somatic — that can be considered, such as a PARP inhibitor for patients with germline BRCA1/2 mutations and immunotherapy for patients with microsatellite instability high (MSI-H) tumors.
Emerging Technologies
Blood tests that detect circulating tumor DNA (ctDNA) are now being used to monitor patients with a pancreatic cancer diagnosis — in addition to imaging and the tracking of CA 19-9 and CEA (carcinoembryonic antigen). Together, these tools allow doctors to track disease over time, understand response to treatment, and potentially identify recurrence earlier than can be detected on imaging.
Emerging Treatments
An early-phase clinical trial called EXTEND is offering promising results on a new treatment approach for patients with a small number of metastatic lesions who currently don’t qualify for surgery. In this small study, patients had four times longer progression-free survival (PFS), and there was a trend toward an increase in overall survival (OS).
longer progression-free survival in the EXTEND trial
of patients harbor mutant KRAS protein
These data support the initiation of a phase 3 clinical trial, EXPAND, currently enrolling to test this new approach in a larger group of patients.
KRAS-targeted therapies have been a major area of progress over the past year. As more than 90% of patients harbor mutant KRAS protein, the ability to inhibit the activity of this once-“undruggable” protein has the potential to change the standard of care for pancreatic cancer patients in the near future. Two main approaches currently in clinical trials are “Pan-RAS” inhibitors and mutant-specific KRAS inhibitors.
Pan-RAS Inhibitors
Daraxonrasib, a “Pan-RAS” inhibitor from Revolution Medicines, binds all forms of RAS and has demonstrated exciting overall response rates in both previously treated and untreated metastatic pancreatic cancer patients. Based on these early results, the expectation is that it is on the verge of becoming a standard-of-care therapy.
Mutant-Specific KRAS Inhibitors
These bind to and block the function of specific mutant versions of the KRAS protein. Zoldonrasib is a KRAS G12D inhibitor (G12D is the most common mutation in pancreatic cancer) and has demonstrated promising results in Ph1/2 clinical trials. The combined use of “Pan-RAS” and mutant-specific KRAS inhibitors is also under evaluation.
Building on promising immunotherapy developments detailed in the 2025 Progress in Pancreatic Cancer presentation, two phase 2 clinical trials evaluating different immunotherapeutic approaches have been initiated. To reverse immune suppression in pancreatic cancer, a current clinical trial is treating patients with an adenosine inhibitor prior to surgery to increase ongoing anti-tumor immune responses.
Following a promising phase 1 clinical trial from Memorial Sloan Kettering (MSK) that evaluated a personalized mRNA anti-tumor vaccine, a phase 2 trial has been initiated with sites around the country, including UCLA. The goal of this trial is to enroll more patients and understand the durability of the resulting anti-tumor immune response.
“There is more progress and hope than ever before.”
— Dr. Timothy Donahue
The exciting advances outlined by Dr. Donahue make clear that current research is being transformed into desperately needed therapies for pancreatic cancer patients. Progress over the past few years has increased the 5-year survival rate and is allowing more patients to live longer with an increased quality of life. The Hirshberg Foundation is proud to support the collaboration, patient education, and research that will keep this momentum going.
