Editor's Note: Pancreatic cancer, often called the “king of cancers,” remains a formidable disease with poor patient outcomes. Challenges stem from the complexity and invasiveness of surgical procedures and limited progress in systemic therapies, which are still largely chemotherapy-based. However, 2024 brought new developments in pancreatic minimally invasive surgery and innovative treatment strategies. In an interview with Oncology Frontier, Dr. Xianjun Yu from Fudan University Shanghai Cancer Center shared his perspective on these advancements, highlighting the refinement of surgical techniques and the emergence of precision medicine approaches for pancreatic cancer.

2024 in Review: Challenges and Progress in Pancreatic Cancer Treatment

Professor Yu began by expressing his gratitude for the opportunity to share the progress made in 2024 and his outlook for 2025. He noted that pancreatic cancer, despite its reputation as the “king of cancers,” continues to rise in incidence, with significant improvements in overall outcomes yet to be achieved. Nevertheless, he emphasized that 2024 was marked by both challenges and breakthroughs in pancreatic cancer treatment.

The Rapid Development of Minimally Invasive Pancreatic Surgery

Pancreatic surgery has undergone significant advancements since 2020, achieving a qualitative leap in technique and application. These refinements have brought transformative changes to the field, enabling surgeons to safely and effectively perform complex, high-risk procedures that were once considered insurmountable.

In 2024, Fudan University Shanghai Cancer Center, recognized as a global leader in pancreatic disease diagnosis and treatment, demonstrated two key advancements. First, the adoption of minimally invasive techniques has progressed significantly, even in the challenging realm of pancreatic surgery. These breakthroughs are credited to the efforts of a talented cohort of young and mid-career surgeons. For example, the center’s project “Innovations and Applications of Key Surgical Techniques and Intervention Strategies in Pancreatic Tumors” was awarded the Shanghai Science and Technology Progress Award in 2024. Multicenter studies have shown that minimally invasive surgery is comparable to open surgery in oncological outcomes and long-term survival while addressing patient concerns about safety, completeness of tumor removal, and survival benefits.

The second advancement is the transition from minimally invasive surgery to microsurgery, which allows for more precise and refined procedures. Microsurgical techniques enable localized tumor resection while preserving organ function, particularly for low-grade malignancies and precancerous lesions. For instance, microsurgery allows the dissection and repair of pancreatic ducts as small as 2 millimeters. These advancements bring significant benefits to patients by removing the “ticking time bomb” of tumors while avoiding unnecessary damage to the organ.

Breakthroughs in Precision Medicine for Pancreatic Cancer

In addition to technical progress, 2024 saw a paradigm shift in treatment strategies for pancreatic cancer, with a growing emphasis on comprehensive management before, during, and after surgery. Research into neoadjuvant and conversion therapies has underscored the importance of systematic management in improving patient outcomes over time.

Precision systemic treatment for pancreatic cancer has also gained momentum. Techniques such as liquid biopsy, pathology-based or genetic testing, and targeted or immune-based therapies have shown increasing potential. Advances in chemotherapy formulations, the development of antibody-drug conjugates (ADCs), and the emergence of new targeted therapies have opened new avenues for treatment.

For instance, the approval of liposomal irinotecan has introduced a new chemotherapy option for pancreatic cancer patients. ADCs, which combine targeted therapy with chemotherapy, have become a focal point in systemic treatment research. Additionally, therapies targeting KRAS mutations (specifically KRAS G12C and G12D) are beginning to demonstrate considerable potential in pancreatic cancer treatment.

Previous studies, such as the POLO trial, have already established PARP inhibitors as a precision treatment option for patients with BRCA mutations. However, Professor Yu noted that some patients without BRCA mutations have also benefited from PARP inhibitors. In 2024, his team published a study in GUT identifying TPX2 as a dual regulator of DNA damage repair and mitotic progression. This discovery positions TPX2 as a potential synthetic lethal target for PARP inhibitors, potentially expanding their application to a broader patient population.

Immunotherapy for pancreatic cancer has also entered a new phase. From vaccines to cell-based therapies, the field has evolved from an initial void to active exploration of optimal timing and methods of application. Questions about whether immunotherapy should be used as first-line treatment for advanced disease, as an adjuvant therapy post-surgery, or in combination with other treatments are beginning to find preliminary answers. Research and clinical applications in these areas are well underway.

Looking Ahead: 2025 and Beyond

Professor Yu concluded by expressing his optimism for the future of pancreatic cancer treatment. He firmly believes that under the guidance of precision medicine, the development of new strategies, approaches, and models will bring greater breakthroughs. With these advancements, 2025 promises to deliver even more surprises and hope for patients facing this challenging disease.