This editorial reviews the evolution of multimodal treatment for pancreatic ductal adenocarcinoma (PDAC), synthesizing recent advances in systemic therapy, minimally invasive and complex surgery, postoperative recovery, recurrence management, AI-guided treatment selection, and RAS-targeted therapy.
Key advances highlighted include: perioperative PAXG outperforming mFOLFIRINOX in resectable/borderline resectable PDAC (median event-free survival 16.0 vs 10.2 months; HR 0.63, with 3-year benefit 33% vs 13%); daraxonrasib (RAS(ON) inhibitor) improving OS and PFS vs chemotherapy in previously treated metastatic PDAC; and deep learning on histopathology showing potential to predict differential benefit from adjuvant gemcitabine vs mFOLFIRINOX.
This is an editorial/narrative review without systematic search methodology, so findings reflect curated expert opinion rather than a comprehensive evidence synthesis. The clinical trials and studies cited vary widely in design and patient populations, limiting direct comparisons.
Clinicians should consider neoadjuvant chemotherapy even for anatomically resectable PDAC, ensure early and adequate systemic treatment, and view surgical recovery and return to chemotherapy as part of a continuous oncological plan. Emerging tools like AI-based pathology biomarkers and RAS-targeted agents may soon further refine treatment selection and sequencing.
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