Mettu and Abbruzzese provide an elegant review of pancreatic adenocarcinoma biology, thoughtfully linking biological insights to prevention with early detection and new therapeutic strategies. With falling death rates for other common malignancies, pancreatic adenocarcinoma may become the second-leading cause of cancer-related death in the United States in the next few years.

80-90% of patients diagnosed with this disease are diagnosed with locally advanced or metastatic disease, beyond reasonable hope for a cure. In terms of prevention and early detection, the relationship of obesity, diabetes, and chronic pancreatitis to pancreatic adenocarcinoma is receiving much more attention.

Therapy of pancreatic ductal adenocarcinoma is improving. Chemotherapy combinations, such as FOLFIRINOX and gemcitabine and albumin-bound paclitaxel,6 can stabilize a significant fraction of patients. Interestingly, of the greater than 50 clinical trials in pancreatic adenocarcinoma listed on the website, the majority deploy agents that target pathways in the tumor microenvironment.

As the federal government is ramping up to invest resources for research in pancreatic oncology, we owe this patient population our investment of time and talent to better understand the disease and seize the opportunities to explore improved management strategies.