Contributed Commentary by Jeffrey M. Venstrom, MD, ClearNote Health
September 11, 2026 | As one of the highest-mortality cancers, pancreatic cancer has long been seen as a death sentence. But just in the past year we have witnessed exciting new study results bringing new hope, such as the RASolute phase 3 trial that showed positive outcomes for patients with advanced pancreatic cancer who were treated with daraxonrasib.
These promising new therapies, all of them inching closer to regular clinical use, add to the significant progress that has been made for pancreatic cancer patients through advances in imaging, surgery, and other areas. Consider the standard Whipple procedure to resect pancreatic tumors: compared to my medical school days, this once-highly risky surgery now has lower morbidity and mortality, assuming the procedure is performed by experienced practitioners.
Collectively, this progress points to the critical next step in driving better outcomes for patients diagnosed with pancreatic cancer. We must push hard to shift these transformative new interventions into use for patients with earlier-stage cancers. Imagine if the benefits we saw with daraxonrasib, which nearly doubled survival time for stage 4 patients, could be expanded to patients with stage 1 or stage 2 cancer. We can imagine adding years of productive life, or even curing disease completely. There is a way to achieve this, and it’s through early detection.
Almost all of the recent trial results prompting so much enthusiasm in the biomedical community come from treatments designed for patients with late-stage cancer. It’s no surprise that this is where drug development starts; these are the patients most desperate for new options. But there’s another, more practical, element: pancreatic cancer is seldom diagnosed in the early stages. If you can’t find these patients, what’s the point of creating a treatment for them?
But we have seen similar situations in other high-mortality cancers, where drugs were successfully shifted over time to earlier-stage cases. EGFR-targeting drugs that were first approved for late-stage lung cancer have now been approved for use with less advanced cancers, while PARP inhibitors can now be used for patients with a variety of early-stage cancers so long as they have certain biomarkers.
In pancreatic cancer, early detection will enable the studies needed to expand drug approvals to earlier-stage cases. Early detection will allow us to build those cohorts and launch the necessary trials.
Fortunately, there has been as much improvement in the area of early detection for pancreatic cancer as there has been for new therapies and surgical procedures. Today, a simple blood test can provide the detailed epigenomic, genomic, and other biomarker data needed to identify patients who have pancreatic cancer, even at its earliest stages and long before noticeable clinical symptoms arise. Some of these liquid biopsy tests interrogate 5mC, a commonly studied type of methylation, while another focuses on 5hmC, a different epigenetic marker associated with active or upregulated genes and cancer activity. Because it includes tissue-specific information, a 5hmC-based test can also generate precise data about the presence or absence of pancreatic cancer.
For the most impact, we should be targeting this kind of blood-based testing to patients who have the highest risk of developing pancreatic cancer: those with a genetic predisposition or family history, or those age 50 and over who are newly diagnosed with type 2 diabetes. Currently, these groups can receive surveillance through imaging, but studies have shown that even routine scans can miss early-stage cancers, and people in these surveillance programs still present with advanced tumors. Alternating between imaging and blood tests could be a useful way to catch cases earlier.
Though we don’t have a cure for every patient with pancreatic cancer, we are certainly not flying blind. We know how to identify patients at elevated risk of this disease. With reliable tools for early detection, we expect to find more patients with early-stage cancer, and establish the cohorts needed to enable fast therapeutic clinical studies that could potentially expand the benefits of novel therapies to patients with more survivable cancers. This is a huge opportunity to improve outcomes in pancreatic cancer: linking earlier detection with novel therapies.
Jeffrey M. Venstrom, MD, serves as chief medical officer at ClearNote Health. After completing his clinical training and practice in medical oncology, he spent the last decade working in the diagnostics industry to oversee development of more effective tests for cancer and oncology biomarkers. He can be reached at jvenstrom@clearnotehealth.com.