The road to overcome pancreatic cancer: Where are we?

Pancreatic cancer (PC) is an intricate malignancy with poor prognosis. In the present state of the art review paper and clinical trial trend analysis, we explore the current clinically employed state of pancreatic cancer body of knowledge and future research directions. When considering PDACs' molecular biology, we underline the role of PanIN in carcinogenesis and mutational gain, as well as the distinctive tumor microenvironment with the characteristic dense fibrotic stroma. The mutational landscape of PC typically involves KRAS, TP53, SMAD4 and CDKN2A genes, but other mutations can be identified depending on the PDAC subtype. Due to various factors, there are currently limited therapeutic options - from a surgical-centered approach in the resectable stage, to a systemic approach in more advanced stages, including the potential applicability of personalized medicine. Currently, there are numerous clinical trials undergoing that study various landscapes - from the use of newer or repurposed chemotherapeutics, to the introduction of newer immunotherapeutic agents, antibody-drug conjugates, TCR-T cell therapy and the study of mDC3/8-KRAS cancer vaccines, among others.