November is Pancreatic Cancer Awareness Month — a time to shine a light on one of the most challenging cancers to treat and the innovative research that is transforming its detection, treatment and patient outcomes.
In 2025, an estimated 7,100 people in Canada will be diagnosed with pancreatic cancer and the five-year net survival rate is about 10 per cent.
Dr. Jennifer Knox, a leading expert in pancreatic cancer care and research at UHN's Princess Margaret Cancer Centre and co-Director of The Wallace McCain Centre for Pancreatic Cancer, shares her insights.
Why is pancreatic cancer considered one of the most challenging cancers to treat?
Pancreatic cancer is notoriously difficult to treat because it's often aggressive and caught at an advanced stage.
Symptoms are vague until the disease has progressed, and that's usually when a diagnosis can be made. And unlike some other cancers, there are currently no screening tools for early detection.
As a result, only a small proportion of patients whose cancers have not yet spread are eligible for surgical removal at diagnosis — the only potential cure of this disease.
Otherwise, patients will have to undergo systemic therapies for treatment. Pancreatic tumours are highly resistant to conventional chemotherapy or immunotherapy.
In 2025, pancreatic cancer is the third leading cause of cancer death in Canada. This is why research into early detection strategies and novel therapies is critical.
Given the challenges to detect pancreatic cancer early and its low survival rate, what can clinicians do differently when pancreatic cancer is diagnosed?
When patients are first diagnosed, clinicians need to think beyond chemotherapy alone.
We need to determine the cancer's molecular features upfront and treat with precision medicine, or we may be missing a window of opportunity to select the best chemotherapy and targeted therapies for patients.
How do we bring precision medicine into first-line treatment in pancreatic cancer? What's the rationale behind it?
We need to look at the cancer's genetic landscape to inform treatment plans. This is done through cancer biomarker testing, a type of genetic testing on the tumour sample.
We have been sequencing pancreatic cancer tumours for over ten years and have amassed one of the most comprehensive libraries in the world. Recently, we published a paper in the Journal of Clinical Oncology on the PASS-01 Trial.
In this clinical trial, we investigated whether there are tumour biomarkers that can be identified in metastatic pancreas cancer to inform treatment decisions. We showed that molecular profiling of metastatic pancreatic cancer not only offers valuable prognostic information but is also potentially useful in guiding chemotherapy selection, if such information can be obtained in a timely fashion.
Our research has identified actionable pancreatic tumour mutations that can inform which targeted therapies a patient might be more suitable for, and what clinical trials they are eligible to participate in.
It's exciting to see your team's research uncover new biomarkers that could guide more effective treatments. What progress has been made in bringing these discoveries into clinical practice?
Our findings have helped support Ontario Health (Cancer Care Ontario) in expanding its Comprehensive Cancer Biomarker Testing Program, which was updated in October 2025, to include testing a panel of genes for all patients in Ontario diagnosed with pancreatic cancer. Patients should be tested as early as possible to take advantage of their tumour's genomics information.
Patients and families can ask their oncologist whether their tumour tissue will be sent for genetic or molecular testing. Oncologists across Ontario have access to this testing through their institution's laboratory system.
This biomarker test is different from germline testing, which is more well known and examines genes inherited through families. Germline testing helps families understand their risk and it has already been included in North American guidelines for all pancreatic cancer patients based on our work and other global research.
What practical challenges remain in ensuring pancreatic cancer patients can benefit from the biomarker test and the treatments it informs?
This improved access is very exciting for the pancreatic cancer community in Ontario. Collecting adequate biopsy specimens (cores) and sending them out early is key. Traditionally, biopsies were collected only to confirm a cancer diagnosis.
Now, they need to provide enough tissue for molecular testing, which requires a shift in thinking. In some cases, it is too difficult to obtain sufficient tumour sample, and we are starting to use liquid biopsies from blood as that technology advances.
The second challenge is having access to novel drugs that match precision treatment decisions. We need access to clinical trials. Building and maintaining clinical trial infrastructure is complex and costly, requiring ongoing support from pharmaceutical partners, government grants and philanthropic contributions. Streamlined regulatory processes and provincial funding pathways are essential to ensure patients can benefit from these innovations.
What's next in pancreatic cancer research?
The future of pancreatic cancer research is focused on two key areas: early detection and personalized therapies.
There are large global trials on blood tests detecting circulating tumour DNA for early detection, and new drugs are also emerging to target this aggressive disease. Our team is leading efforts in biomarker-driven trials aimed to deliver 'smarter' care to every patient.
We are excited about these innovations and bringing new hope to patients.
