Diagnosis and treatment of pancreatic cancer: an expert opinion from the 9th CECOG Pancreas Cancer Academy

Summary Pancreatic ductal adenocarcinoma (PDAC) remains one of the most challenging malignancies, with a dismal prognosis and limited therapeutic options. The 9th CECOG Pancreas Cancer Academy brought together leading international experts to review recent advances and establish a consolidated expert opinion on the biology, diagnosis, and treatment of pancreatic cancer. Pancreatic ductal adenocarcinoma is characterized by extensive molecular heterogeneity, with KRAS mutations being the primary driver of most cases. Diagnosis relies on a multimodal imaging approach, while molecular diagnostics are increasingly essential for identifying actionable biomarkers and understanding resistance mechanisms. Multidisciplinary tumor boards are crucial for addressing all aspects of diagnosis and treatment. Treatment strategies are tailored to disease stage and patient performance status. For resectable disease, upfront surgery followed by adjuvant chemotherapy (preferably mFOLFIRINOX) remains the standard, although neoadjuvant therapy is gaining importance for borderline resectable tumors. In metastatic disease, FOLFIRINOX, NALIRIFOX, and gemcitabine–nab-paclitaxel are first-line options. Second-line therapies focus on switching drug classes and tailoring therapies according to patient fitness. Novel therapies, including targeted agents, immunotherapies, and antibody–drug conjugates, are currently being assessed in clinical trials. Despite progress, the complexity of pancreatic cancer demands continued research into biologically driven treatments and early detection strategies to improve patient survival and quality of life.