Evolving Paradigms in the Treatment of Oligometastatic Pancreatic Ductal Adenocarcinoma.

Multiple randomized trials have suggested that the addition of comprehensive metastasis-directed therapy to best systemic therapy improves disease control and survival among patients with oligometastatic disease, even for histologies with a high propensity for rapid spread. Here, we review the growing literature supporting the oligometastatic paradigm in pancreatic ductal adenocarcinoma. We summarize key details from nascent institutional series and reflect on the recently reported phase II randomized EXTEND trial. We discuss various strategies for enhancing the clinical and technical implementation of metastasis-directed therapy in this patient population. Lastly, we highlight multiple ongoing landmark trials seeking to optimize and validate the role of metastasis-directed therapy in oligometastatic pancreatic cancer. Ultimately, these and other continued clinical and translational research efforts will be critical to improve care and outcomes for patients with oligometastatic pancreatic ductal adenocarcinoma.
Competing Interests: Declarations. Disclosures: A.D. Sherry reports honoraria from Sermo. C.D. Tzeng reports research grants from Sirtex and consulting fees from PanTher. C. Tang reports grants from the Cancer Prevention & Research Institute of Texas (CPRIT), Noxopharm, and the Department of Defense (DoD), receiving royalties from Wolters Kluwer and Osler Institute, and receiving and consulting fees and honoraria from Siemen Healthineer, Lantheus, Telix, Molli Surgical, and Boston Scientific. T. A. Aguilera reports grants from the National Institutes of Health, royalties from UC San Diego and Stanford, and stock from Avelas Biosciences. E.J. Koay reports grants from National Institutes of Health, Stand Up 2 Cancer, MD Anderson Cancer Center, Philips Healthcare, Elekta, and GE Healthcare; personal fees from RenovoRx and Taylor and Francis; and a consulting/advisory role with Augmenix. P. Das reports honoraria from Bayer and ASTRO. S. Pant reports consulting fees from Zymeworks, Ipsen, Novartis, Janssen, Boehringer Ingelheim, AskGene Pharma, BPGbio, Jazz Pharmaceuticals, AstraZeneca, US WorldMeds, Nihon Medi-Physics, Alligator Bioscience, and research funding from Mirati Therapeutics, Lilly, Xencor, Novartis, Rgenix, Bristol Myers Squibb, Astellas Pharma, Purple Biotech, 4D Pharma, Boehringer Ingelheim, NGM Biopharmaceuticals, Janssen, Arcus Biosciences, Elicio Therapeutics, Bionte, Ipsen, Zymeworks, Pfizer, ImmunoMET, Immuneering, and Amal Therapeutics.
(© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)