Skip to main contentLast updated: 11-Nov-2026
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Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Pancreas Cancer Surgeon
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad · 18 years of experience
In short
The biggest news of 2026 is a new kind of medicine that blocks the RAS switch inside the cancer cell. In a large trial it helped people with cancer that had spread and had already been treated once to live clearly longer.
Most other changes are about doing the old things better: testing the tumour at the start, giving medicine before surgery to some patients, and choosing the right operation and follow-up.
Surgery by an experienced team is still the main route to long-term control when the cancer can be removed. Not every new report changes what you should do.
This post is a plain summary of recent research. For the full treatment pathway, see our pancreatic cancer treatment page.
A few results from the last two years have changed practice. Others are interesting but still being tested. The table below separates the two.
| Development | Who it is for | What it means |
|---|---|---|
| RAS-blocking medicine (daraxonrasib) | Cancer that has spread and was already treated once | Large trial showed longer life than usual chemotherapy; a new option once it is available to you |
| NALIRIFOX combination | First treatment for spread cancer | A newer chemotherapy combination that is now a standard choice for fit patients |
| Olaparib after chemotherapy | Spread cancer with a BRCA gene change | Keeps the cancer quiet for longer; needs the gene test |
| Medicine before surgery | Borderline resectable cancer | Better than going straight to surgery; now the usual plan |
| Radiation added to medicine before surgery | Cancer that can be removed or is borderline | Improved the specimen, but did not help patients live longer |
| Surgery for locally advanced cancer after medicine | Cancer touching major vessels | Feasible at national scale in expert hands |
Each row has limits, and your own scan decides which applies. Our post on pancreatic cancer staging and resectability explains how that decision is made.
Several newer medicines work only on cancers with a particular gene change. A tumour test at the time of diagnosis tells us which medicines can be used later, so it should not wait for a relapse.
Today the advice is to test the cancer tissue, and often a blood sample for inherited changes, as soon as the diagnosis is made. This is called next-generation sequencing. The result can matter years later.
Ask for the full report, not only the word “positive” or “negative”. Our post on what the pancreas biopsy report and gene tests mean shows how to read it. An inherited change also matters to your brothers, sisters and children. See risk factors and hereditary syndromes.
It is a promising development, but it does not remove the cancer. It extends life for some people whose cancer has spread and has stopped responding to first-line chemotherapy.
RAS is a growth switch that is stuck “on” in nearly every pancreatic cancer. For decades no medicine could reach it. Daraxonrasib is a tablet that binds the active form of RAS and switches it off. A large international trial, published in May 2026, compared it with chemotherapy in patients who had already received first-line treatment. People on the new medicine lived clearly longer, and the cancer stayed controlled for longer.
| Question | Plain answer |
|---|---|
| Who was studied? | People with spread cancer that had already been treated once |
| Does it remove the cancer? | No. It controls it and extends life |
| Does it have side effects? | Yes. Skin rash, mouth sores and stomach upset are reported, and they need monitoring |
| Is it routine in India? | Not yet. Access depends on approval, supply and trials, so ask your doctor before relying on it |
| Is it for earlier cancer? | Not yet proven. Studies in earlier disease are still going on |
Treatment of spread cancer is built around a whole plan, not one medicine. See metastatic pancreatic cancer treatment for the full picture, including chemotherapy and comfort care.
Yes for borderline cancer, where the tumour touches a major vessel. For cancer that looks clearly removable, the benefit of giving medicine first is still uncertain.
In borderline cancer, trials now show that chemotherapy first lets more patients have a complete removal of the tumour, and those patients live longer than with surgery first. This is now the usual plan. See borderline resectable pancreatic cancer treatment.
For cancer that is clearly removable, the picture is less settled. One large analysis in 2026 found that the apparent gain from medicine first disappears once a statistical bias is corrected. A trial that tests medicine first against surgery first is still open. Until then, both routes are accepted, and the choice depends on fitness, the CA 19-9 level and the scan. Read resectable pancreatic cancer treatment for how we decide.
The Whipple operation itself has not changed much. What has changed is who is offered it, how it is planned, and which extra steps are proved to be unnecessary.
| Question studied | What was found |
|---|---|
| Is an older age a reason to avoid surgery? | No. In a very large national study, age alone did not predict survival |
| Does a clear margin still matter if the nodes are involved? | Yes. A complete removal helps even then |
| Is it better to approach the main artery first? | No advantage over the usual method in a randomised trial |
| Which way of joining the stomach to the bowel is better? | The two ways gave similar results |
| Can surgery follow medicine for locally advanced cancer? | Yes, for many patients, in expert centres |
| Can a benign or low-grade tumour be scooped out? | Fewer major complications but more leaks; the choice is individual |
A few technique questions remain open, including how keyhole surgery compares with open surgery in the Whipple operation. Dr Harsh Shah offers laparoscopic and open operations, and the choice follows your scan and your safety. We discuss that on the day.
A Whipple operation is safer in a unit that does many of them each year. After it, enzymes and diet help recovery. See eating, enzymes and sugar after pancreas surgery.
A little, but no new test yet replaces the scan and biopsy. Blood tests help to follow the disease, and artificial intelligence is only starting to help radiologists.
Follow-up after surgery is planned around scans and markers. See follow-up after pancreatic cancer surgery.
Cysts that make mucus (IPMN) carry a higher long-term risk than once thought, so follow-up is being tailored to each cyst rather than set for everyone.
A large study of people under surveillance found their later risk of pancreatic cancer was far above the general population. The risk was higher when the main duct was wider, in people with a high body weight, and with larger cysts. A new Danish consensus suggests a work-up for cysts above a certain size and for any with main-duct involvement, lighter follow-up for small side-branch cysts, and stopping scans in older people whose cyst has stayed stable for years. Because a cyst may turn into cancer, we treat it with the same care. See pancreatic cystic lesions.
A complete operation, done well, is still the only way to long-term control when the cancer can be removed. Chemotherapy, nutrition and stopping smoking still matter.
Bring every report and ask which new development applies to your stage, your fitness and your tumour test. Then ask what you should do first.
Yes. A tablet that blocks the RAS switch (daraxonrasib) helped people with spread cancer, treated once before, to live clearly longer in a large trial. It controls the cancer but does not remove it, and access in India depends on approval and supply.
No. It controls the disease and extends life for some people. Surgery by an experienced team is still the main route to long-term control when the cancer can be removed.
Several medicines work only on cancers with a particular gene change, for example BRCA, KRAS or MSI-high. Knowing this early lets the team plan the first and later treatments.
It is advised for borderline cancer, where the tumour touches a major vessel. For cancer that is clearly removable, both routes are accepted and the choice depends on fitness, CA 19-9 and the scan.
No. Adding it to the medicine before surgery improved the specimen but did not help patients live longer, so it is used in selected cases only.
Yes, if fit. Large national data showed that age alone did not predict survival. Fitness, nutrition and other illnesses guide the decision.
Not yet for people at ordinary risk. Blood markers help to follow disease, and tests for leftover tumour DNA and computer reading of scans are still under study.
Treat a trial result as a result for a group, not a promise for one person. Bring the report to your doctor and ask whether it applies to your stage, fitness and tumour test.
For the whole treatment pathway, start at the pancreatic cancer treatment page. For questions before you travel, call +91-63555-64601.
Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Consultations, review of reports and scans, operations and follow-up. OPD Monday to Saturday, 9 am to 5 pm.
Appointments: +91-63555-64601 · +91-63590-11009 · Hospital 079-2663 6363
Directions to the hospital · WhatsApp +91-63555-64601
Read about a new pancreatic cancer medicine and wondering if it applies to you or a family member? Dr Harsh Shah goes through the scan, the biopsy and the tumour test reports, then explains which of these developments are useful in your situation and which are not. Bring all your reports. You can also call, or message us on WhatsApp. Call For Appointment Book on WhatsApp Tapping Book on WhatsApp will likely open the WhatsApp app on your phone.
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