In a conversation with CancerNetwork®, Jose G. Trevino, II, MD, FACS, spoke about the current state of the pancreatic ductal adenocarcinoma (PDAC) paradigm as well as next steps for improving the prognosis of patients who present with this disease. Throughout the discussion, Trevino outlined the roles that surgical oncologists can play in disease management, the different demographic and socioeconomic drivers of disparate patient outcomes, and translational research focusing on factors like the tumor microenvironment.

Trevino stressed the idea of pancreatic cancer care as a “team science,” rejecting a “silo mentality” that involves handing off a patient from one department to the next. Because surgical approaches by themselves have remained “limited” in pancreatic cancer for the past 20 to 30 years, he emphasized continued collaboration with medical oncologists, radiation oncologists, and translational scientists to enhance patient quality of life. 

Regarding disparities, Trevino noted the importance of recognizing various barriers to treatment access among those in rural communities as well as unequal outcomes across different racial and ethnic groups of patients, including worse survival among Black populations. Additionally, in the face of continuously rising PDAC incidence, he stressed additional training across the board on how to detect the red flags associated with disease.

“…There has to be a ton of education for our patients and our physicians who see patients on a primary level to know what those red flags are when a patient comes to their clinic. Early detection of early lesions that could eventually turn into pancreatic adenocarcinoma is going to be the key to survival, ultimately. [If we] catch it before it becomes a cancer, we solve a huge problem,” Trevino stated. “Early detection of early lesions is key.”

Trevino is chair of the Division of Surgical Oncology and an associate professor in the Department of Surgery at VCU School of Medicine as well as surgeon-in-chief and Walter Lawrence, Jr., Distinguished Professor of Oncology at VCU Massey Cancer Center.