Advances and Emerging Therapies in the Management of Stage 4 Pancreatic Ductal Adenocarcinoma: A Comprehensive Review (2025)
Abstract Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, characterized by aggressive biology, late diagnosis, and limited therapeutic options. Despite advances in multi-agent chemotherapy, the prognosis for metastatic disease remains poor. This review synthesizes current evidence on standard-of-care regimens, including NALIRIFOX and FOLFIRINOX, emerging targeted and immunotherapeutic approaches, and explores the potential repurposing of antiparasitic agents such as fenbendazole and ivermectin. We discuss recent clinical trials, safety profiles, and future directions for improving outcomes in stage 4 PDAC. Pancreatic Cancer Awareness Introduction Pancreatic cancer is among the most aggressive and therapeutically challenging malignancies, with a 5-year survival rate below 10% for all stages combined. Approximately 80% of pancreatic cancers are pancreatic ductal adenocarcinomas (PDAC) , which are frequently diagnosed at an advanced stage, limiting cura...