Choosing the next drug for pancreatic cancer, when the standard options run out.

Second-line treatment is often a judgment call with little evidence behind it.

First-line treatment for pancreatic ductal adenocarcinoma is usually one of two chemotherapy regimens, FOLFIRINOX or a gemcitabine and nab-paclitaxel combination. Which one a patient starts on depends largely on what their body can tolerate, since FOLFIRINOX is the more aggressive of the two. When the first regimen stops working, the second line is often simply the other one.

The new generation of KRAS inhibitors is beginning to change this picture, and it is a real advance. But it does not reach every patient. Some tumors carry no targetable KRAS alteration, and some progress even after a targeted drug. For those patients, the question of what to try next still has almost no evidence behind it.

That gap is where PancRx is meant to help. Rather than matching on mutations alone, which captures only what is broken and works only a fraction of the time in most solid tumors, PancRx looks at gene activity, a picture of how the tumor is actually behaving, and uses it to find approved drugs whose effect works against that behavior.

1. Read the tumor's activity

   Start from a picture of which genes are switched on in the tumor, taken from a tissue sample or, where possible, a blood draw.

2. Match it against known drugs

   Compare that picture against a large body of information on how approved drugs act on cells, drawn from decades of public research.

3. Find what works against it

   Surface the drugs whose effect runs counter to the tumor's, and rank them by how strongly they push against its behavior, regardless of what those drugs were originally approved to treat.

4. Deliver a clear shortlist

   Return a short, ranked list of candidates with the reasoning behind each, meant to inform a tumor board or treating oncologist rather than to replace their judgment.

A large, underserved need, and an approach that starts from medicines we already trust.

Pancreatic cancer has one of the lowest survival rates of any major cancer, and the patients PancRx focuses on, those who have already run through standard treatment, are among the hardest to help and the least served by what exists today.

Because PancRx works only with drugs that are already approved, it starts from medicines whose safety is already understood. That avoids the long and costly road of developing a new drug from scratch, and points instead to options a clinician could reasonably consider now.

Its value grows with use. The matching improves as it draws on more real patient outcomes, and the data access we are building, including our discussions with PanCAN, is difficult for others to reproduce. A clear clinical need, an approach grounded in existing medicine, and data that becomes more valuable over time are what make this worth building.

University of Pittsburgh. In early data discussions with PanCAN's Know Your Tumor program. Supported by the PUnCh innovation program.