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Review
. 2025 Jun 4;30(6):oyaf154.
doi: 10.1093/oncolo/oyaf154.

Oligometastatic pancreatic cancer: current state of management and emerging therapies

Andrii Khomiak  1 , Nicole B Balmaceda  2 , Sumaya A Ghaffar  1 , Christopher H Lieu  2 , Marco Del Chiaro  1 , Wells A Messersmith  2 , Robert W Lentz  2
Affiliations
Review

Oligometastatic pancreatic cancer: current state of management and emerging therapies

Andrii Khomiak et al. Oncologist. .

Abstract

Oligometastatic pancreatic cancer is a distinct clinical entity with limited metastatic burden. This unique subset of patients harbor a favorable tumor biology and potentially better prognosis compared to widespread metastatic disease. This review explores definitions of oligometastatic pancreatic cancer and the current state of management, including systemic therapy, surgery, and locoregional techniques. While there are few randomized clinical trials directing the management of oligometastatic pancreatic cancer, we provide insights into the treatment challenges, evolving therapeutic approaches, and future directions for this unique subset of patients.

Keywords: locoregional therapy; metastasis-directed therapy; oligometastatic disease; pancreatic ductal adenocarcinoma; surgical metastasectomy; systemic therapy.

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Conflict of interest statement

Dr. Lentz acknowledges clinical research funding to institution from ALX Oncology, Merck, Lilly, Guardant, EDDC, Boehringer Ingelheim, and AstraZeneca, and consulting/advisory role (honoraria to institution) for Agenus, Boehringer Ingelheim, Merck, and Natera. Dr. Del Chiaro reported receiving an industry grant (Haemonetics, Inc) to conduct a multicenter study to evaluate the prognostic implications of TEG in pancreatic cancer and being a co-principal investigator of a Boston Scientific sponsored international multicenter study on the use of intraoperative pancreatoscopy of patients with IPMN. Dr. Messersmith acknowledges clinical research funding to institution from Agenus, ALX Oncology, Exelixis, Mirati, Pfizer, PureTech, RasCal, Revolution Medicines; and consulting/advisory role (honoraria to institution) for Criterium and Amgen (DMSC). No other disclosures were reported.

Figures

Figure 1.
Figure 1.
Treatment strategies for oligometastatic pancreatic ductal adenocarcinoma. This schematic is for illustrative purposes; organ sizes and positions are approximate and not to scale. Abbreviations: CRS, cytoreductive surgery; HIPEC, hyperthermic intraperitoneal chemotherapy; NIPEC, normothermic intraperitoneal chemotherapy; PIPAC, pressurized intraperitoneal aerosol chemotherapy; RFA, radiofrequency ablation; SBRT, stereotactic body radiation therapy. Created in BioRender. Khomiak, A. (2025) https://BioRender.com/o09u510
Figure 2.
Figure 2.
Proposed clinical schema for patient selection and management of oligometastatic pancreatic ductal adenocarcinoma. Abbreviations: CA 19-9, carbohydrate antigen 19-9; ECOG, Eastern Cooperative Oncology Group performance status; FOLFIRINOX, 5-fluorouracil, leucovorin, irinotecan, oxaliplatin; GnP: gemcitabine plus nab-paclitaxel; HIPEC, hyperthermic intraperitoneal chemotherapy; MDT, multidisciplinary team; mPDAC, metastatic pancreatic ductal adenocarcinoma; NALIRIFOX, liposomal irinotecan, 5-fluorouracil, leucovorin, oxaliplatin; NIPEC, normothermic intraperitoneal chemotherapy; OMD, oligometastatic disease; PIPAC, pressurized intraperitoneal aerosol chemotherapy; SBRT, stereotactic body radiation therapy; TACE, transarterial chemoembolization; TARE/SIRT, transarterial radioembolization/selective internal radiation therapy.
See this image and copyright information in PMC

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