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The PancChat Podcast is a collaborative effort from Let’s Win Pancreatic Cancer and the Pancreatic Cancer Action Network (PanCAN), inspired by the long-running #PancChat Twitter/X chat.
Hosted by award-winning journalist Alisyn Camerota, each episode features conversations with leading researchers, clinicians, patients, and advocates who are shaping the future of pancreatic cancer care and research. Together, we deliver expert insights, personal journeys, and the latest breakthroughs—bridging the gap between science and lived experience.
Whether you’re a patient, caregiver, healthcare professional, or simply want to learn more, join us to connect, be inspired, and learn how you can help to accelerate progress in the fight against pancreatic cancer.
Julie Fleshman: Hi, I'm Julie Fleshman, President and CEO of PanCAN. On today's podcast, we will learn more about how doctors choose treatments for pancreatic cancer patients and the role of clinical trials in treatment.
Alisyn Camerota: Hi, everyone. Welcome to our sixth episode. I'm Alisyn Camerota. Today, we take a closer look at the factors that help determine which treatment may be right for which patient and where clinical trials fit into that.
Before we dive in, I want to thank our sponsor, Revolution Medicines.
So let me tell you about our guest. Dr. Andrew Hendifar is a leading researcher focused on developing breakthrough treatments for pancreatic cancer and neuroendocrine tumors at Cedars-Sinai. He heads the gastrointestinal disease research group and founded their hematology and oncology fellowship program. He's also shaping the future of cancer care through his work with national research groups like SWOG, NIH's Neuroendocrine Tumor Task Force, and the Precision Promise Consortium.
Welcome, Dr. Hendifar.
Dr. Andrew Hendifar: Oh, thank you. Thanks for having me.
Alisyn Camerota: It's a pleasure to have you. We've really been looking forward to getting together. Okay, so let me start with our first question. And this is, I think, the most pressing question for anyone who is recently diagnosed.
That is: how do you determine when to go with the standard of care treatment, which is generally chemotherapy, versus when to do something newer, say immunotherapy or clinical trials?
Dr. Andrew Hendifar: Yeah, that's a great question. It's an issue that comes up a lot. I think when you're dealing with pancreatic cancer, maybe speak to your treating doctor a little bit and see what they're thinking about clinical trials. I think as a general rule, trials are always appropriate, and clinical trials at any point in a patient's treatment story will fit the standard treatment. So in other words, if a patient has not been treated, then the clinical trial will usually add a new treatment to the standard therapy, versus if standard therapies have failed, you might be in a clinical trial of just an experimental therapy alone.
Alisyn Camerota: But I mean, you as a doctor-so I understand that patients need to obviously consult with their own doctors, but I find as the wife of a patient that I had to do a lot of my own legwork and research. But as you, as a doctor, how do you determine when you see a patient: I'm going to go with the standard of care chemotherapy versus I think this patient is a great candidate for something more experimental?
Dr. Andrew Hendifar: If you asked me this question a few years ago, I think I'd give you a different answer. But I think today what I would recommend is that every patient who has pancreatic cancer should have their tumor sequenced. And depending on the type of pancreatic cancer they have-if it's KRAS mutated, if you know what type of KRAS mutation-I would recommend looking for a clinical trial right up front as soon as you can. And, you know, there are clinical trials for patients who are untreated, who've already had treatment, etc. And just doing your best to get on a new study.
Some of these new medications are very promising.
Alisyn Camerota: Yes, I've seen that firsthand. So can you explain the difference, Doctor, between genetic testing and tumor molecular testing?
Dr. Andrew Hendifar: It's a great question. The tumor testing is testing the DNA of the tumor. So what's wrong with it? And when we do tumor DNA testing, we find out the mutation that caused the cancer. When you do genetic testing, you're doing testing of your own DNA from your healthy cells. That's to look to see if you inherited a predisposing gene from your family.
Alisyn Camerota: And so how do both of those tests individually and, I guess, together influence the treatment choices that you come up with?
Dr. Andrew Hendifar: Yeah, the biggest influence on treatment choices is the tumor DNA testing. The genetic testing is important as far as, you know, family members-if you have a gene that you inherited, you kind of have to figure out like, okay, where did it come from? Who else might have it? What other problems, you know, can we avoid? It's more like planning for the future and for, you know, the whole-you're basically-for your family, it's benefiting a lot of extended people. But as far as informing treatment decisions, it only rarely does. But really, the tumor testing is key for treating the tumor, and the genetic testing is key for treating the overall health of your family.
Alisyn Camerota: And at what point-that's really good to know-at what point should a patient get tested? Because, you know, time is so of the essence. And I sort of remember that there was this urgency of: do you start treatment before the results come back, you know, from the biopsy of the tumor? So what's the cadence of that timing?
Dr. Andrew Hendifar: Lots of good questions. So I would recommend getting all the testing as soon as possible. As far as whether or not you need to treat before some of the testing results come back will really depend on how things are going. If there's no pain, if everything is going pretty well, there's not a lot of cancer in the body and the patient's very healthy, yeah, you wait for the results to come back first, for sure. But if things are in a tougher situation, if there's lots of symptoms, if someone's unwell, then you just kind of have to start treatment.
The turnaround for genetic testing is pretty quick. For tumor testing, it takes about two to three weeks. Some of the hangups are going to be where the pathology lives-the hospital or the clinic that has the biopsy specimen, they have to package it and ship it out to the commercial laboratory unless they're doing it in their own laboratory, which is not as common unless you're at a big place. If you're at a big hospital, they'll do their own testing, but usually they have to send it out. That's a lot of times where the holdup comes in.
So it takes about two to three weeks for all that to happen.
Alisyn Camerota: At what point during that process does the patient, or do you, begin to look into clinical trials for that patient?
Dr. Andrew Hendifar: I mean, as soon as I have the information back from the tumor testing, I'm thinking about studies. So I'm texting-because it's easier than emailing to get immediate answers-I'm texting a lot of the doctors around the country, just looking around, trying to figure out where does this particular-and what's hard about it is that it's changing every few months. So that's what's, you know, if you look at something today, it's going to change in three, four weeks, which is annoying. But good for progress, but tough if you're a patient trying to figure this out.
Talk to your doctor. I really recommend ClinicalTrials.gov, typing in the type of mutation you have. So for example, it's going to be KRAS something. So I will put "KRAS G12V" in my search term, and I'll usually get the studies I'm looking for. And you can put as a search term also "pancreatic cancer." Sometimes a Google search can also help, but I really think ClinicalTrials.gov is probably the best.
Alisyn Camerota: And why is it changing every few weeks? What's changing every few weeks?
Dr. Andrew Hendifar: There are new treatments. Right now, the landscape for new therapies for pancreatic cancer has changed incredibly because they've been able to develop new inhibitors for KRAS. I could talk about the science a little bit, but it's a little bit complicated. But I think what's important for the patients to know is that for the first time, there are pills that target the underlying mutation for pancreatic cancer, and they're working. So what happens is that a trial will open, it will either be for a certain mutation and then a certain space, and then it will roll and close.
That's why you get this turnover. So, and then different companies are in different phases. If you do a phase 1 or a phase 2 trial, you're not going to get randomized, but if you're in a phase 3 trial, you will get randomized, which is another issue that patients aren't so keen on-getting randomized. Right now, if you have a G12D-as in David-alteration or mutation, there are the most studies available. It's the most common mutation, and there are the most products or different medications from different pharmaceutical sponsors.
For any of them, there could be-and there are-available clinical trials.
Alisyn Camerota: I know. What were you going to say, Doctor?
Dr. Andrew Hendifar: It's kind of hard. I feel really bad for the patients. Even for me -- this is what I do for a living -- it's still hard for me to find studies. I really feel for the patients trying to sort this out.
It does take work, it takes searching, it takes asking, it takes phone calls. A lot of times I would recommend that you call the research office directly of any place that you see that has the study. That really will help you to understand if you qualify. You don't need to meet with any doctors. You need to speak to the research staff.
And that will really help you figure out what to do.
Alisyn Camerota: Well, you just hit on exactly what I was going to ask you about or what I was going to say. It's daunting for the patients. It is daunting because when you go on something like ClinicalTrials.gov, you know, it just spits out like brrr. There's tons of stuff. You don't know which one is open. It's hard to tell which one is open. Some of them are geographically undesirable to where you live. You don't know if you necessarily will be eligible for it. I mean, to your point, Doctor, patients have to be super assertive.
Dr. Andrew Hendifar: It's incredibly hard. You're so right. I mean, the only cheat code I have is: type in the KRAS, the specific mutation, for your search term. That'll really help whittle down a lot of the options. And, you know-
Alisyn Camerota: That's good. I mean, I think that that is a good cheat because then it just boils down the, you know, 400 available around the country. And also geographically, it does make a difference. It's hard if you're in Connecticut to go to a clinical trial in Oregon. People do it, but it's hard.
Okay, so once someone gets on a clinical trial, how might their treatment plan change? You alluded to this-as opposed to the standard of care, for instance, with the KRAS. It's a pill, which is different than chemo, right?
Dr. Andrew Hendifar: Some studies are looking at the pill and comparing it to the chemo, so you'll get one or the other. Some-and actually that's the phase 3 trial that looks like it's completed enrollment now. Other studies will just give you the pill by itself, and that's usually if chemo hasn't worked. And, you know, not in general, but just specifically, like if you've had chemo at least one time and it hasn't worked. And then, yeah, so there are different ways to-and different types of trials-but those would be the most common.
Sometimes they'll do the chemo plus the pill. And sometimes there'll be studies-there are a lot of basket trials that are trying all types of combinations. And so it's hard to know ahead of time, before you look out into the landscape, what type of study is going to be available at any particular time. But, you know, all of them are actually pretty good, and right now it's a pretty exciting time to get involved in pancreatic cancer research. So although it's tough, it's worth the effort, and I encourage everyone to go try to find some new studies.
Alisyn Camerota: Yes. I mean, my personal experience-I find that the timing also is important because there are some clinical trials. Maybe this has changed now over the past two years, but if you've had chemo, they don't want you. In other words, there are some things that lock you out-barriers to getting on the clinical trial.
Dr. Andrew Hendifar: That's true. Especially what they call first-line trials. So I'll try to break this down. I know we don't have a lot of time, but most trials are going to be either first-line, which means you haven't started treatment yet. Sometimes you can enroll in a first-line trial if you had your tumor removed and you had adjuvant treatment a long time ago, then you could qualify for first-line, even though maybe three years ago you had some treatment.
Then the next one is second-line. Second-line means you've tried one treatment and it hasn't worked. And then after that, it's going to be what's called phase 1 trials. And in phase 1 trials, they're going to want you to have already had treatment and it hasn't worked. But other than that, those are basically three categories.
It's important to know that some people think that phase 1 trials are not good, but that's not true. And they think that in phase 1 trials, you might not-you know-so nowadays phase 1 trials, a lot of times they're looking at novel combinations. So they got the doses right for all the medicines, they're just putting them together, and that can be very-quite favorable for a patient. So don't be discouraged if you see it's phase 1 either.
Alisyn Camerota: I'm glad that you're clarifying that because I think that the impression is that phase 1 is highly experimental.
Dr. Andrew Hendifar: Right, yeah. Times change. Nowadays everyone does these really big phase 1, multiple arms, it's very interesting. So phase 1 sometimes -- patients are the happiest because there's never a randomized phase 1, they never randomize. They put you into distinct buckets and they'd look at the bucket as a whole instead of comparing patients in two groups right against each other.
So a lot of times phase 1s are good.
Alisyn Camerota: But just help clarify that. If you are in a phase 1, how experimental is it? I mean, you are a guinea pig on some level, or have they tested it enough that they know-to make it to phase 1, they know it's safe?
Dr. Andrew Hendifar: Correct, so there are different types of phase 1. So you're bringing up great points. So it'll be designated as a phase 1 if they don't know the dose, or if they're putting a few drugs together for the first time. So that's why it's still called a phase 1. Although for us, when we put two drugs that we know together for the first time, we are less like, "oh, that's"-we feel like it's less experimental than the FDA.
The FDA has to make sure that there's no unexpected side effects when you put them together. But as doctors and clinicians, we know it's not going to be so much overlap. It's not going to be that much of a problem.
Alisyn Camerota: That's good. I mean, just give me your bottom-line advice for families who are confronting this awful disease because it's just the scariest, most devastating-one of the most devastating diagnoses you can get. And so when you hear that you have pancreatic cancer, what's the first thing that patients should do to try to take charge of their own treatment?
Dr. Andrew Hendifar: Yeah. My heart goes out to everyone who's listening to this, who's getting a diagnosis for themselves or family members for the first time. I would say what I would do-the first things is, like you already brought up, Alisyn, great points. Make sure you get the genetic testing, make sure you get the tumor DNA testing, make sure that's already-if not already ordered, then make sure it's ordered. Get those results, try to make sense of those results, work with the doctor who's taking care of them, and then try to navigate what can be complicated.
Sometimes it's easy. So sometimes you have a thing and then you have a mutation and there's a study right next door, and then you call them up and they have a slot and you go right in, right? And sometimes it's not so easy. But don't be discouraged. And help your doctor, and then your doctor will help you, and as a team together, I think, you could be successful in doing that kind of a thing.
Alisyn Camerota: Yeah. I mean, I think that there's such little reason, often so little reason, to be optimistic when you get a diagnosis of pancreatic cancer. But I think to your point, and I want to drive this home for everybody, there's never been a better time to be diagnosed with this awful disease because it does feel like you guys are on the cusp.
Dr. Andrew Hendifar: Yeah, it's true. I mean, for the first time in my career, we're giving patients pills and they're feeling better. It's just really remarkable. And I would say this too: don't think of the obstacles, because they might not really be obstacles. Don't focus on them too much.
Like, for example-so I have patients say to me, "It's gonna be hard to travel." Yeah, a little bit of travel is hard, but some of these trials, they'll pay for your flights, they'll pay for your hotel, they'll make it work. So don't let the barriers that you might think be there prematurely kind of take you out of getting into one.
Alisyn Camerota: Yeah, I mean I think that you've set the table perfectly for why people would be excited about clinical trials. Who wouldn't be eligible for a clinical trial? What patient shouldn't go that route?
Dr. Andrew Hendifar: Yeah, I think sometimes if you're too sick, then it's not safe. If your blood tests-yeah, there are certain parameters for blood tests that you need to be able to meet. And sometimes too, somebody's priorities might not be there. Like the patient might say -- I've had patients say to me -- "I don't, I understand I have a diagnosis and I understand that there are options for me in a clinical trial, but my priority is to be closer to home, to be with family, and that's okay for me." So it's not for everybody.
But I think that the barriers we most frequently encounter are those blood test requirements and then the line. That's always confusing like, "What do you mean I can't go on because I've had this treatment or that treatment?" But unfortunately, that's the way it is. You have to make sure that the number of treatments you've had before matches up with this trial.
Alisyn Camerota: Yes, understood. Well, Dr. Hendifar, thank you very much. What have I missed? What else do you want to say about all of these treatment options and how patients should tackle it?
Dr. Andrew Hendifar: Yeah, I mean, it's a grea -- I think there are a few things. For the first time in a long time, there are a lot -- and it's not just for KRAS inhibitors, there's also GDF15 inhibitors which help for the weight loss. So, and that's already been published in the New England Journal of Medicine, it's all great, people are gaining weight and feeling and looking better. I think for the first time in a long time, really hope is there for our patients with pancreatic cancer. So I really encourage all of us who are dealing with this difficult problem to remain hopeful, to remain optimistic and to keep working.
I think we're going to get there soon and make things a whole lot better over the next five years. Yeah, that's the message I wanted to get across.
Alisyn Camerota: From your lips to God's ears, that would be great. Well, Dr. Hendifar, thank you very much for sharing all of your expertise and this information with patients who desperately need it. Really great to talk to you.
Dr. Andrew Hendifar: Pleasure. Thank you, Alisyn. Thanks for having me.
Alisyn Camerota: Yeah, my pleasure. And thanks to everybody for listening. I'm Alisyn Camerota and I'll see you next time.
Cindy Gavin: Hi, everyone. I'm Cindy Gavin, CEO and co-founder of Let's Win Pancreatic Cancer. I want to take a moment to thank Dr. Pishvaian and Dr. Hendifar for that meaningful discussion, and of course, our host, Alisyn Camerota, for leading the way.
Please visit Let's Win Pancreatic Cancer and PanCAN for more information on pancreatic cancer treatments and clinical trials. You could visit us at pancan.org or at letswinpc.org. I hope you'll tune in next month when the podcast will take a closer look at pancreatic cancer surgery options.