A white paper: the product of a pancreas cancer think tank.

Contrasting with improved survival for most other gastrointestinal cancers, the 5-year survival of patients with ductal adenocarcinoma of the pancreas remains low at a dismal 4%. In 2000, an estimated 28,300 patients were diagnosed with pancreatic cancer in the United States These patients can expect to benefit from some progress in management. Minimally invasive procedures such as helical computed tomography and endoscopic ultrasound can be used for accurate initial staging. The application of fine-needle aspiration biopsy and the availability of biliary stents to relieve bile duct compression have resulted in fewer laparotomies. Those patients who are candidates for resection can be reassured that this surgery has become safer, especially at experienced centers. Supportive care, especially in pain management, has improved. Finally, the introduction of a new drug, gemcitabine, for use in pancreas cancer brings hope that the chemoresistance previously observed in this disease can be broken. Nonetheless, much remains to be learned. In an effort to focus on the issues and the research opportunities in pancreas cancer, a Think Tank was convened on September 16, 1999, in Park City, Utah. This international event was attended by 64 invited extramural scientists with established dedication to and experience in pancreas cancer research, 6 National Cancer Institute scientists, and 12 representatives from industry. The participants were divided into six working groups in the following areas: (a) genetics/risk/prevention; (b) pancreas cancer histology; (c) pancreas cancer biology; (d) early detection; (e) biology of pancreas cancer associated with cachexia and other constitutional symptoms; and (f) pancreas cancer therapy. These groups met both separately and together for various sessions. The Think Tank was sponsored by the NCI, the Lustgarten Foundation for Pancreas Cancer Research, and numerous industrial sponsors. Pancreas cancer advocacy was represented through the Pancreas Cancer Action Network (PanCan). The following report summarizes this meeting and represents a first step at identifying the key research opportunities and required infrastructure needed to advance our knowledge about this difficult malignancy.