After a decade of research in southern Taiwan, scientists are uncovering insights that could change how one of medicine’s toughest diseases is treated.
Pancreatic cancer has long been one of the most aggressive and hard-to-treat malignancies. With a five-year survival rate of just 13%, according to the American Cancer Society, the disease continues to pose one of medicine’s greatest diagnostic and therapeutic challenges. What’s more, symptoms tend not to surface until the cancerous cells have spread beyond the pancreas — often to the bile ducts or liver — at which point medical intervention offers little benefit.
In Taiwan, pancreatic cancer is not among the most common cancers — ranking 12th among males and 13th among females — yet it remains the eighth leading cause of cancer mortality in men and fifth in women. Incidence increased from 4.62 per 100,000 people in 2002 to 6.04 in 2013, according to a peer-reviewed study published in the journal Cancer Medicine in 2018.
One hospital, National Cheng Kung University (NCKU) in Tainan, has long focused on improving patient outcomes for pancreatic cancer through a regimen combining chemotherapy, targeted therapy, and immunotherapy. Developed in 2012 under the guidance of gastroenterologist Dr. Shan Yen-shen, who later served as Dean of NCKU’s College of Medicine from August 2019 until July 2025, the treatment incorporates the Japanese oral chemotherapy drug called S-1, which Shan’s team found to be particularly effective for local patients.
“Compared to some other chemotherapy drugs used in the West, S-1 is better tolerated by East Asian patients, with only minor, manageable side effects like diarrhea,” Dr. Shan says.
S-1 is available in many Asian countries and some European nations, but is not approved for use in the United States.
From research to results
From 2013 to 2020, National Cheng Kung University Hospital treated 131 patients with locally advanced pancreatic cancer. Of those patients, 117 received neoadjuvant chemotherapy (used to shrink a tumor before surgery, making it easier to remove), and 29 patients underwent conversion surgery, which is used to improve the chances of complete removal of a tumor after neoadjuvant chemotherapy. The median survival of patients who underwent surgery increased from 14.1 months to 29.1 months.
“In patients with locally advanced pancreatic cancer and marginally resectable pancreatic cancer, survival can be significantly improved if they can receive adjuvant chemotherapy followed by surgery,” Dr. Shan says.
Earlier this year, a team of researchers led by Dr. Shan and Tsai Shaw-jenq, chair professor at National Chung Cheng University’s Department of Physiology, published a study in the scientific journal Molecular Cancer that identified a novel signaling mechanism in pancreatic cancer patients. Knowledge of the mechanism could prove valuable in improving future survival rates.
According to the study, which was based on experiments in mice, the newly discovered TIMP1-CD63 signaling mechanism allows KRAS-mutated cells — found in about 90% of pancreatic cancer patients — to evade destruction by the immune system.
Additionally, a gene deficiency known as dual specificity phosphatase-2 (DUSP2) causes KRAS-mutated cells to continue growing. Together, these factors create a “vicious cycle” that drives disease progression. Disrupting this cycle may offer a promising way to inhibit further tumor growth, the authors noted.
Researchers in Taiwan are also working on improving the capability to detect pancreatic cancer. The location of the organ deep in the abdomen makes it hard to visualize with standard diagnostic tools, and there is no standardized screening for the disease.
Some researchers posit that AI-powered tools can improve early diagnosis — when treatment success rates are highest. In May, National Taiwan University Hospital (NTUH) announced it had developed an AI-powered tool called PANCREASaver. In a news release, NTUH said that the tool uses deep learning algorithms and multi-image training data to automatically analyze CT scans, delineate the pancreas, and flag suspicious lesions directly within the hospital’s Picture Archiving and Communications System.
“National clinical validation trials have demonstrated that PANCREASaver achieves an 80% sensitivity rate for early-stage pancreatic tumors (under two centimeters) and an overall diagnostic accuracy exceeding 90%, significantly enhancing radiologists’ confidence and efficiency in making timely diagnoses,” NTUH said in the press release.
PANCREASaver has received regulatory approval from Taiwan’s Food and Drug Administration (FDA) and is in use at NTUH. It has also received U.S. FDA Breakthrough Device Designation, which means it could potentially enter the U.S. market at an expedited pace.
Looking ahead, Dr. Shan acknowledges that much work remains to be done to improve outcomes for pancreatic cancer patients. He expresses hope that screening procedures can be improved so that the disease can be more frequently detected before the primary tumor has spread outside the pancreas, and there is still a chance patients can be cured.
