Targeted cancer drugs and immunotherapy for pancreatic cancer

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack the cancer. They are called immunotherapies.

You might have one of these treatments if your cancer has a gene change (mutation) Open a glossary item or a certain protein that helps the cancer grow. This may be as part of a clinical trial Open a glossary item

You generally have to be quite fit and well to have some of these drugs. Your doctor will tell you if this treatment may be an option for you.

Tests on your pancreatic cancer cells

Doctors are increasingly testing to check for changes in genes (mutations) or certain proteins that  help the cancer grow. They may look for changes in the:

  • neurotrophic tyrosine receptor kinase (NTRK) gene
  • BRCA1 Open a glossary item or BRCA2 Open a glossary item genes
  • changes in other genes involved in DNA Open a glossary item repair

They usually test a sample of your pancreatic cancer tissue from when you were first diagnosed. Or from your operation if you had one.

The results of the tests may show whether a targeted cancer drug or immunotherapy is suitable for you. 

Targeted cancer drugs

NTRK gene change

If your cancer has an NTRK gene change, there are drugs available to treat locally advanced or metastatic pancreatic cancer when there are no other treatment options. They are:

  • larotrectinib (Vitrakvi)
  • entrectinib (Rozlytrek)

How do you have larotrectinib and entrectinib?

Larotrectinib is a capsule or liquid that you swallow. You have this twice a day.

Entrectinib is a capsule that you swallow. You take this once a day.

You have these medicines for as long as the treatment is working. And you are not getting too many side effects.

We have information about each of these drugs on our cancer drugs A to Z list.

Drugs that help the body's immune system (immunotherapy)

Immunotherapy can help the body's natural defence system (immune system) to find and destroy pancreatic cancer cells. 


Nivolumab is a type of immunotherapy called a checkpoint inhibitor Open a glossary item. Checkpoint inhibitors are monoclonal antibodies Open a glossary item that block proteins such as PD-1. They work by taking the breaks off the immune system to help it attack cancer cells.

You may have nivolumab if your cancer has DNA changes called microsatellite instability Open a glossary item (MSI-high) or mismatch repair deficiency Open a glossary item (dMMR). Only a very small number of pancreatic cancers have these changes. 

Microsatellites are short, repeating arrangements (sequences) of DNA inside cells. Every time a cell divides, it makes new copies of these DNA sequences. Cells can correct any mistakes that happen in this process. Mismatch repair proteins identify and repair any mistakes made when cells make copies of DNA.

But if these mismatch repair processes are faulty, mistakes can happen when the cell divides. This causes changes in the new copies of DNA. Changes in the length of the new DNA sequence are called microsatellite instability. These changes can cause cells to grow abnormally.

Knowing if there are any of these DNA changes helps your doctor plan your treatment.

You might have nivolumab if your tests show you have either:

  • a high level of microsatellite instability (MSI-high)
  • no mismatch repair genes identified (mismatch repair deficient, dMMR)

Understanding the medical terms for some of the results is quite complicated. Your doctor or nurse will explain what it means if you have these changes in your cancer.

Side effects

Targeted cancer drugs and immunotherapy drugs can cause different side effects. Some of these can be serious. Your doctor or nurse will talk to you about this. Always tell them about any side effects you have and follow the advice they give you.

Choose a drug on our A to Z list to read about side effects.

Research into targeted and immunotherapy drugs for pancreatic cancer

Researchers are trying to find better treatments for pancreatic cancer. This includes learning more about the genetic make-up of individual cancers and developing different types of targeted drugs and immunotherapies.

They are looking at these drugs on their own or combined with other treatments. 

New treatments are tested in clinical trials, so ask your doctor if there are any trials suitable for you

  • National Cancer Drugs Fund List
    NHS England, April 2017. Last Updated March 2023

  • ESMO recommendations on microsatellite instability testing for immunotherapy in cancer, and its relationship with PD-1/PD-L1 expression and tumour mutational burden: a systematic review-based approach
    C Luchini and others
    Annals of Oncology, 2019. Volume 30, Pages 1232 to 1243

  • Immune-Based Therapies and the Role of Microsatellite Instability in Pancreatic Cancer
    M Ghidini and others
    Genes (Basel), January 2021. Volume 1, Issue 33

  • Larotrectinib for treating NTRK fusion-positive solid tumours
    National Institute for Health and Care Excellence (NICE), May 2020

  • Entrectinib for treating NTRK fusion-positive solid tumours
    National Institute for Health and Care Excellence (NICE), August 2020

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
03 May 2023
Next review due: 
03 May 2026

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