Progress and challenges in expanding access to clinical trials in pancreatic cancer.

Clinical trials are essential for developing new cancer treatments and improving patient care. However, participation remains low across oncology and is particularly challenging for people with pancreatic cancer, who often experience rapid disease progression, limited treatment options, and short timeframes for trial enrolment. In this Review, we examine the factors that limit clinical trial participation in pancreatic cancer, including patient identification and referral, eligibility assessment, molecular testing, and trial delivery. We discuss how restrictive eligibility criteria, inconsistent integration of trial processes into routine care, variability in molecular testing, and logistical barriers reduce opportunities for participation. We also consider practical strategies to improve access, including earlier and more systematic trial identification, broader clinical eligibility criteria, timely molecular testing, more flexible trial designs, and decentralised models of care. Improving participation will require coordinated changes across clinical pathways, trial design, and healthcare systems to ensure that trial availability translates into equitable patient access.