Roxane Isal was diagnosed with stage 4 pancreatic cancer that had spread to her liver in April 2024. Her first thoughts were for her children, then aged nine and six.
"I presumed I had just months to live, so my immediate reaction was 'That's just not enough time'," said Roxane, 43. "I couldn't bear to think of the birthdays and milestones I would miss, or that I would not be there to support them as they grew up."
Pancreatic cancer is one of the most feared cancers, claiming the lives of half of those affected within three months of diagnosis. About 10,500 people are diagnosed with the disease in the UK each year, and seven in ten cases are so advanced by that point that the patient only receives palliative care, according to the charity Pancreatic Cancer UK. Cases are rising, up by a fifth since the 1990s, mostly in women under 55, like Roxane. Known risk factors include age, smoking, being overweight and having a family history of the disease.
Two years after her diagnosis, Roxane is alive and cancer-free. "I'm still here, which is a miracle," said Roxane, who lives in west London with her husband Steve, 52, who works in e-commerce, and their children Maya, 11, and Ellis, eight. "My daughter has just entered secondary school, which is a milestone I thought I would never see."
BRCA gene mutation opened up treatment options
Roxane's survival has been made possible by intense new research into pancreatic cancer and by the fact that she carries the BRCA gene mutation, which is linked to breast and ovarian cancer but also raises the risk of pancreatic cancer. Paradoxically, the same mutation can make tumours more receptive to certain chemotherapy and can enhance the effect of a cancer drug called a PARP inhibitor, which exploits the same defective DNA repair process that raises cancer risk to kill cancer cells.
"Carriers of the BRCA gene respond more effectively to treatment with platinum chemotherapy," said Professor Naureen Starling, a reader at the Institute of Cancer Research and the NHS consultant medical oncologist who treated Roxane.
Research published in the New England Journal of Medicine in 2019 found that certain stage 4 pancreatic cancer patients with the BRCA gene also responded to the PARP inhibitor olaparib. Taking olaparib after chemotherapy roughly doubled the time before the cancer returned, from 3.8 months to 7.4 months, and a third of stage 4 patients were still alive three years later. The dual therapy is not a listed NHS treatment, but doctors can obtain it for NHS patients through "compassionate access" requests to the pharmaceutical company. "Some patients with BRCA do exceptionally well," said Professor Starling, living "many years" rather than just a few months.
Symptoms that were easy to miss
Early-stage pancreatic cancer can be almost symptomless. The pancreas, which produces digestive enzymes and hormones, sits behind the stomach, and symptoms such as indigestion, back pain, fatigue and weight loss are so vague that the cancer is often advanced before it is detected. More than 90 per cent of patients visit their GP multiple times in the two years before diagnosis, according to Pancreatic Cancer UK.
Roxane began feeling lethargic after eating in 2021 but, working full-time as a digital marketing consultant while raising her children, put it down to normal tiredness. She also developed a "strange reaction" to bread, chilli and alcohol, which made her feel warm and shaky. She did not see her GP until late 2023, when blood tests came back normal.
Three months later, back pain became "so strong I couldn't hold myself upright," she recalled, which she blamed on hours of computer work; in fact the tumour was pressing on nerve endings in her back. By January 2024 she was barely eating and constantly exhausted, and in April she nearly passed out after a bite of a croissant. She went to A&E, where blood tests showed poor liver function, and a subsequent MRI found a 3.5cm cancer on her pancreas that had spread to her liver.
"I broke down in tears," she said. "After phoning my husband, I was immediately consumed with how best to tell the children." She was "surprised but relieved" to learn her faulty BRCA gene gave her treatment options not available to all patients.
Chemotherapy, ablation and radiotherapy
Roxane had ten sessions of chemotherapy between May and October 2024. "It was horrific," she recalled. "I crawled from bed to sofa to hospital and back again. I lost 8kg, going from 62kg to 54kg." She is 5ft 9in tall. That September she also had ablation, in which heat was used to destroy three cancerous patches on her liver, followed by radiotherapy in December. Since January 2025 she has taken olaparib alongside a daily oral chemotherapy tablet, and scans show she remains cancer-free.
New drug nearly doubles survival time
A recent breakthrough trial found that a new oral drug, daraxonrasib, extended survival for people with advanced pancreatic cancer. The drug blocks the KRAS protein, which drives most pancreatic cancers. Published in the New England Journal of Medicine, the trial found it nearly doubled survival time compared with standard chemotherapy, from seven to 13 months, with manageable side-effects.
"Around 90 per cent of pancreatic cancer patients have a mutation in the KRAS gene," explained Michelle Garrett, a professor of cancer therapeutics at the University of Kent. "This means that the KRAS protein is always 'on', so the signal for pancreatic cancer cells to grow and divide is always on. Daraxonrasib provides hope for those whose cancer has spread and could potentially be used at earlier stages of the disease."
The discovery received an emotional reception when it was unveiled in May at the annual conference of the American Society of Clinical Oncology. "It was a spine-tingling moment because the research demonstrates that what was previously undruggable is now druggable," said Professor Starling. Daraxonrasib is not yet available on the NHS but has been approved by the US regulator, the Food and Drug Administration.
Calls for more research and clinical trials
Researchers are also working on new diagnostic tests to catch the disease sooner. A team at Imperial College London is developing a breath test to identify compounds released by the cancer in its early stages, which it is hoped could form the basis of a test for GPs. Scientists at the University of Essex are separately studying blood biomarkers for the disease.
But Diana Jupp, chief executive of Pancreatic Cancer UK, said there was still a long way to go. "Decades of underinvestment in research and appallingly low numbers of patients able to access clinical trials are holding us back," she said. A survey by the charity in May, involving 1,117 people with pancreatic cancer, found that just 12 per cent had the chance to take part in a clinical trial. Because the disease is typically diagnosed late, many patients deteriorate too quickly to qualify. Pancreatic Cancer UK has launched a campaign calling on the government to increase the number of clinical trials, widen access to them and fund further research.
"Who knows what other discoveries may be just around the corner if only scientists can get the funding?" said Roxane.
