Federal Funding and Clinical Trial Sponsorship in Pancreatic Cancer From 2003 to 2022

Pancreatic cancer remains one of the deadliest malignancies, with a persistently low five-year survival rate. The Recalcitrant Cancer Research Act (RCRA) of 2012 is one example of legislation aimed at accelerating research in high-mortality cancers. This study examines long-term trends in federal funding and clinical trial sponsorship for pancreatic cancer over a 20-year period, spanning before and after the RCRA. We conducted a retrospective analysis of National Cancer Institute (NCI) funding data and pancreatic cancer clinical trials registered on ClinicalTrials. gov between 2003 and 2022. Linear regression with pre- and post-2013 comparisons evaluated changes over time. NCI support for pancreatic cancer increased 3. 5-fold – from 78 million in 2003 to 250 million in 2022 (inflation-adjusted). The annual growth rate rose from 7. 4 million per year before 2013 to 12. 2 million per year after 2013. The share of the NCI’s budget allocated to pancreatic cancer also rose from 0. 9% to 3. 4%, with no significant shift in slope after 2013 (P=. 98). Federally-funded clinical trials declined sharply before 2013, decreasing by 2. 8% per year, and then stabilized after 2013, with a nonsignificant slope of –0. 95% per year (interaction P=. 06). Meanwhile, industry-sponsored trials grew substantially, increasing from 30% to nearly 75%, increasing by 2. 0% per year after 2013. Findings were consistent in logistic regression models. These findings suggest that while federal investment in pancreatic cancer research has grown, the expansion of clinical trials has been driven largely by industry, suggesting that federal investment has likely been directed toward foundational and preclinical research. Strengthening public-private collaboration and maintaining federal engagement will be critical to ensuring that research advances align with patient-centered goals.