A recent meta-analysis, including seven clinical trials, three of which were phase 2 trials in pancreatic adenocarcinoma, concluded that autophagy-inhibitor-based therapy was associated with improved progression-free survival (RR 1.72, 95%CI 1.05–2.82) and overall survival (RR 1.39, 95%CI 1.11–1.75) than standard chemotherapy.93 Additionally, an inhibitor of PAD4, Cl-amidine, has been shown to have beneficial effects in murine models of breast and colon cancer,66,94,95 suggesting that the role of PAD4 inhibitors in the treatment of pancreatic cancer should also be explored. This evidence concerns the gene PADI4 and familial pancreatic carcinoma.