Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers, with rising cases and strong resistance to standard chemotherapy. Precision oncology is bringing new hope by identifying biomarkers and targeted treatments that can guide personalized care.
Chemotherapy, including FOLFIRINOX and gemcitabine plus nab-paclitaxel, remains the main treatment, but response rates rarely exceed 40% because of chemoresistance. Scientists are discovering biomarkers that help predict which patients will benefit from specific drugs. For taxane-based therapies (such as nab-paclitaxel), resistance is linked to high drug-efflux pump activity and increased class III β-tubulin. Liquid biopsy may help predict response to these treatments. For platinum-based therapies, patients with mutations in DNA-damage-repair genes—especially BRCA1/2 and PALB2—respond better, making genomic profiling critical.
Next-generation sequencing (NGS) is transforming PDAC diagnosis by identifying tumor mutations that can be targeted with drugs. New KRAS-targeted therapies are being developed, particularly for G12D and other common variants. PARP inhibitors like olaparib are recommended as maintenance treatment for metastatic PDAC with BRCA1/2 mutations after initial platinum therapy. Other rare but actionable fusions—such as NTRK, NRG1, and RET—can also be matched with approved targeted drugs.
Growing use of genomic testing and liquid biopsies is helping tailor treatment to each patient’s tumor. Identifying molecular subtypes may further guide therapy choices. Although many biomarkers still need validation, precision-guided treatment is steadily improving care for this aggressive disease.