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Daraxonrasib is an orally bioavailable RAS(ON) multi-selective tri-complex inhibitor of the oncogenic mutant and wild-type variants of N, H and KRAS. We previously reported encouraging efficacy in a phase 1/2 clinical trial evaluating daraxonrasib monotherapy at clinically active dose levels in patients with previously treated, RAS mutant metastatic pancreatic adenocarcinoma (PDAC), providing the basis for confirmatory evaluation in the randomized phase 3 RASolute 302 clinical trial. Here we report mechanisms of acquired resistance to daraxonrasib monotherapy observed through targeted sequencing of over 800 genes in paired pretreatment and end of treatment circulating tumor DNA samples from 44 patients in the phase 1/2 clinical trial. Treatment-emergent genomic alterations in the RAS signaling pathway were observed in more than half (26 of 44; 59%) of these patients, including, most notably, mutant KRAS amplifications in one-third (16 of 44; 36%), as well as alterations in receptor tyrosine kinase (RTK) (4 of 44; 9%), MAPK (11 of 44; 25%) and PI3K (4 of 44; 9%) pathways. Notably, no acquired secondary KRAS mutations were observed, distinct from resistance profiles of mutant-selective KRAS G12C(OFF) inhibitors. To corroborate these clinical findings, we found, or mechanistically established, concordant mechanisms of daraxonrasib resistance in human and murine preclinical models of PDAC, including mutant KRAS and MYC amplification and RTK upregulation, with these alterations guiding various combination therapy concepts. Notably, daraxonrasib combined with agents targeting DNA damage response, RTKs or the mutant-selective RAS(ON) G12D inhibitor zoldonrasib averted resistance in preclinical models. Collectively, these results show that most daraxonrasib genomic resistance mechanisms drive reactivation of RAS pathway signaling and guide potential combination strategies in PDAC for further investigation.

Desmoplastic stroma defines pancreatic ductal adenocarcinoma (PDAC), a highly lethal malignancy. This stroma drives tumor progression, immune evasion, drug resistance, and poor drug delivery. Although targeting tumor stroma has shown preclinical promise, most clinical trials have failed due to limited translational success. A major hurdle is the stroma's extreme heterogeneity and dynamic nature, meaning uniform treatments fail. Emerging evidence supports the existence of distinct 'stromal states' with differential biological functions and therapeutic vulnerabilities. Characterizing these states provides a framework to stratify patients and guide precise, stroma-directed therapies. This review summarizes the clinical landscape of PDAC stroma-targeting strategies, discusses distinct stromal states, and outlines emerging opportunities to exploit the stroma as a therapeutic axis in PDAC to improve clinical trial outcomes.

Traditional bulk-level transcriptomic sequencing cannot link cell type-specific gene expression to patient survival. In this study, we integrate single-nucleus RNA-seq and longitudinal data from 152 patients with pancreatic ductal adenocarcinoma (PDAC), profiling 1.2 million cells to construct a prognostic map connecting cell type-resolved gene expression with overall survival. Using a single-cell-resolved spatial transcriptomic platform, we further analyze 3.1 million cells and correlate their spatial distribution with therapeutic response. To empower the translational research community, we develop ctPANDA, an interactive platform offering cell-type-level prognostic insights. This atlas identifies PLOD2 as a promising target, with elevated expression predicting poorer outcomes across eight cell types. We have developed a proof-of-concept compound that can effectively degrade PLOD2 and inhibit PDAC progression in vivo. Collectively, this study advances the prognostic analysis from bulk-level to cell-type resolution, establishing a framework linking gene expression to clinical outcomes and providing actionable insights for target discovery and precision oncology.

Survival in metastatic pancreatic ductal adenocarcinoma (mPDAC) has long been limited by a dismal second-line therapeutic ceiling dictated by conventional chemotherapy. However, breakthrough data from the ASCO 2026 Annual Meeting and the publication of the phase III RASolute-302 trial mark a definitive shift toward targeted KRAS inhibition. This correspondence highlights how the first-in-class pan-RAS (ON) inhibitor daraxonrasib (RMC-6236) virtually doubled median overall survival (13.2 vs. 6.6 months) and progression-free survival compared to chemotherapy in second-line mPDAC, establishing a new standard of care. Concurrently, we evaluate emerging allele-specific strategies from ASCO 2026 designed to optimize target engagement and safety. These include the selective KRAS G12D inhibitor DN022150 and promising horizontal combinations pairing the G12D inhibitor HRS-4642 with either the anti-PD-L1 antibody adebrelimab or a Nectin-4-targeted antibody-drug conjugate (ADC). Furthermore, we address the KRAS G12C cohort where farnesyl transferase co-inhibition (darlifarnib plus adagrasib) successfully bypasses adaptive resistance. Ultimately, the therapeutic landscape of mPDAC is transitioning toward tailored genomic frameworks. Future success will rely on optimizing the clinical sequencing or combination of pan-RAS and allele-specific agents, guided by real-time liquid biopsies, to permanently dismantle resistance and transform mPDAC into a manageable molecular entity.

The Tn antigen, a truncated O-glycan, is frequently elevated in pancreatic ductal adenocarcinoma (PDAC). Multiple therapeutic approaches targeting Tn have been developed, but they have not demonstrated clear efficacy signals in early phase clinical studies. Improving Tn-targeted strategies in PDAC will require both overcoming the immunosuppressive tumor microenvironment and defining pathways by which truncated O-glycans promote growth and immune evasion. Here, we showed that Tn reshapes the tumor immune landscape of PDAC. Expression of Tn antigen on PDAC cells enhanced proliferation in vitro and tumor growth in vivo. Tn expression remodeled the immune microenvironment, skewing tumor-associated macrophages toward M2-like phenotypes, reducing cross-presenting dendritic cells, and expanding myeloid-derived suppressor cells (MDSCs). Single-cell RNA sequencing confirmed expansion of MDSCs and downregulation of antigen processing and presentation in the immune cell infiltrate of Tn+ tumors. Tumor-intrinsic transcriptomic analyses revealed activation of TNF-α/NF-κB signaling and induction of IL-34, a cytokine linked to monocyte survival and differentiation in Tn antigen expressing tumors. Additionally, high Tn expression in both organoids derived from pancreatic cancer patients and in PDAC mouse models was associated with increased IL-34 expression. Genetic deletion of Il34 in PDAC cells attenuated Tn-driven tumorigenesis and reduced MDSC infiltration, while recombinant IL-34 promoted myeloid cell differentiation and proliferation in vitro. Together, these findings establish a glyco-immune-cytokine axis in which truncated O-glycans contribute to IL-34-mediated immunosuppression, providing mechanistic insight and potential therapeutic targets in PDAC.

Pancreatic ductal adenocarcinoma (PDAC) is characterised by a dismal prognosis and insensitivity to immune checkpoint blockers (ICBs); however, the underlying mechanism remains elusive. This study aimed to identify tumour cell-intrinsic regulators that promote immune evasion and ICB resistance in PDAC. Multi-omics analysis and clinical cohort studies identified protein disulfide isomerase family A member 6 (PDIA6) as a regulator of the immune microenvironment. Flow cytometry, multiplex immunohistochemistry, electron microscopy and Glutathione S-Transferase (GST) pulldown assays confirmed that PDIA6 repressed PRKR-like endoplasmic reticulum kinase (PERK) activation and immunogenic cell death (ICD). Chromatin immunoprecipitation confirmed that KRASG12D and YY1 modulated PDIA6 transcription. LSL-Kras G12D/+ ;LSL-Trp53 R172H/+ ;Pdx-1-Cre (KPC) mouse models showed that PDIA6 inhibition improved ICB response. Multi-omics screening identified PDIA6 as a biomarker of CD8+ T-cell paucity and poor prognosis in patients with PDAC. High PDIA6 levels predicted poor ICB response in the PDAC cohorts. PDIA6 inhibition reprogrammed the immunosuppressive tumour microenvironment and hindered mouse PDAC growth in the presence of CD8+ T-cell, which is attributed to enhanced ICD. PDIA6 interacted with cysteine 453 of PERK, abrogating the disulphide bond-mediated dimerisation and activation of PERK, an ICD inducer. Oncogenic KRASG12D potently upregulated PDIA6 via YY1-mediated transcriptional activation. We identified a small-molecule inhibitor of PDIA6, PACMA31, and demonstrated that targeting PDIA6 with PACMA31 improved ICB efficacy in a PDAC mouse model with KRAS mutations. PDIA6, driven by KRASG12D, alleviates ICD and promotes immune evasion, functioning as a predictive biomarker to screen ICB-sensitive patients and a therapeutic target to improve ICB efficacy in PDAC with KRAS mutations.

RNA 5-methylcytosine (m5C) has emerged as a critical epigenetic regulator in cancer biology, yet its role in the tumour immune microenvironment (TME) remains incompletely understood. We aimed to elucidate the functional role and underlying mechanism of NOP2/Sun RNA methyltransferase 6 (NSUN6), an m5C methyltransferase, in shaping the TME of pancreatic ductal adenocarcinoma (PDAC). The clinical significance of NSUN6 was assessed in human PDAC cohorts. The impact of NSUN6 on antitumour immunity was evaluated using murine PDAC models. Single-cell RNA sequencing was employed to characterise the TME landscape of PDAC. RNA bisulfite sequencing and RNA sequencing were used to identify NSUN6 targets. The synergistic effects of C-C motif chemokine ligand 2 (CCL2) blockade combined with immune checkpoint blockade (ICB) therapy were investigated. NSUN6 deficiency significantly enhanced macrophage accumulation and polarisation toward immunosuppressive phenotypes, thereby impairing CD8+ T cell-mediated antitumour immunity in PDAC. Mechanistically, NSUN6 deficiency downregulated KDM5A expression in an m5C-dependent manner, resulting in transcriptional activation of CCL2. Elevated CCL2 secretion promoted the accumulation and polarisation of protumorous macrophages, fostering an immunosuppressive TME and inducing resistance to ICB. Notably, CCL2 blockade reversed protumorous macrophage infiltration and restored ICB sensitivity in Nsun6-deficient murine PDAC models. Clinical analysis further revealed a positive correlation between NSUN6 expression and favourable immune responses in ICB-treated cohorts. NSUN6 deficiency drives immune suppression through the m5C-KDM5A-CCL2 axis in PDAC. Targeting the NSUN6-CCL2 axis represents a promising strategy to sensitise PDAC to ICB therapy.

Liquid biopsy of pancreatic cancer via circulating tumor DNA (ctDNA) is challenged by the extreme rarity of targets, a limitation that conventional passive biosensors cannot overcome. Here, we engineered an intelligent micromotor that actively captured, transported, and electrochemically reported ctDNA. The asymmetric flask-shaped micromotor (HPCMF) was constructed from carbonaceous micro-flasks (CMF) decorated with platinum nanoparticles (PtNPs) and supramolecular (HP5) stabilized PtNPs. The HP5 moieties served as docking sites for methylene blue-labeled assist-DNA (MB-aDNA) via host-guest interactions, creating a mobile capture interface. Propelled by PtNP-catalyzed bubble generation from H2O2, the micromotor reached an average speed of 56.16 μm s-1 (5% H2O2). Upon recognizing target DNA (tDNA) in serum, it autonomously navigated to a probe DNA-modified (pDNA) glassy carbon electrode, where a ternary complex (MB-aDNA/tDNA/pDNA) assembled and anchored, positioning MB for efficient electron transfer. This active enrichment strategy achieved a linear range of 1 pM - 10 μM, a detection limit of 0.18 pM, accurate quantification in simulated pancreatic juice and mouse serum (recoveries 76.5-106.2%), and a 52.4% reduction in assay time relative to digital PCR (dPCR). This work establishes a generic "mobile sensing" framework for next-generation autonomous diagnostic devices.

Cholangiocarcinoma is a highly malignant tumor with an increasing incidence around the world. Discovery of novel molecular targets and effective therapies for cholangiocarcinoma are urgently needed. Palmitoylation is a reversible lipid modification mainly catalyzed by ZDHHC family palmitoyltransferases. However, its function and underlying mechanisms in cholangiocarcinoma remain poorly understood. Here, we found that protein palmitoylation levels and ZDHHC5 expression were upregulated in cholangiocarcinoma. Knockdown of ZDHHC5 inhibited the growth of cholangiocarcinoma. Mechanistically, ZDHHC5 modulates the activity of MAPK signaling pathway by regulating palmitoylation of BRAF at Cys194/195. Palmitoylation facilitates the membrane localization of BRAF and stabilizes BRAF protein. Either knockdown of ZDHHC5 or disruption of palmitoylation sites of BRAF inhibited ERK signaling. Furthermore, we found that cholangiocarcinoma cells expressing high levels of ZDHHC5 exhibited increased activities of MAPK signaling pathway and increased sensitivities to MAPK signaling pathway inhibitors. This study identifies a previously unknown ZDHHC5-BRAF-ERK axis that promotes the growth of cholangiocarcinoma and represents a potential crucial role in therapeutic.

Cancer-associated fibroblasts (CAFs) are central players in the tumour microenvironment (TME) of primary liver cancer, influencing both cancer progression and treatment response. Studies involving single-cell RNA sequencing and spatial multi-omics have significantly expanded our understanding of CAF heterogeneity and functional diversity, although consolidated markers to identify CAF subtypes and therapy-dependent plasticity remain largely unknown. In this review, CAF subpopulations, including their markers and functions, are comprehensively summarised in hepatocellular carcinoma and intrahepatic cholangiocarcinoma. The spatial distribution of CAF subtypes from tumour core to boundary correlates with their phenotypes and functions. We focus on mapping dynamic changes of CAF subtypes in response to therapy, including chemotherapy and immunotherapy, and how these changes influence treatment response and prognosis in liver cancer. Finally, we discuss key challenges in targeting specific CAF subtypes and general CAF activation pathways in current clinical trials. This review provides a holistic view of the current and future landscape of CAF-targeting and CAF-regulating strategies in combination with standard-of-care treatments for liver cancer.

The restoration of liver mass after partial hepatectomy (PH) and split liver transplantation (SLT) relies on efficient liver regeneration, a process highly susceptible to metabolic dysregulation. Although remodeling of the tricarboxylic acid (TCA) cycle is commonly observed during liver injury and regeneration, the specific role of succinic acid remains unclear. Here, we integrated radiomics, transcriptomics, metabolomics, and functional assays to systematically evaluate the association between succinic acid and liver regeneration. Multi-omics analysis of 20 SLT patients demonstrated that elevated succinic acid levels were strongly associated with impaired regenerative outcomes, and weighted gene co-expression network analysis identified the TCA cycle as a key regeneration-associated metabolic module. In a 70% PH mouse model, succinic acid administration was associated with reduced survival and decreased hepatocyte proliferation, consistent with impaired liver regeneration. Mechanistically, succinic acid exhibited distinct effects in different cell types: in macrophages, it enhanced inflammatory activation and increased interleukin-6 (IL-6) secretion, whereas in hepatocytes it reduced IL-6-induced STAT3 phosphorylation and downstream regenerative signaling. Furthermore, molecular docking, molecular dynamics simulations, and surface plasmon resonance assays supported an interaction between succinic acid and the STAT3 SH2 domain, providing structural evidence consistent with modulation of STAT3 signaling. Collectively, these findings suggest that succinic acid may function as an immunometabolic regulator that contributes to impaired liver regeneration by altering macrophage-derived IL-6 signaling and hepatocyte STAT3 activation. These findings also support further investigation of the succinic acid-STAT3 axis as a potential therapeutic target for promoting liver regeneration following hepatic injury or resection.

Chimeric antigen receptor (CAR) T-cell therapies have transformed the treatment of B-cell malignancies, yet challenges including manufacturing delays, T-cell exhaustion, and limited persistence impede broader clinical success. Here, we report the single-day production of nonactivated CAR T cells engineered to secrete interleukin-18 (IL-18), a proinflammatory cytokine that enhances T-cell function. These nonactivated CART19-IL-18 cells (IL-18-secreting anti-CD19 CAR T cells) exhibit robust antitumor efficacy across xenograft models of lymphoma, leukemia, and pancreatic cancer. IL-18 expression enhances the functional advantages of naïve-like nonactivated CAR T cells, resulting in improved persistence, metabolic fitness, and resistance to exhaustion. Single-cell transcriptomic analysis revealed upregulation of IL7R, KLF2, and MCL1, alongside suppression of inhibitory checkpoint genes such as PDCD1, TOX, and HAVCR2. Metabolomic profiling demonstrated enhanced mitochondrial bioenergetics, with increased spare respiratory capacity and accumulation of α-ketoglutarate, malate, and spermine. Functional in vitro and in vivo profiling demonstrated enhanced per-cell cytotoxicity and in vivo durability. We complemented these studies with single-cell transcriptomic and metabolomic analyses to define CAR T-cell biological states beyond what is captured by xenograft tumor clearance. This IL-18-enhanced, activation-free CAR T-cell product offers a clinically actionable platform with the potential to reduce vein-to-vein time while improving product potency and persistence, providing a rationale for clinical testing in patients with tumors refractory to standard CAR T-cell therapy.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) effectively induces rapid liver hypertrophy in patients with initially unresectable liver tumours, yet the immunological mechanisms remain unclear. We aim to elucidate the immune alterations and underlying mechanisms driving liver regeneration following ALPPS. The cohort study included single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics on remnant liver tissues from ALPPS patients. Neutrophil infiltration was validated by flow cytometry and histological analyses in the world's largest ALPPS clinical cohort and mouse ALPPS models. Functional validation, including neutrophil depletion, matrix metalloproteinase 9 (MMP9) inhibition and CD177 blockade, as well as Cd177 knockout and CD177+ neutrophil infusion in vivo. scRNA-seq revealed substantial neutrophil infiltration following stage 1 ALPPS. Depletion of neutrophils impaired liver regeneration. Among subsets, CD177+ neutrophils were metabolically active with enhanced neutrophil extracellular traps formation and secreted MMP9. MMP9 inhibition disrupted extracellular matrix (ECM) degradation and hepatocyte growth factor alpha (HGF-α) release, impairing regeneration. CD177+ neutrophils interacted with endothelial cells via CD177-PECAM1 to facilitate transmigration, while hepatic stellate cell-derived CXCL8 promoted neutrophil chemotaxis via CXCL8-CXCR1/2. Cd177 deficiency attenuated neutrophil infiltration and regenerative growth, while CD177+ neutrophil infusion restored regeneration, which was abolished in Cd177-/- mice. CD177+ neutrophils drive liver regeneration by promoting endothelial transmigration, ECM degradation and HGF-α release. These findings reveal a neutrophil-mediated mechanism driving surgical liver regeneration and support the potential of CD177+ neutrophil infusion to establish a proregenerative hepatic environment for therapeutic strategies in liver failure.