Organoid models to predict chemotherapy response and guide surgical strategy in pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with limited predictive biomarkers for chemotherapy response. Patient-derived organoids (PDOs), developed from endoscopic or surgical samples, faithfully replicate tumor genetics and microarchitecture, allowing rapid ex vivo drug testing. Early studies from the United States, Japan, and Europe demonstrate that PDO chemosensitivity strongly correlates with clinical response, enabling personalized preoperative strategies. PDO-guided chemotherapy could refine neoadjuvant selection, minimize ineffective regimens, and inform optimal surgical timing. This translational advance represents a promising shift toward precision surgery in PDAC, warranting international standardization and integration into multidisciplinary workflows.