Are there any new biomarkers with clinical application potential for pancreatic cancer? Are there any new potentially exploitable molecules for predicting disease outcomes in the coming years?

Pancreatic ductal adenocarcinoma remains one of the most lethal malignancies, largely due to late diagnosis, profound heterogeneity, and resistance to conventional therapies. While CA19-9 remains the only widely used clinical biomarker, its limitations in sensitivity and specificity are well recognized. I would like to ask the gastroenterology, oncology, and translational research community: Which novel biomarker candidates—whether derived from liquid biopsy (ctDNA methylation, exosomal RNAs, circulating tumor cells), tumor microenvironment components (cancer-associated fibroblasts, matrix remodeling proteins), or metabolic signatures—are currently demonstrating the most robust and reproducible performance in early-stage validation cohorts? Beyond diagnosis, are there any emerging molecules with genuine potential to predict treatment response, recurrence risk, or chemoresistance in the coming 3–5 years? Additionally, from a drug development perspective, are there any “druggable” predictive biomarkers that could simultaneously serve as therapeutic targets? I am particularly interested in hearing from colleagues involved in multicenter validation studies, as well as critical perspectives on why so many promising candidates have historically failed to reach the clinic. Thank you.