Molecular dissection of pancreatic cancer signaling: Toward targeted therapies for KRAS, MDM2-TP53, EGFR, and PI3K/AKT/mTOR.

KRAS mutations are commonly found in 90% of pancreatic ductal adenocarcinoma (PDAC) cases, making it one of the deadliest cancers. Key oncogenic signaling networks, such as KRAS, TP53-MDM2, EGFR, and PI3K/AKT/mTOR, are frequently altered in this invasive disease. These networks function within a dense desmoplastic tumor environment that inhibits drug delivery and fosters therapeutic resistance. Although KRAS mutations are a primary oncogenic driver and occur in approximately 90% of patients with PDAC, variant-specific biology (e.g., G12D, G12R, G12V, and G12C) affects downstream signaling dependency and treatment response. Although specific KRASG12C inhibitors have been developed, their use in PDAC remains limited because of compensatory pathway activation and mutation prevalence. Similarly, whereas EGFR amplification and adaptive signaling bypass pathways decrease the durability of EGFR-targeted therapies, TP53 inactivation and MDM2 axis dysregulation contribute to genomic instability and treatment resistance. Although resistance to chemotherapy and targeted therapies, survival signaling, and metabolic reprogramming are all significantly affected by the PI3K/AKT/mTOR system, the therapeutic results with pathway inhibitors have been mixed. Significantly, these signaling pathways function within a coordinated, interdependent network, wherein single-agent approaches are compromised by crosstalk and feedback activation. This review synthesizes these main signaling axes, emphasizing molecular pathology, including mutation-specific biology, diagnostic techniques such as liquid biopsy and NGS, the role of natural compounds, the tumor microenvironment (TME) in pancreatic cancer (PC), and the limitations noted in therapeutic trials. Novel therapeutic approaches include KRAS-directed degradation techniques, pathway co-inhibition, rational combination methods, and therapy paradigms driven by the TME. To discover new molecules with long-lasting therapeutic effects, a system-level understanding of pathway interactions within the PDAC microenvironment is necessary.