Extracellular RNAs in pancreatic cancer: from pathogenesis to precision medicine.

INTRODUCTION

Pancreatic cancer is highly aggressive with poor prognosis and limited therapies. Extracellular RNAs (exRNAs), including microRNAs (miRNAs), long noncoding RNAs (lncRNAs), and circular RNAs (circRNAs), play key roles in its progression. Transported through vesicles or freely circulating, they regulate proliferation, epithelial-mesenchymal transition, angiogenesis, immune evasion, and metastasis. exRNAs contribute to chemoresistance, immune suppression, tumor growth, and intercellular communication, shaping pancreatic cancer's aggressive phenotype and overall tumor microenvironment.

AREAS COVERED: Recent research highlights exRNAs as prognostic biomarkers and therapeutic targets. Modulating exRNA expression or inhibiting their function may offer new strategies to overcome resistance to existing therapies. This review summarizes current knowledge on the relevance of exRNAs and their potential applications in understanding pathogenesis and improving treatment. A deeper insight into exRNA-mediated signaling networks may help develop innovative therapeutic approaches for more effective pancreatic cancer management in the future.

EXPERT OPINION: Pancreatic cancer, especially pancreatic ductal adenocarcinoma, has poor prognosis due to late diagnosis, aggressiveness, and treatment resistance. exRNAs, including circRNAs, miRNAs, and lncRNAs, regulate tumor progression and are promising biomarkers and therapeutic targets. Despite challenges with stability, delivery, and patient variability, exRNAs show considerable potential for early detection, personalized therapy, genome-editing strategies, and combination treatments with chemotherapy or immunotherapy.