PDAC heterogeneity resolved spatially at the single-cell level: new biological answers, new questions on optimal translation†

Pancreatic cancer is a highly aggressive disease. Developing new strategies and using powerful methodologies for its early detection, coupled with in-depth comprehension of the mechanisms governing subtype evolution, will not only help to stratify PDAC patients' prognosis but also prevent unfavourable subtype plasticity upon treatment with chemotherapy. Michiels et al have developed a new approach to better capture PDAC heterogeneity at the single tumour duct spatial resolution level, leveraging detection of transcripts for mutant KRAS and multiple subtype markers. Their study sheds light on the association of mutant KRAS and PDAC phenotypic heterogeneity. The findings support functional cooperation of plastic tumour cells and opens new challenges towards PDAC patient stratification and therapeutic intervention. Pathology-based tools will be of prime importance to address these issues in a clinically meaningful manner. © 2024 The Pathological Society of Great Britain and Ireland.