Clinically available KRAS inhibitors mainly target G12C, which is rare in PDAC and often acquires resistance. Oncogenic KRAS inactivates RB1 via CDK4/6, while RB1 mutation is rare. Thus, CDK4/6 inhibition offers an indirect strategy to counter KRAS-driven malignancy without direct KRAS targeting.
Virtually all pancreatic ductal adenocarcinomas (PDACs) are initiated by activating mutations in the oncogene KRAS, which occur in multiple distinct allelic forms. Although considerable efforts have led to the development of inhibitors targeting specific mutant KRAS proteins, the only agents currently approved for clinical use selectively target the KRASG12C variant. However, KRASG12C mutations are exceedingly rare in pancreatic cancer.
Furthermore, in patients with KRASG12C-mutant pancreatic cancer, treatment with KRASG12C inhibitors has shown only modest clinical benefit, comparable to that of conventional chemotherapeutic regimens, and even in cases with an initial objective response, acquired resistance almost invariably emerges within a limited time frame.








