Decoding Drug Resistance in Pancreatic Cancer: A Subcellular Structure Perspective

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with drug resistance representing the primary barrier to effective treatment. Current research has largely focused on individual signaling pathways or isolated organelle functions, yet a comprehensive understanding of how these subcellular structures coordinate to drive resistance remains lacking. This review synthesizes current knowledge through the perspective of subcellular structural homeostasis, the dynamic balance maintained by intracellular organelles. We examine how key subcellular structures, the cell membrane, mitochondria, endoplasmic reticulum, ribosomes, lysosomes, exosomes, and stress granules, undergo functional remodeling to promote drug resistance. It is crucial that these organelles do not work independently but form an integrated and dynamic communication network. Mitochondria serve as the intracellular signaling hub, integrating calcium signals, metabolic progress, and stress responses, while exosomes function as intercellular messengers that spread the anti-drug-resistant phenotype between cells. This framework reveals why targeting individual structures often fails and highlights the therapeutic potential of disrupting inter-organelle communication. We discuss emerging clinical strategies targeting subcellular structures and identify critical knowledge gaps, including the need for non-invasive biomarkers and combination approaches that target multiple network nodes. By shifting the focus from isolated organelles to their coordinated interplay, this review offers a new paradigm for overcoming drug resistance in PDAC.