Highlights d Macrophages polarized by pancreatic cancer cells release pyrimidine nucleosides d Pyrimidine release is a property of alternatively activated macrophage metabolism d Deoxycytidine from macrophages inhibits gemcitabine treatment of cancer cells d Targeting macrophages enhances gemcitabine treatment of pancreatic cancer

Pancreatic cancer has become the 3 rd leading cause of cancer death, with little improvement in outcomes despite decades of research. Surgery remains the only chance of cure, yet, only 20% will be alive at 5 years after pancreatic resection. Few chemotherapeutics provide any improvement in outcome, and even then, for approved therapies, the survival benefits are marginal. Genomic sequencing studies of pancreatic cancer have revealed a small set of consistent mutations found in most pancreatic cancers, and beyond that a low prevalence for targetable mutations. This may explain the failure of conventional clinical trial designs to show any meaningful survival benefit, except in small and undefined patient sub-groups. With the development of next generation sequencing technology, genomic sequencing and analysis can be performed in a clinically meaningful turnaround time. This can identify therapeutic targets in individual patients and personalize treatment selection.Incorporating pre-clinical discovery and molecularly guided therapy into clinical trial design has the potential to significantly improve outcomes in this lethal malignancy. In this review, we discuss the findings of recent large scale genomic sequencing projects in pancreatic cancer and the potential relevance of these data to therapeutic development.3

Highlights d HNF4A loss upregulates GSK3b and drives a squamous-like metabolic profile d GSK3b targeting inhibits glycolysis in squamous patientderived cell lines (PDCLs) d A subset of squamous PDCLs acquires GSK3b drug tolerance d ATAC-seq analysis reveals an accessible WNT gene program in drug-tolerant PDCLs