Pancreatic cancer is a highly malignant tumor of the digestive system, with a significantly lower five-year survival rate than other malignancies. Gemcitabine (GEM) is the primary chemotherapeutic agent for pancreatic cancer, but its efficacy is often limited by chemotherapy resistance of tumor. This article elaborates on the intrinsic cellular mechanism and non-cell-autonomous mechanism of GEM resistance in pancreatic cancer and summarizes how to enhance the sensitivity of pancreatic cancer cells to GEM by inducing ferroptosis through the regulation of polyunsaturated fatty acid peroxidation, iron metabolism control, and antioxidant systems, in order to investigate the association between ferroptosis and GEM resistance mechanisms and provide new directions for the clinical treatment of pancreatic cancer.
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