Patient-derived organoid testing shows promise for tailoring therapy in pancreatic ductal adenocarcinoma.

• 91% of organoids matched to standard-of-care regimens, with 34% of poorly matched cases potentially qualifying for more effective options.
• Patients receiving well-matched neoadjuvant chemotherapy showed significantly better CA 19-9 response (60% normalization) and lymph node down-staging (69% N0) compared to poorly matched cases (29% normalization, 33% N0).

Matching therapy to organoid profiles could enhance survival rates—median overall survival rose from 19.5 to 30.3 months.