Despite many decades of research, pancreatic ductal adenocarcinoma (PDAC) remains one of the most difficult cancers to diagnose and treat effectively. Although there have been improvements in the 5-year overall survival rate, it is still very low at 12.5%. The limited efficacy of current therapies, even when PDAC is detected early, underscores the aggressive nature of the disease and the urgent need for more effective treatments. Clinical management of PDAC still relies heavily on a limited repertoire of therapeutic interventions, highlighting a significant gap between research efforts and available treatments. Over 4300 clinical trials have been or are currently investigating different treatment modalities and diagnostic strategies for PDAC, including targeted therapies, immunotherapies, and precision medicine approaches. These trials aim to develop more effective treatments and improve early detection methods through advanced imaging techniques and blood-based biomarkers. This review seeks to categorize and analyze PDAC-related clinical trials across various dimensions to understand why so few chemotherapeutic options are available to patients despite the numerous trials being conducted. This review aims to provide a comprehensive and nuanced understanding of the landscape of PDAC-related clinical trials, with the overarching goal of identifying opportunities to accelerate progress in drug development and improve patient outcomes in the fight against this devastating disease.

Pavlovian conditioning tasks have been used to identify the neural systems involved with learning cue–outcome relationships. In delay conditioning, the conditioned stimulus (CS) overlaps or co-terminates with the unconditioned stimulus (US). Prior studies demonstrate that dopamine in the nucleus accumbens (NAc) regulates behavioral responding during delay conditioning. Furthermore, the dopamine response to the CS reflects the relative value of the upcoming reward in these tasks. In contrast to delay conditioning, trace conditioning involves a “trace” period separating the end of the CS and the US delivery. While dopamine has been implicated in trace conditioning, no studies have examined how NAc dopamine responds to reward-related stimuli in these tasks. Here, we developed a within-subject trace conditioning task where distinct CSs signaled either a short trace period (5 s) or a long trace period (55 s) prior to food reward delivery. Male rats exhibited greater conditioned responding and a faster response latency to the Short Trace CS relative to the Long Trace CS. Voltammetry recordings in the NAc found that the CS-evoked dopamine response increased on Short Trace trials but decreased on Long Trace trials. Conversely, US-evoked dopamine responses were greater on Long Trace trials relative to Short Trace trials. The CS dopamine response correlated with the response latency and not with conditioned responding. Furthermore, the relationship between CS dopamine and latency was best explained by an exponential function. Our results collectively illustrate that the trace period is encoded by the bidirectional NAc dopamine response to the CS during pavlovian conditioning.

Stress produces transient physiological responses that lead to long-lasting changes in cue-driven behavior. In particular, a single exposure to stress facilitates reward learning in male rats. Since stress can produce distinct behavioral phenotypes between males and females, it is critical to additionally determine how stress impacts reward learning in females. To address this, female rats were exposed to restraint stress immediately prior to training on an appetitive Pavlovian conditioning task with food rewards. Females were categorized based on their estrous cycle stage on the first day of Pavlovian conditioning. A single exposure to stress enhanced conditioned responding in non-estrus females but suppressed conditioned responding in estrus females. Therefore, a single stress experience produced opposing effects on cue-driven behavior depending upon the estrous cycle stage. In contrast, both estrus and non-estrus rats exposed to repeated prior stress exhibited an increase in conditioned responding relative to animals that underwent a single stress exposure. We further examined if the distal stress experience subsequently impacted extinction and the ability to learn a new cue-reward association. Prior stress did not affect extinction, though estrus and non-estrus rats exposed to repeated prior stress exhibited higher levels of conditioned responding to the novel cue-reward pairing. Taken together, our data demonstrate that the influence of stress on reward learning is impacted acutely by the estrous cycle as well as by one’s prior history with stress.

Pavlovian conditioning tasks have been used to identify the neural systems involved with learning cue-outcome relationships. In delay conditioning, the conditioned stimulus (CS) overlaps or co-terminates with the delivery of the unconditioned stimulus (US). Prior studies demonstrate that dopamine in the nucleus accumbens (NAc) regulates behavioral responding during delay conditioning. Furthermore, the dopamine response to the CS reflects the relative value of the upcoming reward in these tasks. In contrast to delay conditioning, trace conditioning involves a ‘trace’ period separating the end of the CS and the US delivery. While dopamine has been implicated in trace conditioning, no studies have examined how NAc dopamine responds to reward-related stimuli in these tasks. Here, we developed a within-subject trace conditioning task where distinct CSs signaled either a short trace period (5s) or a long trace period (55s) prior to food reward delivery. Male rats exhibited greater conditioned responding and a faster response latency to the Short Trace CS relative to the Long Trace CS. Voltammetry recordings in the NAc found that the CS-evoked dopamine response increased on Short Trace trials but decreased on Long Trace trials. Conversely, US-evoked dopamine responses were greater on Long Trace trials relative to Short Trace trials. The CS dopamine response correlated with the response latency and not with conditioned responding. Furthermore, the relationship between CS dopamine and latency was best explained by an exponential function. Our results collectively illustrate that the trace period is encoded by the bidirectional NAc dopamine response to the CS during Pavlovian conditioning. Significance statement: Learning to associate a cue with given outcome is a fundamental process underlying reward seeking behavior. Striatal dopamine is important for associating cues with rewards during Pavlovian conditioning. However, it is unclear how the dopamine system responds to cues during trace conditioning when there is temporal gap between the cue and reward. Here, we performed voltammetry recordings of striatal dopamine levels in male rats during trace conditioning. We find that cue-evoked dopamine signals encode the trace period and is related to the response latency. While prior reports find dopamine neurons signal the relative reward value by increases in dopamine levels, we demonstrate that the dopamine response to reward-predictive cues can signal the reward value through bidirectional changes in dopamine transmission.

Cocaine use disorder remains a critical public health concern with limited treatment options. Astrocytes are increasingly recognized as active regulators of neurotransmission and are emerging as important contributors to addiction neurobiology. Here, we examined how chemogenetic activation of astrocytic Gq signaling within the ventral tegmental area (VTA) influences cocaine-associated behaviors in drug-naïve and cocaine-experienced rats. Using a subthreshold dose of cocaine in a conditioned place preference (CPP) paradigm, we found that VTA astrocyte Gq activation facilitated the acquisition of cocaine CPP in drug-naïve rats but suppressed the development of cocaine CPP in cocaine-experienced rats. Additionally, chemogenetic activation of VTA astrocyte Gq signaling suppressed voluntary cocaine intake in a self-administration paradigm. Together, these findings demonstrate that VTA astrocyte Gq signaling shapes cocaine-associated behaviors in a drug history-dependent manner, highlighting VTA astrocytes as a potential therapeutic target in cocaine use disorder.