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5.4 Biomarker-guided treatment In the precision treatment strategy for gemcitabine resistance, biomarker guided treatment based on dynamic monitoring of RRM2 copy number based on ctDNA and multi-omics prediction models (such as the EXPLOR trial) provides a new paradigm for individualized intervention: Gemcitabine resistance, RRM2 gene copy number amplification drives resistance by accelerating deoxyribonucleotide triphosphate (dNTP) synthesis and enhancing DNA repair, while ctDNA-based liquid biopsy technology (such as ddPCR/NGS) can dynamically monitor the level of RRM2 amplification and track the evolution of resistant clones in real time