IntroductionPancreatic cancer remains a leading cause of death with poor prognosis. Current standard chemotherapies offer limited survival benefits, and no standard treatment exists for patients failing two lines of therapy. Preclinical evidence suggests that targeting MNK and VEGFR pathways can remodel the immunosuppressive tumor microenvironment and enhance immunotherapy efficacy. This study evaluates the safety and efficacy of JDB153 (an MNK/VEGFR inhibitor) combined with serplulimab (an anti