Combination therapy with miR-1291 prodrug and Gem-nP is proven the most effective in controlling tumor growth in two other PDX mouse models established with patients’ PDAC tissues (PA-0375: A, B, and C; PA-0327: D, E, and F). (A) and (D) PDX tumor growth was significantly suppressed by miR-1291 monotherapy or combination therapy, as compared to MSA or buffer control. *P<0.05, **P < 0.01, and ***P < 0.001 (2-way ANOVA with Bonferroni post-tests). (B)and (E)Comparison of dissected tumor from mice with different treatments. (C) and (F) Weights of the dissected xenograft tumors. *P < 0.05, **P < 0.01, ***P < 0.001 (1-way ANOVA). Values are mean ± SD (N = 5 per group). Because PA-0327 was more aggressive, dose of miR-1291 prodrug was increased to 20 µg/mouse for both monotherapy and combination therapy in this PDX model which, surprisingly, produced optimal outcomes.