The COL11A1/Akt/CREB axis exerts anti-apoptotic effects on cancer cells and protects tumors from Gemcitabine (GEM)-induced apoptotic cell death by modulating the function of the BAX/BCL-2 signaling node COL11A1/Akt, disturbing the BCL-2/BAX balance, inhibiting cytochrome c (Cyt-C) release, and binding Apaf-1/procaspase-9/Cyt-C, which suppresses the apoptotic program and induces GEM resistance in pancreatic cancer cells [94]. Here, BAX is linked to familial pancreatic carcinoma.