The elevation of nuclear factor erythroid 2–related factor 2 (NRF2)–antioxidant pathway markers, heightened glutaminolysis, and elevated GPX4 levels collaboratively bolster chemoresistance in pancreatic cancer cells, shedding light on the potential contributions of glutamine metabolism and NRF2 signaling in the regulation of GPX4 function by MDH2 and chemoresistance in HCC [57]. This evidence concerns the gene GPX4 and familial pancreatic carcinoma.