Alzhrani Rami, Alsaab Hashem O, Vanamal Kushal, Bhise Ketki, Tatiparti Katyayani, Barari Ayatakshi, Sau Samaresh, Iyer Arun K
Use-Inspired Biomaterials and Integrated Nano Delivery Systems Laboratory, Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit 48201, United States.
Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia.
Adv Ther (Weinh). 2021 Jun;4(6). doi: 10.1002/adtp.202000262. Epub 2021 Apr 24.
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive disease with the lowest survival rate among all solid tumors. The lethality of PDAC arises from late detection and propensity of the tumor to metastasize and develop resistance against chemo and radiation therapy. A highly complex tumor microenvironment composed of dense stroma, immune cells, fibroblast, and disorganized blood vessels, is the main obstacle to current PDAC therapy. Despite the tremendous success of immune checkpoint inhibitors (ICIs) in cancers, PDAC remains one of the poorest responders of ICIs therapy. The immunologically "cold" phenotype of PDAC is attributed to the low mutational burden, high infiltration of myeloid-derived suppressor cells and T-regs, contributing to a significant immunotherapy resistance mechanism. Thus, the development of innovative strategies for turning immunologically "cold" tumor into "hot" ones is an unmet need to improve the outcome of PDAC ICIs therapies. Other smart strategies, such as nanomedicines, sonic Hedgehog inhibitor, or smoothened inhibitor, are discussed to enhance chemotherapeutic agents' efficiency by disrupting the PDAC stroma. This review highlights the current challenges and various preclinical and clinical strategies to overcome current PDAC therapy difficulties, thus significantly advancing PDAC research knowledge.
胰腺导管腺癌(PDAC)是一种侵袭性很强的疾病,在所有实体瘤中生存率最低。PDAC的致死率源于检测延迟以及肿瘤转移和对化疗及放疗产生耐药性的倾向。由致密基质、免疫细胞、成纤维细胞和紊乱血管组成的高度复杂的肿瘤微环境是当前PDAC治疗的主要障碍。尽管免疫检查点抑制剂(ICIs)在癌症治疗中取得了巨大成功,但PDAC仍然是ICIs治疗反应最差的癌症之一。PDAC的免疫“冷”表型归因于低突变负担、髓系来源的抑制细胞和调节性T细胞的高浸润,这是导致显著免疫治疗耐药机制的原因。因此,开发将免疫“冷”肿瘤转变为“热”肿瘤的创新策略是改善PDAC免疫检查点抑制剂疗法疗效的未满足需求。还讨论了其他智能策略,如纳米药物、音猬因子抑制剂或 smoothened 抑制剂,以通过破坏PDAC基质来提高化疗药物的效率。本综述强调了当前的挑战以及克服当前PDAC治疗困难的各种临床前和临床策略,从而显著推进PDAC的研究知识。