Division of Surgical Oncology, Department of Surgery, Louisiana State University (LSU) Health, New Orleans, LA, United States.
Department of Pathology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
Front Immunol. 2024 Feb 1;15:1287459. doi: 10.3389/fimmu.2024.1287459. eCollection 2024.
Pancreatic Ductal Adenocarcinoma (PDAC) is projected to become the 2nd leading cause of cancer-related deaths in the United States. Limitations in early detection and treatment barriers contribute to the lack of substantial success in the treatment of this challenging-to-treat malignancy. Desmoplasia is the hallmark of PDAC microenvironment that creates a physical and immunologic barrier. Stromal support cells and immunomodulatory cells face aberrant signaling by pancreatic cancer cells that shifts the complex balance of proper repair mechanisms into a state of dysregulation. The product of this dysregulation is the desmoplastic environment that encases the malignant cells leading to a dense, hypoxic environment that promotes further tumorigenesis, provides innate systemic resistance, and suppresses anti-tumor immune invasion. This desmoplastic environment combined with the immunoregulatory events that allow it to persist serve as the primary focus of this review. The physical barrier and immune counterbalance in the tumor microenvironment (TME) make PDAC an immunologically cold tumor. To convert PDAC into an immunologically hot tumor, tumor microenvironment could be considered alongside the tumor cells. We discuss the complex network of microenvironment molecular and cellular composition and explore how they can be targeted to overcome immuno-therapeutic challenges.
胰腺导管腺癌 (PDAC) 预计将成为美国癌症相关死亡的第二大主要原因。早期检测的局限性和治疗障碍导致这种难以治疗的恶性肿瘤的治疗效果缺乏实质性的成功。间质是 PDAC 微环境的标志,它形成了物理和免疫屏障。基质支持细胞和免疫调节细胞受到胰腺癌细胞异常信号的影响,使适当的修复机制的复杂平衡转变为失调状态。这种失调的产物是包裹恶性细胞的间质环境,导致密集、缺氧的环境,促进进一步的肿瘤发生,提供先天的全身耐药性,并抑制抗肿瘤免疫浸润。这种间质环境与允许其持续存在的免疫调节事件一起,构成了本综述的主要焦点。肿瘤微环境 (TME) 中的物理屏障和免疫平衡使 PDAC 成为一种免疫冷肿瘤。为了将 PDAC 转化为免疫热肿瘤,可以将肿瘤微环境与肿瘤细胞一起考虑。我们讨论了微环境分子和细胞组成的复杂网络,并探讨了如何针对这些网络来克服免疫治疗挑战。
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