The Paradoxical Web of Pancreatic Cancer Tumor Microenvironment

Am J Pathol. 2019 Jan;189(1):44-57. doi: 10.1016/j.ajpath.2018.09.009.

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is increasing in incidence and is projected to become the second leading cause of cancer death in the United States. Despite significant advances in understanding the disease, there has been minimal increase in PDAC patient survival. PDAC tumors are unique in the fact that there is significant desmoplasia. This generates a large stromal compartment composed of immune cells, inflammatory cells, growth factors, extracellular matrix, and fibroblasts, comprising the tumor microenvironment (TME), which may represent anywhere from 15% to 85% of the tumor. It has become evident that the TME, including both the stroma and extracellular component, plays an important role in tumor progression and chemoresistance of PDAC. This review will discuss the multiple components of the TME, their specific impact on tumorigenesis, and the multiple therapeutic targets.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Carcinoma, Pancreatic Ductal* / drug therapy
  • Carcinoma, Pancreatic Ductal* / immunology
  • Carcinoma, Pancreatic Ductal* / pathology
  • Disease Progression
  • Drug Delivery Systems*
  • Drug Resistance, Neoplasm* / drug effects
  • Drug Resistance, Neoplasm* / immunology
  • Humans
  • Pancreatic Neoplasms* / drug therapy
  • Pancreatic Neoplasms* / immunology
  • Pancreatic Neoplasms* / pathology
  • Tumor Microenvironment* / drug effects
  • Tumor Microenvironment* / immunology