Fig. 6: This figure summarises the postulated mechanisms underpinning the effects of triple therapy on advanced pancreatic cancer.

Gemcitabine causes cancer cell death in both the established tumours and metastases via increased apoptosis and decreased proliferation of cancer cells. At the same time, inhibition of both the ligand and receptor components of the HGF/c-MET pathway blocks PSC–cancer cell interactions, thereby inhibiting EMT and stemness. These effects inhibit dissemination of cancer cells from the primary tumour and also oppose establishment of new metastases. This two-pronged approach targeting cancer cells combined with effective inhibition of a major pathway that mediates stromal–tumour interactions eliminates metastasis and decreases tumour growth, even at an advanced stage of pancreatic cancer.