Patients with advanced-stage pancreatic ductal adenocarcinoma often have dismal outcomes, despite an initial response sometimes to standard-of-care chemotherapy. This treatment refractoriness partly reflects the effects of the tumour microenvironment (TME), which is highly heterogeneous but can include a dense desmoplastic stroma as well as various immune cell and cancer-associated fibroblast populations, most of which collectively promote resistance to treatment and disease progression. In this Review, the authors summarize the role of the TME in determining the outcomes of patients with pancreatic ductal adenocarcinoma, and consider novel therapeutic approaches that might promote the development of a tumour-suppressive TME.
- Heng-Chung Kung
- Kevin W. Zheng
- Lei Zheng
