The tumour microenvironment in pancreatic cancer — clinical challenges and opportunities
Cet article passe en revue les différentes approches destinées à modifier le micro-environnement tumoral pour traiter un adénocarcinome canalaire métastatique du pancréas, analyse les résultats contradictoires observés entre les études précliniques et cliniques puis identifie les stratégies thérapeutiques multimodales en cours d'investigation
Metastatic pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal solid tumours despite the use of multi-agent conventional chemotherapy regimens. Such poor outcomes have fuelled ongoing efforts to exploit the tumour microenvironment (TME) for therapy, but strategies aimed at deconstructing the surrounding desmoplastic stroma and targeting the immunosuppressive pathways have largely failed. In fact, evidence has now shown that the stroma is multi-faceted, which illustrates the complexity of exploring features of the TME as isolated targets. In this Review, we describe ways in which the PDAC microenvironment has been targeted and note the current understanding of the clinical outcomes that have unexpectedly contradicted preclinical observations. We also consider the more sophisticated therapeutic strategies under active investigation — multi-modal treatment approaches and exploitation of biologically integrated targets — which aim to remodel the TME against PDAC.
Nature Reviews Clinical Oncology , résumé, 2020