Destruction of Tumor Microenvironment as a Promising Treatment Approach in Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) accounts for over 90% of pancreatic cancers. Every year, we face approximately 500,000 new PDAC patients and almost the same number of deaths from this devastating disease both in men and women. The dismal prognosis can be attributed to the immunosuppressive composition of the tumor microenvironment, causing antitumor immune response inhibition, resulting in pancreatic cancer initiation, insidious and rapid progression, and dissemination. The dense desmoplastic stroma, an essential component of the cancer microenvironment, is acting as a physical barrier manifesting in treatment-insensitive pancreatic cancer. Disruption of the dense and immunosuppressive stroma with radio and ablative therapies gives us promising results as the possible inductor and enhancer of an antitumor immune response. In this review, we discuss stromal-targeting ablation methods along with radiotherapy as a dense stromal environment destruction tool and activator of antitumor immune response in pancreatic cancer patients.