Abstract Although cancer treatment saves many lives, some types of cancer, such as pancreatic ductal adenocarcinoma (PDAC), exhibit therapeutic resistance and continue to show high mortality. Tumors in cancers such as PDAC contain a substantial amount of cancer-associated fibroblast (CAF)-secreted collagen and other extracellular matrix (ECM) components, which significantly contribute to cancer therapeutic resistance. In the tumor microenvironment, CAFs stabilize the tissue by producing ECM components, remodel ECM through degradation, induce metastasis through epithelial–mesenchymal transition, and suppress cancer immune responses. Recent advances in single-cell analysis have gradually elucidated the subtypes of CAFs and their functions, leading to the emergence of CAF-targeting therapeutic strategies. In this review, I provide an overview of CAFs, their functions and classifications, the mechanisms underlying their role in therapeutic resistance, and the current status of CAF-targeting therapeutic strategies. Moreover, I explored how we can advance cancer treatment by leveraging our understanding of CAFs.
Hidetaka Masuda (2025) studied this question.