Molecular mechanism of tumor microenvironment and recent approaches for the immunotherapy of pancreatic cancer

One of the most aggressive cancers, pancreatic cancer (PC) frequently has a dismal prognosis. The only known treatment for this illness is surgery, which is usually followed by adjuvant chemotherapy. However, only a tiny percentage of patients with resectable and non-metastatic tumors can receive surgery. In the future, more patients may be eligible for surgery thanks to customized neoadjuvant therapy strategies based on molecular profiling of tumor biopsies. Patients with resectable or borderline resectable PC may benefit from neoadjuvant chemotherapy or chemoradiotherapy before surgery in non-metastatic instances. Furthermore, patients with locally advanced or (oligo-/poly-)metastatic pancreatic tumors who show a substantial feedback to (neoadjuvant) chemotherapy should be considered for surgery if there is potential for achieving an R0 resection. Advances in immunotherapy aimed at eliciting robust immune responses against tumors, along with research into the molecular mechanisms underpinning PC development, could open new therapeutic avenues. These innovations may also assist in selecting patients for the most effective treatment strategies.