# The tumour microenvironment in pancreatic cancer: clinical challenges and opportunities

Source: https://onco.cc/key-papers/paper-ho-pancreatic-tumour-microenvironment-review-nrco-2020/  
OnCo record `paper-ho-pancreatic-tumour-microenvironment-review-nrco-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A review of every attempt to attack the tissue around pancreatic cancer, explaining why deconstructing the scar tissue and blocking single immune-suppressing pathways failed and what multi-target approaches are being tried instead.

## Summary

Metastatic pancreatic ductal adenocarcinoma remains one of the most lethal solid tumours despite multi-agent chemotherapy. Efforts to exploit the tumour microenvironment by deconstructing the desmoplastic stroma and targeting immunosuppressive pathways have largely failed; evidence now shows the stroma is multi-faceted, illustrating the complexity of targeting isolated features. The review describes how the microenvironment has been targeted, notes clinical outcomes that unexpectedly contradicted preclinical observations, and considers multi-modal approaches and biologically integrated targets aimed at remodelling it.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Nature Reviews Clinical Oncology
- Year: 2020
- DOI: 10.1038/s41571-020-0363-5
- Authors: Ho WJ, Jaffee EM, Zheng L.
- Findings: Stromal deconstruction and single-pathway immunosuppression blockade have largely failed clinically.; The stroma is multi-faceted; isolated targets contradict preclinical predictions.
- What it means: The reference for why pancreatic microenvironment trials read as a list of failures and what the field now means by remodelling rather than removing the stroma.
- Caveats: Narrative review.; Published before the most recent stromal and vaccine readouts.

## Sources

- Ho, Jaffee and Zheng, Nat Rev Clin Oncol 2020: the tumour microenvironment in pancreatic cancer: https://doi.org/10.1038/s41571-020-0363-5
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32398706/

## Connected records

- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- institutions: [Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center](https://onco.cc/institutions/johns-hopkins/)
- pathways: [Fibroblast activation, desmoplasia & matrix stiffness](https://onco.cc/pathways/caf-activation-desmoplasia/), [Myeloid suppression: TAMs, MDSCs & don't-eat-me signals](https://onco.cc/pathways/myeloid-suppression-axis/), [Tumour microenvironment (TME)](https://onco.cc/pathways/tumor-microenvironment/)
- terms: [Desmoplasia (tumour stroma)](https://onco.cc/terms/desmoplasia/), [Hot vs cold tumours](https://onco.cc/terms/cold-vs-hot/)
- people: [Elizabeth M. Jaffee](https://onco.cc/people/elizabeth-jaffee/), [Lei Zheng](https://onco.cc/people/lei-zheng/)
- journals: [Nature Reviews Clinical Oncology](https://onco.cc/journals/nature-reviews-clinical-oncology/)

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