Review Article

Crosstalk between the Tumor Microenvironment and Immune System in Pancreatic Ductal Adenocarcinoma: Potential Targets for New Therapeutic Approaches

Table 1

Target agents directed against TME or immunotherapies under investigation in PDAC.

NameType/structureMechanism of actionEffect

ALT-803Fusion proteinBinds IL-2/IL-15 receptor beta common gamma chain (IL-2R beta gamma) receptor on natural killer (NK) and CD8+Activation and increase of NK cell memory CD8+ levels
AM0010Covalent conjugate of recombinant human interleukin-10 (IL-10) and polyethylene glycol (PEG)Activates cell-mediated immunity against cancer cells by stimulating the CD8+ differentiation and expansionPotential antifibrotic, anti-inflammatory, immunomodulating, and antineoplastic activities
AMG 820Fully human monoclonal antibody (IgG2)Against the colony-stimulating factor-1 (CSF-1 or M-CSF) receptor c-fms (or CSFR1)Suppresses recruitment and activation of TAMs
AnakinraRecombinant human nonglycosylated IL-1 receptor antagonistBlocks IL-1 activityInhibition of VEGF, TNF-α, and IL-6 cascade resulting in inhibition of tumor angiogenesis
AtezolizumabHumanized, Fc optimizedBinds to PD-L1, blocking its binding to and activation of PD-1 on activated T-cellsEnhancement of T-cell-mediated immune response and reversal of T-cell inactivation
AvelumabHuman monoclonal antibody (IgG1)Binds to PD-L1 preventing interaction with PD-1May restore immune function activation of cytotoxic T lymphocytes
BL-8040Short peptideBinds to the chemokine receptor CXCR4, preventing the binding of stromal-derived factor-1 to the CXCR4 receptorDecreases tumor cell proliferation and migration
CCX872-BSmall moleculeHuman C-C chemokine receptor type 2 (CCR2) antagonistInhibition of both CCR2 activation and CCR2-mediated signal transduction
CD8 + NKG2D + AKT cellCellsHuman CD8+ tumor specific engineered to express the natural killer cell-activating receptor group 2D (NKG2D) and the serine/threonine kinase AKTPotential immunomodulating and antineoplastic activities
CRS-207Recombinant Listeria-based cancer vaccine expressing human mesothelinListeria invades professional phagocytes within the immune system and expresses mesothelin, activating a cytotoxic T lymphocyte response against mesothelin-expressing tumor cellsPotential immunostimulatory and antineoplastic activities
DurvalumabFc-optimized monoclonal antibodyBinds to PD-L1 blocking its binding to and activation of PD-1 expressed on activated T-cellsReverses T-cell inactivation and activates the immune system to exert a cytotoxic T lymphocyte response against PD-L1-expressing tumor cells
GalunisertibSmall moleculeAntagonist of TGF-β receptor type 1 (TGFBR1)Prevents the activation of the TGF-β-mediated signalling pathways inhibiting tumor proliferation
GVAXAllogeneic cancer vaccine composed of lethally irradiated whole melanoma cancer cells that are genetically modified to secrete the immunostimulatory cytokine granulocyte-macrophage colony-stimulating factorStimulates the body’s immune system against tumor cellsEnhances the activation of dendritic cells, promotes antigen presentation to both B- and T-cells, and increases IL-2-mediated lymphokine-activated killer cell function
iAPA-DC/CTLA cell-based product composed of dendritic cells (DCs) pulsed with tumor-associated antigens and devoid of the inhibitory effect of antigen presentation attenuators (iAPA) combined with cytotoxic T lymphocytesPrevents the expression of APA genes and inhibits attenuation of antigen presentationPotential immunostimulating and antineoplastic activities
IbrutinibSmall moleculeBinds to and irreversibly inhibits BTK activityPrevents both B-cell activation and B-cell-mediated signalling leading to growth inhibition of the malignant B-cells overexpressing BTK
IDO-1 inhibitorSmall moleculeTargets and binds to indoleamine 2,3-dioxygenase 1, a cytosolic enzyme responsible for the oxidation of tryptophan into the immunosuppressive metabolite kynurenineRestores and promotes proliferation and activation of various immune cells and causes a reduction in Tregs
IpilimumabRecombinant human monoclonal antibody (IgG1)Binds to CTLA4 expressed on T-cellsInhibits the CTLA4-mediated downregulation of T-cell activation leading to a cytotoxic T lymphocyte-mediated immune response
M7824Bifunctional fusion protein composed of a monoclonal antibody against PD-L1 fused to the extracellular domain of human TGF-β receptor II“Trap” for all three TGF-β isoformsSuppressed tumor growth and metastasis
MCS110 (Lacnotuzumab)Humanized monoclonal antibodyBinds to M-CSF and blocks M-CSF-mediated signalling through the M-CSF receptor CD116Antineoplastic activities
NivolumabFully human monoclonal antibody (IgG4)Binds PD-1 and blocks its activation by PD-L1Activation of T-cell immune responses against tumor
PamrevlumabHumanized monoclonal antibodyBinds to connective tissue growth factor (CTGF) preventing the binding to the receptor and its subsequent activationMay prevent and reverse fibrosis; prevents tumor cell proliferation in CTGF-expressing tumor cells
PDR 001 (Spartalizumab)Humanized monoclonal antibodyDirected against the negative immunoregulatory human cell surface receptor programmed death-1Prevents PD-1-mediated signalling and results in both T-cell activation and the induction of T-cell-mediated immune responses against tumor cells
PEGPH20Recombinant form of human hyaluronidaseDegrades hyaluronic acid- (HA-) coating tumor cellsInhibition of tumor cell growth, lowering of the interstitial fluid pressure and allowing better penetration of chemotherapeutic agents into the tumor bed
PembrolizumabHumanized monoclonal immunoglobulin antibody (IgG4)Directed against PD-1Restores T-cell activation and immune response
PexidartinibSmall moleculeBinds to and inhibits phosphorylation of stem cell factor receptor (KIT), colony-stimulating factor-1 receptor (CSF1R), and FMS-like tyrosine kinase 3 (FLT3)Inhibition of tumor cell proliferation and downmodulation of macrophages, osteoclasts, and mast cells
RO7009789Recombinant monoclonal antibodyBinds to CD40 on a variety of immune cell typesActivation of antigen-presenting cells (APCs), B-cells, and T-cells, resulting in an enhanced immune response
TremelimumabHuman immunoglobulin monoclonal antibody (IgG2)Directed CTLA4A cytotoxic T lymphocyte immune response against cancer cells
VactosertibSmall moleculeInhibitor of the serine/threonine kinase TGFBR1 also known as activin receptor-like kinase 5 (ALK5)Inhibits the activity of TGFBR1 and prevents TGF-β/TGFBR1-mediated signalling and suppresses tumor growth
VCN-01AdenovirusReplication-competent adenovirus encoding the human glycosylphosphatidylinositol-anchored enzyme PH20 hyaluronidasePotential antitumor activity
γδ T-cellCellsSecrete interferon-gammaDirect killing of tumor cells, activation of cytotoxic T lymphocyte response against tumor cells