title: Advances in pancreatic cancer.
abstract: OBJECTIVE
  This review intends to describe recent studies on the interaction between pancreatic cancer cells and tumor stroma, and potential opportunities and limitations to therapeutically targeting the stroma.
  
  
  RESULTS
  Pancreatic cancer is characterized by densely desmoplastic stroma. It is becoming increasingly clear that there are complex and mutually supportive interactions between cancer cells and the stroma. Specific signaling pathways exist between cancer cells and cancer-associated fibroblasts that contribute to hypoxic desmoplasia. Recent developments in therapeutic approaches to targeting the stroma have demonstrated potential for enhancing efficacy of cytotoxic therapies. However, the heterogeneity and genomic complexity between tumors has also become more evident based on recent findings. There is increasing evidence for hierarchy of cancer cells with identification of a subpopulation of cancer stem cells that are inherently resistant to traditional therapies.
  
  
  CONCLUSIONS
  Targeting pancreatic cancer stroma is a novel therapeutic strategy that appears justified based on recent studies; however, continued focus is needed to develop more effective therapies against cells resistant to standard chemotherapy.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Kim
authors.forename: Diane M
authors.initials: DM
authors.lastname: Simeone
mesh_terms: D000818:Animals; D015687:Cell Hypoxia; D054377:Chemokine CXCL12 / Q000378:metabolism; D005347:Fibroblasts / Q000378:metabolism; D053823:Hedgehog Proteins / Q000378:metabolism; D006801:Humans; D007111:Immunity, Cellular; D010179:Pancreas / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D015398:Signal Transduction; D017154:Stromal Cells / Q000378:metabolism
chemical_list: D054377:Chemokine CXCL12; D053823:Hedgehog Proteins