Micro- and immune environment of cancer in association with extension to advanced disease

Neoadjuvant chemotherapy (NAT) has been induced as a standard treatment for refractory pancreatic cancer (PDAC) and it is often experienced that NAT can result in hardness reduction and gross tumor area obscuration in PDAC tissue. This effective NAT causes tissue remodeling of PDAC with the alteration of the collagen molecules in the quality and quantity, which are often involved in the malignant characteristics. It is suggested that effective NAT changes the extracellular matrix with collagen profiles through the interaction between cancer-associated fibroblasts and cancer cells via Ephrin-A5 and EphA2 and downstream modifications.

Figure 4 Rescued anti-tumor immunity with recovering TNFR1 signaling pathway