Chinese Medicine for the treatment of pancreatic cancer by targeting the tumor microenvironment: mechanistic insights and therapeutic potential

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy with aggressive progression and rapid development of therapeutic resistance. The tumor microenvironment (TME) has been gradually revealed as a major contributor to the interventional dilemma, which is composed of diverse cellular and acellular components, constructing a desmoplastic and immunosuppressive pro-tumorigenic environment for cancer cells. The heterogeneity, plasticity, and dynamic interplay of these components give rise to complex compensatory responses to therapies, requiring a comprehensive, multi-target remodeling strategy. Chinese herbal medicine (CHM) has been suggested to exert effects in modulating the TME and thus suppressing tumor growth and enhancing the efficacy of conventional therapies. Based on insights into the complex TME and its role in metastasis and resistance, this review summarizes findings from studies that explore the modulatory effects of CHM classified by the components it targets, revealing the therapeutic potential of CHM and prospects for innovative intervention strategies and approaches.