Current status and future prospects of immunotherapy for pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive and prevalent malignancy challenged by early detection, frequent presentation at advanced stages, and high likelihood of postoperative recurrence and metastasis. Despite ongoing research efforts, the 5-year survival rate for PDAC has only marginally improved. Although pharmacotherapy remains the cornerstone of multidisciplinary management strategies for PDAC, treatment options for advanced disease have historically been limited. In recent years, an increasing number of clinical trials have identified novel agents and combination therapies with promising efficacy for advanced PDAC. Immunotherapy has demonstrated significant success across various solid tumors, yet application for PDAC has so far yielded limited clinical benefit. Combination approaches integrating immune checkpoint inhibitors with chemotherapy, radiotherapy, and other therapeutic modalities have shown preliminary evidence of efficacy, although further investigation is necessary. Emerging immunotherapeutic strategies, such as adoptive cell transfer, oncolytic virotherapy, and tumor vaccines, have exhibited potential for PDAC treatment, albeit accompanied by inherent limitations. Hence, a more thorough understanding of the complex tumor microenvironment in PDAC is essential to improve the effectiveness of immunotherapeutic interventions. Personalized and precision-driven combination immunotherapies represent a promising frontier in the future of PDAC treatment. This review outlines recent advances and future perspectives in immunotherapy for PDAC, aiming to inform and enhance therapeutic strategies for this devastating malignancy.