Pancreatic cancer remains a challenging disease with limited treatment options, resulting in high mortality rates. The predominant approach to managing pancreatic cancer patients continues to be systemic cytotoxic chemotherapy. Despite substantial advancements in immunotherapy strategies for various cancers, their clinical utility in pancreatic cancer has proven less effective and durable. Whether administered as monotherapy, employing immune checkpoint inhibitors, tumor vaccines, chimeric antigen receptors T cells, or in combination with conventional chemoradiotherapy, the clinical outcomes remain underwhelming. Extensive preclinical experiments and clinical trials in the realm of pancreatic cancer have provided valuable insights into the complexities of immunotherapy. Chief among the hurdles are the immunosuppressive tumor microenvironment, limited immunogenicity, and the inherent heterogeneity of pancreatic cancer. In this comprehensive review, we provide an overview and critical analysis of current clinical immunotherapy strategies for pancreatic cancer, emphasizing their endeavors to overcome immunotherapy resistance. Particular focus is placed on strategies aimed at reshaping the immunosuppressive microenvironment and enhancing T cell-mediated tumor cell killing. Ultimately, through deeper elucidation of the underlying pathogenic mechanisms of pancreatic cancer and the refinement of therapeutic approaches, we anticipate breakthroughs that will pave the way for more effective treatments in this challenging disease.

胰腺癌仍然是一种具有挑战性的疾病，治疗选择有限，导致死亡率很高。治疗胰腺癌患者的主要方法仍然是全身细胞毒性化疗。尽管针对各种癌症的免疫治疗策略取得了实质性进展，但它们在胰腺癌中的临床应用已被证明不太有效和持久。无论是单一疗法、使用免疫检查点抑制剂、肿瘤疫苗、嵌合抗原受体 T 细胞，还是与传统放化疗联合治疗，临床结果仍然令人印象深刻。胰腺癌领域的广泛临床前实验和临床试验为免疫治疗的复杂性提供了宝贵的见解。其中最主要的障碍是免疫抑制性肿瘤微环境、有限的免疫原性以及胰腺癌固有的异质性。在这篇综合综述中，我们对当前胰腺癌临床免疫治疗策略进行了概述和批判性分析，强调了他们为克服免疫治疗耐药性所做的努力。特别关注旨在重塑免疫抑制微环境和增强 T 细胞介导的肿瘤细胞杀伤的策略。最终，通过更深入地阐明胰腺癌的潜在致病机制和改进治疗方法，我们预计突破将为这种具有挑战性的疾病的更有效治疗铺平道路。