RECENT FINDINGS IN IMMUNOTHERAPY TREATMENT OF PANCREATIC CANCER - A NARRATIVE REVIEW

Introduction Despite the established role of immunotherapy in several malignancies, pancreatic ductal adenocarcinoma remains largely resistant to these approaches. A highly immunosuppressive tumor microenvironment represents a major barrier to effective immune based treatment. At the molecular level, multiple studies have identified potential targets that may be exploited to modulate immune responses in pancreatic cancer. Aim To summarize and critically evaluate recent clinical and translational evidence on the use of immunotherapy in pancreatic cancer published between 2023 and 2025. Methods A narrative literature review was performed using PubMed, focusing on clinical and randomized clinical trials published from January 2023 to October 2025. The search terms included pancreatic cancer and immunotherapy. Only English language publications with available full text were considered. Results Preclinical and translational studies consistently demonstrate immune dysfunction within the pancreatic cancer tumor microenvironment, which limits the effectiveness of immunotherapy. Clinical data indicate that immune checkpoint inhibitors do not provide meaningful benefit as monotherapy. Combination strategies with chemotherapy or radiotherapy generally produced inconsistent results, with limited benefit observed only in selected patient subgroups. TGF β based vaccination approaches combined with immune checkpoint inhibitors were associated with prolonged progression free and overall survival in specific settings. Vaccine based strategies, including personalized mRNA vaccines and dendritic cell vaccines, demonstrated durable recurrence free survival or measurable molecular responses in early phase clinical trials. Conclusions Recent literature shows advances in the biological understanding of immunotherapy resistance in pancreatic cancer, but molecular and immunological findings are not consistently translated into clinical benefit. Among the investigated strategies, personalized mRNA vaccines and dendritic cell based immunotherapies currently provide the most consistent positive signals and represent priority directions for further evaluation in controlled clinical trials.