The importance of the tumor microenvironment in the therapeutic management of cancer

Abstract

Tumor prognosis is generally defined by various tumor parameters. However, it is well known that paracrine, endocrine and cell–cell interactions between the tumor and its microenvironment contribute to its growth. The tumor microenvironment (TME) can also influence disease prognosis and is likely to be considered as an important prognostic factor. In addition, conventional therapies can influence the microenvironment and antitumor immunity. Similarly, the TME will influence the effectiveness of therapy. The purpose of this review is to demonstrate how TME is important in therapeutic management. Key interactions between TME and different cancer therapies as well as their current clinical consequences have been described. More research is needed to establish the important network between tumor cells and their environment to highlight their relationships with conventional therapies and develop global therapeutic strategies.

Keywords:

• cancer prognosis
• conventional therapies
• integrated therapy
• therapeutic strategies
• tumor microenvironment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Tumor mass is made of tumor cells and non-tumoral components known as the ‘tumor microenvironment’.

• The TME is a key factor in tumor biology as it contributes to tumor growth and therapeutic response.

• Surgery modifies the peritumoral residual tissue by affecting the immune system.

• The place of surgery in global strategies has to consider the concept of ‘pre-metastatic niche’.

• Chemotherapy can also act on TME and destroy tumor cells during hematogenous spread.

• The conventional therapies also influence the TME.

• TME will be important to consider in therapeutic management.

• In the next years, global therapeutic strategies such as immuno-surgery, chemo-immunotherapy and radio-immunotherapy will bring new hopes to cure cancer.