# Desmoplasia (tumour stroma)

Source: https://onco.cc/terms/desmoplasia/  
OnCo record `desmoplasia` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The dense scar-like tissue that makes up most of a pancreatic tumour, walling off cancer cells from drugs and immune cells.

## Summary

Cancer-associated fibroblasts, collagen, and hyaluronan can constitute 70-90% of PDAC volume, compressing vessels, limiting drug delivery, and excluding T cells. Stroma-depleting strategies failed or harmed (hedgehog inhibitors, PEGPH20 in HALO-301), revealing that stroma also restrains tumours. FAP-expressing fibroblasts are now an imaging and radioligand target rather than a depletion target.

## Fields

- Kind: Term
- Last checked: 2026-09-06

## Notes

- Pancreatic ductal adenocarcinoma is where the stroma was first attacked and where the attack failed: hedgehog inhibition raised intratumoural gemcitabine transiently in mice (Olive 2009), but deleting myofibroblasts or hedgehog signalling produced more aggressive tumours and shorter survival (Ozdemir 2014, Rhim 2014), and hyaluronan degradation raised the response rate without changing survival in 492 patients (Van Cutsem 2020). The stroma is now read as reactive or deserted tissue states anchored in fibroblast plasticity (Grunwald 2021).

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Desmoplasia
- Wikipedia: https://en.wikipedia.org/wiki/Desmoplasia

## Connected records

- cancers: [Locally advanced unresectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/locally-advanced-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- technologies: [FAPI PET](https://onco.cc/technologies/fapi-pet/), [Targeting tumour mechanics and pressure](https://onco.cc/technologies/mechanobiology-therapy/)
- targets: [FAP](https://onco.cc/targets/fap/)
- terms: [Cancer-associated fibroblasts (CAFs)](https://onco.cc/terms/cancer-associated-fibroblasts/), [Classical versus basal-like (squamous) subtypes of pancreatic cancer, and GATA6](https://onco.cc/terms/classical-vs-basal-like/), [Fibroblast subtypes in the pancreatic cancer stroma (myCAF, iCAF and apCAF)](https://onco.cc/terms/caf-subtypes-pancreatic/), [Hot vs cold tumours](https://onco.cc/terms/cold-vs-hot/), [Pancreatic cancer: the failed and stopped programmes and why](https://onco.cc/terms/pancreatic-failed-programmes/), [Stroma-rich and desmoplastic tumours in molecular data](https://onco.cc/terms/desmoplastic-stroma-rich/), [Tumour purity](https://onco.cc/terms/tumour-purity/)
- key papers: [Depletion of carcinoma-associated fibroblasts and fibrosis induces immunosuppression and accelerates pancreas cancer with reduced survival](https://onco.cc/key-papers/paper-ozdemir-caf-depletion-accelerates-pancreatic-cancer-cancer-cell-2014/), [Distinct populations of inflammatory fibroblasts and myofibroblasts in pancreatic cancer](https://onco.cc/key-papers/paper-ohlund-caf-subtypes-mycaf-icaf-jem-2017/), [Inhibition of hedgehog signaling enhances delivery of chemotherapy in a mouse model of pancreatic cancer](https://onco.cc/key-papers/paper-olive-hedgehog-stroma-gemcitabine-delivery-science-2009/), [Randomized Phase III Trial of Pegvorhyaluronidase Alfa With Nab-Paclitaxel Plus Gemcitabine for Patients With Hyaluronan-High Metastatic Pancreatic Adenocarcinoma](https://onco.cc/key-papers/paper-halo-301-pegvorhyaluronidase-jco-2020/), [Spatially confined sub-tumor microenvironments in pancreatic cancer](https://onco.cc/key-papers/paper-grunwald-subtme-pancreatic-cell-2021/), [Stromal contribution to the colorectal cancer transcriptome](https://onco.cc/key-papers/paper-isella-stromal-contribution-colorectal-transcriptome-nat-genet-2015/), [Stromal elements act to restrain, rather than support, pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-rhim-stroma-restrains-pancreatic-cancer-cell-2014/), [Stromal gene expression defines poor-prognosis subtypes in colorectal cancer](https://onco.cc/key-papers/paper-calon-stromal-gene-expression-poor-prognosis-colorectal-nat-genet-2015/), [The tumour microenvironment in pancreatic cancer: clinical challenges and opportunities](https://onco.cc/key-papers/paper-ho-pancreatic-tumour-microenvironment-review-nrco-2020/), [Virtual microdissection identifies distinct tumor- and stroma-specific subtypes of pancreatic ductal adenocarcinoma](https://onco.cc/key-papers/paper-moffitt-virtual-microdissection-subtypes-nat-genet-2015/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [Anchor a TGF-beta trap in the tumour stroma so it cannot act everywhere](https://onco.cc/ideas/idea-bio2-tumour-anchored-tgfbeta-trap/), [Clear the suppressive neutrophils out of pancreatic tumours first](https://onco.cc/ideas/idea-bio2-cxcr2-neutrophil-blockade/), [Match therapy to the type of scar-forming cell in the tumour](https://onco.cc/ideas/idea-bio2-caf-subtype-assignment/), [Reprogramme the stroma rather than remove it: second-generation stromal trials with a stromal biomarker and a survival endpoint](https://onco.cc/ideas/idea-pdac-stromal-reprogramming-not-depletion/), [Soften the tissue that new metastases need in order to grow](https://onco.cc/ideas/idea-bio2-matrix-stiffness-prevention/)
- drugs: [Pegvorhyaluronidase alfa](https://onco.cc/drugs/pegvorhyaluronidase-alfa/)
- trials: [HALO 109-301](https://onco.cc/trials/halo-301/), [STARPAC2](https://onco.cc/trials/starpac2/)
- bottlenecks: [Cold tumours and the immunosuppressive microenvironment](https://onco.cc/bottlenecks/b-tme-immunosuppression/)
- pathways: [Cold tumours: immune deserts and exclusion](https://onco.cc/pathways/immune-desert-exclusion/), [Fibroblast activation, desmoplasia & matrix stiffness](https://onco.cc/pathways/caf-activation-desmoplasia/), [Invasion: proteases, adhesion & the invasive front](https://onco.cc/pathways/invasion-ecm-degradation/), [TGF-β signalling](https://onco.cc/pathways/tgf-beta/)

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