To date, extensive efforts to harness immunotherapeutic strategies for the treatment of pancreatic ductal adenocarcinoma (PDAC) have yielded disappointing results in clinical trials. These strategies mainly focused on cancer vaccines and immune checkpoint inhibitors alone or in combination with chemotherapeutic or targeted agents. However, the growing preclinical and clinical data sets from these efforts have established valuable insights into the immunological characteristics of PDAC biology. Most notable are the immunosuppressive role of the tumour microenvironment (TME) and PDAC’s characteristically poor immunogenicity resulting from tumour intrinsic features. Moreover, PDAC tumour heterogeneity has been increasingly well characterized and may additionally limit a “one-fits-all” immunotherapeutic strategy. In this review, we first outline mechanisms of immunosuppression and immune evasion in PDAC. Secondly, we summarize recently published data on preclinical and clinical efforts to establish immunotherapeutic strategies for the treatment of PDAC including diverse combinatorial treatment approaches aiming at overcoming this resistance towards immunotherapeutic strategies. Particularly, these combinatorial treatment approaches seek to concomitantly increase PDAC antigenicity, boost PDAC directed T-cell responses, and impair the immunosuppressive character of the TME in order to allow immunotherapeutic agents to unleash their full potential. Eventually, the thorough understanding of the currently available data on immunotherapeutic treatment strategies of PDAC will enable researchers and clinicians to develop improved treatment regimens and to design innovative clinical trials to overcome the pronounced immunosuppression of PDAC.

The diagnosis and treatment of cancer are associated with impairment at the physical and at psychological level. In addition, side effects are a potentially treatment-limiting factor that may necessitate dose reduction, delay, or even discontinuation of therapy, with negative consequences for outcome and mean survival. Numerous studies have shown that physical activity and sports and exercise therapy programs are not only practicable but also recommendable for oncologic patients during the acute phase and in the aftercare. Furthermore, nutrition plays an important role in all stages of tumor therapy. A timely integration of a nutrition therapy and physical activity in the form of physiotherapy and sports therapy serves to prevent and reduce treatment-associated side effects. Evidence-based recommendations on cancer prevention through nutrition therapy, physical activity, and sports and exercise therapy should be integrated into treatment plans for oncology patients as well as in health care services for the general population. Individual counselling by trained nutrition and exercise specialists may be advisable to receive concrete recommendations on the respective tumor entity or specific side effects. This mini review is based on a selective literature search in the PubMed database and Cochrane Central Register of Controlled Trials on the subjects of healthy diet and physical activity in primary prevention and follow-up about cancer.

Background: Early integration of palliative care concurrently to standard cancer care is associated with several benefits for patients and their caregivers. However, communication barriers on part of the caring physicians often impede a timely referral to palliative care. This study describes the protocol of the evaluation of a communication skills training aiming to strengthen the ability of physicians to address palliative care related topics adequately and early during disease trajectory. Methods: We will implement a communication skills training and evaluate it within a prospective, multi-centered, two-armed randomized controlled trial (RCT), which will be conducted at four sites in Germany. Eligible subjects are all physicians treating patients with advanced cancer in their daily routine. An intervention group (IG) receiving a group training will be compared to a wait-list control group (CG) receiving the training after completion of data collection. At pre- and post-measurement points, participants will conduct videotaped conversations with standardized simulated patients (SP). Primary outcome will be the external rating of communication skills and consulting competencies addressing palliative care related topics. Secondary outcomes on core concepts of palliative care, basic knowledge, attitudes, confidence and self-efficacy will be assessed by standardized questionnaires and self-developed items. A further external assessment of the quality of physician-patient-interaction will be conducted by the SP. Longitudinal quantitative data will be analyzed using covariate-adjusted linear mixed-models. Discussion: If the communication skills training proves to be effective, it will provide a feasible intervention to promote an earlier communication of palliative care related topics in the care of advanced cancer patients. This would help to further establish early integration of palliative care as it is recommended by national and international guidelines. Trial registration: German Clinical Trials Register DRKS00017025 (date of registration: 4 June 2019).

Purpose: This study aimed to evaluate the effects of a 12-week programme, including moderate strength training with and without whole-body vibration (WBV), on chemotherapy-induced peripheral neuropathy (CIPN) associated symptoms in breast cancer patients undergoing paclitaxel-containing therapy. The goal was to assess the effects on sensory, motor, and autonomic symptoms and on balance, depth sensitivity, and the vibration sensation. Methods: In this randomized controlled trial, 66 patients were allocated to one of three groups: (i) strength training only (SG), (ii) strength training with WBV (VG), and (iii) a control group (CG) with standard activity advices. Supervised training sessions occurred twice a week during chemotherapy. Outcomes, including balance (Fullerton Advanced Balance Scale, Berg Balance Scale), vibration sensation (tuning fork test), and CIPN symptoms (EORTC QLQ-CIPN20), were assessed at baseline (T0), 6 weeks (T1), and 12 weeks (T2). Results: No adverse events were recorded, and adherence was high (68.18%). Positive trends indicated stabilized vibration sensation in the SG and VG compared to the control group, but no significant differences were observed. Vibration perception decreased less in the intervention groups, and motor symptoms worsened only in the control group. Balance remained stable across all groups. Conclusion: Both strength training alone and combined with WBV are feasible and safe during chemotherapy. Although WBV did not provide additional benefits over strength training alone, both interventions showed potential protective effects against CIPN symptoms. Implications for cancer survivors. Moderate strength training, with or without WBV, may help prevent or alleviate CIPN symptoms, supporting better physical function during chemotherapy. Early implementation of such programmes could reduce treatment-related side effects.