The tumor microenvironment plays an important role in the initiation and progression of pancreatic adenocarcinoma (PDAC). In this systematic review, we provide an overview of clinical trials with stroma-targeting agents. We systematically searched MEDLINE/PubMed and the EMBASE database, using the PRISMA guidelines, for eligible clinical trials. In total, 2330 records were screened, from which we have included 106 articles. A meta-analysis could be performed on 51 articles which describe the targeting of the vascular endothelial growth factor (VEGF) pathway, and three articles which describe the targeting of hyaluronic acid. Anti-VEGF therapies did not show an increase in median overall survival (OS) with combined hazard ratios (HRs) of 1.01 (95% confidence interval (CI) 0.90–1.13). Treatment with hyaluronidase PEGPH20 showed promising results, but, thus far, only in combination with gemcitabine and nab-paclitaxel in selected patients with hyaluronic acid (HA)^high tumors: An increase in median progression free survival (PFS) of 2.9 months, as well as a HR of 0.51 (95% CI 0.26–1.00). In conclusion, we found that anti-angiogenic therapies did not show an increased benefit in median OS or PFS in contrast to promising results with anti-hyaluronic acid treatment in combination with gemcitabine and nab-paclitaxel. The PEGPH20 clinical trials used patient selection to determine eligibility based on tumor biology, which underlines the importance to personalize treatment for pancreatic cancer patients.

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In recent years, the discovery and development of clustered regularly interspaced short palindromic repeats (CRISPR) technology has revolutionized and accelerated functional genetic screening in cancer research. In this review, we discuss different methods of executing CRISPR screens, with a focus on pediatric tumour entities. Historically, these tumours were thought to resemble their adult counterparts. However, the new era of genomic research and the extensive use of gene editing has identified pediatric tumours as distinct entities with drastically different development and presentation. Here we provide an overview of CRISPR screens performed in pediatric tumour models and highlight unique considerations for pediatric tumour screens. In particular, the results from CRISPR screens combining treatment with genetic knockouts can push treatment for pediatric patients. We conclude by discussing the potential of CRISPR genetic screening to unravel pediatric tumour biology and identify new treatment options.