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The tumor microenvironment (TME) plays an important role in the development of tumors. Immunoregulatory cells and cytokines facilitate cancer cells to avoid immune surveillance. Overexpression of immune checkpoint molecules such as CTLA-4 and PD-1/PD-L1 inhibits immune function and enables cancer cells to avoid clearance by the immune system. Thus, minimizing tumor immunosuppression could be an important strategy for cancer therapy. Currently, many immune checkpoint-targeted drugs, such as PD-1/PD-L1 inhibitors, have been approved for marketing and have shown unique advantages in the clinical treatment of cancers. The concept of "strengthening resistance to eliminate pathogenic factors" in traditional Chinese medicine (TCM) is consistent with the immunotherapy of cancer. According to previous studies, the role of TCM in tumor immunotherapy is mainly associated with the positive regulation of natural killer cells, CD8/CD4 T cells, dendritic cells, M2 macrophages, interleukin-2, tumor necrosis factor- α , and IFN- γ , as well as with the negative regulation of Tregs, myeloid-derived suppressor cells, cancer-associated fibroblasts, PD-1/PD-L1, transforming growth factor- β , and tumor necrosis factor- β. This paper summarizes the current research on the effect of TCM targeting the TME, and further introduces the research progress on studying the effects of TCM on immune checkpoints. Modern pharmacological studies have demonstrated that TCM can directly or indirectly affect the TME by inhibiting the overexpression of immune checkpoint molecules and enhancing the efficacy of tumor immunotherapy. TCM with immunomodulatory stimulation could be the key factor to achieve benefits from immunotherapy for patients with non-inflammatory, or "cold", tumors. [ABSTRACT FROM AUTHOR]

In this paper, we investigate a mathematical model of pancreatic cancer, which extends the existing pancreatic cancer models with regulatory T cells (Tregs) and Treg inhibitory therapy. The model consists of tumor-immune interaction and immune suppression from Tregs. In the absence of treatments, we first characterize the system dynamics by locating equilibrium points and determining stability properties. Next, cytokine induced killer (CIK) immunotherapy is incorporated. Numerical simulations of prognostic results illustrate that the median overall survival associated with treatment can be prolonged approximately from 7 to 13 months, which is consistent with the clinical data. Furthermore, we consider cyclophosphamide (CTX) therapy as well as the combined therapy with CIK and CTX. Intensive simulation results suggest that both CTX therapy and the combined CIK/CTX therapy can reduce the number of Tregs and increase the overall survival (OS), but Tregs and tumor cells will gradually rise to equilibrium state as long as therapies are ceased. [ABSTRACT FROM AUTHOR]