The Tumor Microenvironment in Tumorigenesis and Therapy Resistance Revisited

SIMPLE SUMMARY: Tumors are not masses of cancer cells alone but made up of cancer cells, other cells including fibroblasts, macrophages, endothelial cells, as well as secreted factors, blood vessels and the extracellular matrix (ECM). This comprehensive review presents new findings on the role of each component of the tumor cell surroundings and the effect on the success of cancer drugs. We show in this paper that the tumor cell’s surroundings are not simply ‘bystanders’ but are actively involved in tumor growth and can cause resistance to treatment. Initially, cells and ECM around tumor cells do not promote their growth but over time, tumor cells ‘convert’ their surroundings to promote their growth. An increase in tumor size means tumor cells must overcome a lack of oxygen and nutrients, be able to remove waste and form secondary tumors. A better knowledge of tumor cells and their surrounding means better drugs for tumor cells and their surroundings. ABSTRACT: Tumorigenesis is a complex and dynamic process involving cell-cell and cell-extracellular matrix (ECM) interactions that allow tumor cell growth, drug resistance and metastasis. This review provides an updated summary of the role played by the tumor microenvironment (TME) components and hypoxia in tumorigenesis, and highlight various ways through which tumor cells reprogram normal cells into phenotypes that are pro-tumorigenic, including cancer associated- fibroblasts, -macrophages and -endothelial cells. Tumor cells secrete numerous factors leading to the transformation of a previously anti-tumorigenic environment into a pro-tumorigenic environment. Once formed, solid tumors continue to interact with various stromal cells, including local and infiltrating fibroblasts, macrophages, mesenchymal stem cells, endothelial cells, pericytes, and secreted factors and the ECM within the tumor microenvironment (TME). The TME is key to tumorigenesis, drug response and treatment outcome. Importantly, stromal cells and secreted factors can initially be anti-tumorigenic, but over time promote tumorigenesis and induce therapy resistance. To counter hypoxia, increased angiogenesis leads to the formation of new vascular networks in order to actively promote and sustain tumor growth via the supply of oxygen and nutrients, whilst removing metabolic waste. Angiogenic vascular network formation aid in tumor cell metastatic dissemination. Successful tumor treatment and novel drug development require the identification and therapeutic targeting of pro-tumorigenic components of the TME including cancer-associated- fibroblasts (CAFs) and -macrophages (CAMs), hypoxia, blocking ECM-receptor interactions, in addition to the targeting of tumor cells. The reprogramming of stromal cells and the immune response to be anti-tumorigenic is key to therapeutic success. Lastly, this review highlights potential TME- and hypoxia-centered therapies under investigation.