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Tumor-derived exosomes could restrain DC maturation, down-regulate the expression of surface markers like CD80, CD86, and MHC-II, and up-regulate the expression of CD11b and PD-L1, which ultimately obstructed the anti-tumor activity of Teff and reinforced immune evasion [185,186,187]

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Meanwhile, the prodrug of triptolide, has been developed in clinical trials for patients with advanced solid tumors (NCT03129139) and refractory pancreatic malignancy (NCT03117920 and NCT04896073)

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For patients in dose-escalation phases, crossing time zones may require dose timing adjustments