While many cellular mechanisms leading to chemotherapeutic resistance have been identified, there is an increasing realization that tumor-stroma interactions also play an important role. In particular, mechanical alterations are inherent to solid cancer progression and profoundly impact cell physiology. Here, we explore the impact of compressive stress on the efficacy of chemotherapeutics in pancreatic cancer spheroids. We find that increased compressive stress leads to decreased drug efficacy. Theoretical modeling and experiments suggest that mechanical stress leads to decreased cell proliferation which in turn reduces the efficacy of chemotherapeutics that target proliferating cells. Our work highlights a mechanical-form of drug resistance, and suggests new strategies for therapy.Mechanical alterations of solid tumors are a hallmark of cancer progression. Among the many occurring modifications, the most representative forms of mechanical alterations in tumors are changes in extracellular matrix rigidity[1] and build up of compressive stress [2]. Compressive stress accumulation can be found in many cancers such as glioblastoma multiform [3] or pancreatic ductal adenocarcinoma (PDAC) [2].PDAC is one of the deadliest cancers, with extremely poor prognosis when diagnosed and no efficient treatment available besides surgery. PDAC development is characterized by excessive deposition of extracellular material during which strong modifications of the mechanical environment arises. In particular, the deposition of negatively-charged hyaluronic acid leads to electroswelling of extracellular matrix and subsequent compressive stress experienced by tumor cells [4]. The local growth of cancer cells in an elastic environment also leads to build-up of compressive stress through a process known as growth-induced pressure [5,6]. PDAC tumors are extremely compressed, within the kPa range [7].In vitro, compressive stress can alter cell physiology in multiple ways, from proliferation [8,9] to migration [10,11]. In vivo, it has recently been shown that compressive stress built-up in PDAC tumors can exceed blood pressure and participate in blood vessel collapse [12]. Most of large vessels (diameter above 10µm) are clamped, leading to poor perfusion. Vessel collapse is associated with drug resistance: classical first-line chemotherapeutics such as gemcitabine are thought to be unable to reach the tumor, which decreases or even prevents the effect of the drug. Intravenous injection of a pegylated-form of hyaluronidase, an enzyme digesting hyaluronic acid, renormalizes blood vessels and, in combination with gemcitabine, increases chemotherapeutic efficacy [12].The proposed mechanism overcoming this form of resistance is better tumor perfusion through decrease in compressive stress. However, it remains unclear how the combination of hyaluronidase and gemcitabine really works. Indeed, if the vessels are so collapsed that gemcitabine does not penetrate the tumor, hyaluronidase should not have a better chance to reach the tumor. Another pot...