Hersey P
Oncology & Immunology Unit, Newcastle, NSW, Australia.
Pharmacol Ther. 1999 Feb;81(2):111-9. doi: 10.1016/s0163-7258(98)00038-2.
Over the last decade, there has been a considerable increase in understanding of immune responses against cancers, the antigenic structures on tumor cells recognised by the immune system, and the development of more effective vaccines. There is, however, very limited understanding of why the immune system most often fails to control tumor growth and progression. In some patients, it is difficult to demonstrate immune responses to their tumors, and it may be assumed that this reflects poor recognition of tumor antigens, induction of anergy in lymphocytes, or suppression of immune responses by tumor-derived factors. In other patients, tumor progression appears to occur despite the presence of antibody or cell-mediated responses. This may indicate selection of tumor cells that have lost tumor antigens or HLA antigens by immune responses against the tumor. Tumor cells may also become resistant to mediators of apoptosis, such as Fas ligand and tumor necrosis factor-related apoptosis-inducing ligand used by lymphocytes to kill tumor cells. It is suggested that development of effective immunotherapy will need to include strategies that take into account these limitations of immune responses and classification of tumors according to the treatment approach most likely to succeed.
在过去十年中，人们对针对癌症的免疫反应、免疫系统识别的肿瘤细胞上的抗原结构以及更有效疫苗的研发有了相当大的了解。然而，对于免疫系统为何最常无法控制肿瘤生长和进展，人们的了解非常有限。在一些患者中，很难证明其对肿瘤有免疫反应，可能会认为这反映了对肿瘤抗原的识别不佳、淋巴细胞无反应性的诱导或肿瘤衍生因子对免疫反应的抑制。在其他患者中，尽管存在抗体或细胞介导的反应，肿瘤仍会进展。这可能表明通过针对肿瘤的免疫反应选择了已失去肿瘤抗原或HLA抗原的肿瘤细胞。肿瘤细胞也可能对凋亡介质产生抗性，例如淋巴细胞用来杀死肿瘤细胞的Fas配体和肿瘤坏死因子相关凋亡诱导配体。有人认为，有效的免疫疗法的发展将需要纳入一些策略，这些策略要考虑到免疫反应的这些局限性，并根据最有可能成功的治疗方法对肿瘤进行分类。
