Immunotherapy of brain tumors.

In the process of malignant transformation, astrocytoma cells display a number of surface antigens not expressed by their normal adult counterparts and which have been identified by monoclonal antibodies and characterized biochemically. These include tumor associated antigens (TAA) such as oncofetal antigens of neuroectodermal origin or oncogene products such as epitopes in the extracellular domain of the epidermal growth factor receptor, as well as major histocompatibility antigens (MHC) of class I and class II. Glioma cells also secrete lymphokines like IL-1 and IL-6. The concomitant expression of TAA and MHC together with the disruption of the blood brain barrier may elicit a humoral or cell mediated immune response from the tumor bearing host as demonstrated by the functional analysis of tumor infiltrating lymphocytes. However this response is extremely weak and obviously inefficient because the tumor cells secrete factors which can inhibit or completely abrogate the immune attack by cytotoxic T cells. Among these factors, TGF-beta 2 and PGE2 are of particular interest since they may explain the generally depressed cellular immune response observed in patients with malignant gliomas. To be efficient any form of immunotherapy will require abatement of these suppressive activities in addition to stimulation of the effector functions.