Cancer Bio-Immunotherapy Unit; CRO-IRCCS; National Cancer Institute; Aviano, Italy.
Hum Vaccin Immunother. 2013 May;9(5):1078-83. doi: 10.4161/hv.23970. Epub 2013 Feb 13.
The idiotype of B-cell non-Hodgkin lymphomas has been intensively investigated for its proven immunogenicity as a promising cancer vaccine. Indeed, available data clearly indicate that these vaccines are able to induce tumor-specific immune responses and molecular remissions in patients with follicular lymphoma. However, only one of the three phase III trials performed so far demonstrated a prolonged disease-free survival in vaccinated patients. The observed failures have been mainly ascribed to defects in the study design and not to the limited efficacy of idiotype vaccines per se. Therefore, innovative and optimized idiotype-based vaccine formulations are being developed in order to overcome current limitations and improve the clinical benefit of this immunotherapeutic strategy. Among the most promising advances, the development of "off-the-shelf" vaccines appears of particular relevance, being potentially able to overcome the limitations related to the complex, time-consuming and expensive production of the individualized idiotypic vaccines currently used. Moreover, there is a pressing need to identify biomarkers suitable for the identification of the subset of patients who are most likely to benefit from vaccination. Recent findings also indicate that idiotypic vaccines may be safely and successfully used in additional clinical settings, including lymphoma patients after high-dose chemotherapy and autologous stem cell transplantation.
B 细胞非霍奇金淋巴瘤的独特型已被深入研究，因为其具有很强的免疫原性，是一种很有前途的癌症疫苗。事实上，现有数据清楚地表明，这些疫苗能够诱导滤泡性淋巴瘤患者的肿瘤特异性免疫反应和分子缓解。然而，到目前为止，进行的三项三期试验中只有一项显示接种疫苗的患者无病生存期延长。观察到的失败主要归因于研究设计的缺陷，而不是独特型疫苗本身的疗效有限。因此，正在开发创新和优化的基于独特型的疫苗配方，以克服当前的局限性并提高这种免疫治疗策略的临床获益。在最有前途的进展中，“现成”疫苗的开发显得尤为重要，因为它有可能克服与目前使用的个体化独特型疫苗的复杂、耗时和昂贵的生产相关的局限性。此外，迫切需要确定合适的生物标志物，以鉴定最有可能从疫苗接种中获益的患者亚组。最近的研究结果还表明，独特型疫苗可以安全且成功地用于其他临床环境，包括大剂量化疗和自体干细胞移植后的淋巴瘤患者。
