Rini Brian
Cleveland Clinic, Cleveland, OH.
Semin Oncol. 2014 Oct;41 Suppl 5:S30-40. doi: 10.1053/j.seminoncol.2014.09.005. Epub 2014 Sep 7.
Advances in our understanding of the complex mechanisms of immune regulation and the interactions between tumor cells and the immune system have provided a solid foundation for advancing cancer immunotherapy and have inspired novel therapeutic strategies. Optimizing the effectiveness of immunotherapy will require targeting the antitumor immune response at multiple levels, and this may be achieved through synergistic combinations. Examples include combining two cancer vaccines to achieve a "prime and boost" effect, combining two immune checkpoint inhibitors, combining immunotherapy with targeted agents, or combining immunotherapy with low-dose chemotherapy or radiation. Immune checkpoint inhibitors, such as ipilimumab and nivolumab, will likely play an important role in the future of immunotherapy. The ability to block key pathways by which tumor cells seek to evade or suppress the immune response is critical to realizing the potential of cancer immunotherapy. Other exciting advances include recombinant oncolytic viruses and adoptive transfer of chimeric antigen receptor T cells. However, many challenges remain if durable tumor eradication with minimal toxicity is to be achieved in a broader population of cancer patients.
我们对免疫调节复杂机制以及肿瘤细胞与免疫系统之间相互作用的理解取得了进展,为推进癌症免疫治疗奠定了坚实基础,并激发了新的治疗策略。优化免疫治疗的有效性需要在多个层面靶向抗肿瘤免疫反应,这可以通过协同组合来实现。例如,联合两种癌症疫苗以实现“启动和增强”效应,联合两种免疫检查点抑制剂,将免疫治疗与靶向药物联合,或将免疫治疗与低剂量化疗或放疗联合。免疫检查点抑制剂,如伊匹单抗和纳武单抗,可能在免疫治疗的未来发挥重要作用。阻断肿瘤细胞逃避或抑制免疫反应的关键途径的能力对于实现癌症免疫治疗的潜力至关重要。其他令人兴奋的进展包括重组溶瘤病毒和嵌合抗原受体T细胞的过继性转移。然而,如果要在更广泛的癌症患者群体中以最小的毒性实现持久的肿瘤根除,仍存在许多挑战。