Ai Midan, Curran Michael A
Department of Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit Number: 901, Houston, TX, 77030, USA.
Cancer Immunol Immunother. 2015 Jul;64(7):885-92. doi: 10.1007/s00262-014-1650-8. Epub 2015 Jan 3.
The discovery that antibody blockade of the T cell co-inhibitory receptor cytotoxic T lymphocyte-associated protein 4 (CTLA-4) can restore tumor immunity against many murine transplantable tumors leading to complete rejection of established cancer forever changed the field of immunotherapy. In more robust murine models as well as human cancer, however, CTLA-4 blockade alone can slow tumor growth and extend patient survival, but is rarely curative. Subsequent studies have revealed a large family of T cell immune checkpoint receptors which tumors engage to shield themselves from host immunity. As with CTLA-4, blockade of one of these additional inhibitory receptors, programmed death 1, has led to remarkable therapeutic responses against tumors of multiple lineages. Checkpoint monotherapy has demonstrated that durable, immune-mediated cures of established metastatic cancers are possible, yet the percentage of patients experiencing these outcomes remains low due to both redundant mechanisms of immune suppression in the tumor and limiting toxicity associated with some therapies. Thus, extending the curative potential of immunotherapy to a larger percentage of patients with a broader spectrum of malignancies will likely require combinations of co-inhibitory blockade and co-stimulatory activation designed to peel back multiple layers of tumor immune suppression while at the same time minimizing immune-mediated toxicity. As over a dozen T cell immune checkpoints and an additional dozen more co-stimulatory receptors have now been described, the challenge before us is to identify the most advantageous combinations of these agents based on the knowledge of their underlying biology and preclinical studies in murine tumor models.
发现抗体阻断T细胞共抑制受体细胞毒性T淋巴细胞相关蛋白4(CTLA-4)可恢复针对许多小鼠可移植肿瘤的肿瘤免疫,从而导致已建立的癌症被完全排斥,这永远改变了免疫治疗领域。然而,在更强大的小鼠模型以及人类癌症中,单独阻断CTLA-4可以减缓肿瘤生长并延长患者生存期,但很少能治愈。随后的研究揭示了一大类T细胞免疫检查点受体,肿瘤利用这些受体来保护自己免受宿主免疫的攻击。与CTLA-4一样,阻断这些额外的抑制性受体之一程序性死亡1,已导致对多种谱系肿瘤产生显著的治疗反应。检查点单药治疗已证明,对已建立的转移性癌症进行持久的、免疫介导的治愈是可能的,但由于肿瘤中免疫抑制的冗余机制以及与某些疗法相关的毒性限制,经历这些结果的患者百分比仍然很低。因此,将免疫治疗的治愈潜力扩展到更大比例的患有更广泛恶性肿瘤的患者,可能需要联合抑制阻断和共刺激激活的组合,旨在消除多层肿瘤免疫抑制,同时将免疫介导的毒性降至最低。由于现在已经描述了十几种T细胞免疫检查点和另外十几种共刺激受体,我们面临的挑战是根据它们的基础生物学知识和在小鼠肿瘤模型中的临床前研究,确定这些药物最有利的组合。