Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX, USA.
Department of Neurology, University of Texas Austin Dell Medical School, Austin, TX, USA.
Adv Exp Med Biol. 2021;1342:233-258. doi: 10.1007/978-3-030-79308-1_7.
Immunotherapy has changed the landscape of treatment of many solid and hematological malignancies and is at the forefront of cancer breakthroughs. Several circumstances unique to the central nervous system (CNS) such as limited space for an inflammatory response, difficulties with repeated sampling, corticosteroid use for management of cerebral edema, and immunosuppressive mechanisms within the tumor and brain parenchyma have posed challenges in clinical development of immunotherapy for intracranial tumors. Nonetheless, the success of immunotherapy in brain metastases (BMs) from solid cancers such as melanoma and non-small cell lung cancer (NSCLC) proves that the CNS is not an immune-privileged organ and is capable of initiating and regulating immune responses that lead to tumor control. However, the development of immunotherapeutics for the most malignant primary brain tumor, glioblastoma (GBM), has been challenging due to systemic and profound tumor-mediated immunosuppression unique to GBM, intratumoral and intertumoral heterogeneity, and lack of stably expressed clonal antigens. Here, we review recent advances in the field of immunotherapy for neuro-oncology with a focus on BM, GBM, and rare CNS cancers.
免疫疗法改变了许多实体瘤和血液系统恶性肿瘤的治疗格局，是癌症突破的前沿。中枢神经系统（CNS）具有一些独特的情况，如炎症反应的空间有限、重复采样困难、皮质类固醇用于治疗脑水肿以及肿瘤和脑实质内的免疫抑制机制，这些都给颅内肿瘤的免疫疗法的临床开发带来了挑战。尽管如此，免疫疗法在黑色素瘤和非小细胞肺癌（NSCLC）等实体瘤脑转移瘤（BM）中的成功证明了中枢神经系统不是免疫特权器官，能够启动和调节导致肿瘤控制的免疫反应。然而，由于胶质母细胞瘤（GBM）所特有的全身性和深刻的肿瘤介导免疫抑制、肿瘤内和肿瘤间异质性以及缺乏稳定表达的克隆抗原，GBM 等最恶性的原发性脑肿瘤的免疫治疗药物的开发具有挑战性。在这里，我们重点介绍 BM、GBM 和罕见的中枢神经系统癌症，综述神经肿瘤学免疫治疗领域的最新进展。
