Brown Michael
Department of Neurosurgery, Duke University, Durham, NC, USA.
Cancer Treat Res. 2022;183:91-129. doi: 10.1007/978-3-030-96376-7_3.
Malignant tumors frequently exploit innate immunity to evade immune surveillance. The priming, function, and polarization of antitumor immunity fundamentally depends upon context provided by the innate immune system, particularly antigen presenting cells. Such context is determined in large part by sensing of pathogen specific and damage associated features by pathogen recognition receptors (PRRs). PRR activation induces the delivery of T cell priming cues (e.g. chemokines, co-stimulatory ligands, and cytokines) from antigen presenting cells, playing a decisive role in the cancer immunity cycle. Indeed, endogenous PRR activation within the tumor microenvironment (TME) has been shown to generate spontaneous antitumor T cell immunity, e.g., cGAS-STING mediated activation of antigen presenting cells after release of DNA from dying tumor cells. Thus, instigating intratumor PRR activation, particularly with the goal of generating Th1-promoting inflammation that stokes endogenous priming of antitumor CD8 T cells, is a growing area of clinical investigation. This approach is analogous to in situ vaccination, ultimately providing a personalized antitumor response against relevant tumor associated antigens. Here I discuss clinical stage intratumor modalities that function via activation of PRRs. These approaches are being tested in various solid tumor contexts including melanoma, colorectal cancer, glioblastoma, head and neck squamous cell carcinoma, bladder cancer, and pancreatic cancer. Their mechanism (s) of action relative to other immunotherapy approaches (e.g., antigen-defined cancer vaccines, CAR T cells, dendritic cell vaccines, and immune checkpoint blockade), as well as their potential to complement these approaches are also discussed. Examples to be reviewed include TLR agonists, STING agonists, RIG-I agonists, and attenuated or engineered viruses and bacterium. I also review common key requirements for effective in situ immune activation, discuss differences between various strategies inclusive of mechanisms that may ultimately limit or preclude antitumor efficacy, and provide a summary of relevant clinical data.
恶性肿瘤常常利用先天免疫来逃避免疫监视。抗肿瘤免疫的启动、功能和极化从根本上取决于先天免疫系统提供的背景,尤其是抗原呈递细胞。这种背景在很大程度上由病原体识别受体(PRR)对病原体特异性和损伤相关特征的感知所决定。PRR激活诱导抗原呈递细胞传递T细胞启动信号(如趋化因子、共刺激配体和细胞因子),在癌症免疫循环中起决定性作用。事实上,肿瘤微环境(TME)内的内源性PRR激活已被证明可产生自发的抗肿瘤T细胞免疫,例如,垂死肿瘤细胞释放DNA后cGAS-STING介导的抗原呈递细胞激活。因此,促使肿瘤内PRR激活,尤其是以产生促进Th1的炎症从而激发抗肿瘤CD8 T细胞的内源性启动为目标,是一个不断发展的临床研究领域。这种方法类似于原位疫苗接种,最终提供针对相关肿瘤相关抗原的个性化抗肿瘤反应。在此,我将讨论通过激活PRR发挥作用的临床阶段肿瘤内治疗方式。这些方法正在多种实体瘤环境中进行测试,包括黑色素瘤、结直肠癌、胶质母细胞瘤、头颈部鳞状细胞癌、膀胱癌和胰腺癌。还将讨论它们相对于其他免疫治疗方法(如抗原定义的癌症疫苗、CAR-T细胞、树突状细胞疫苗和免疫检查点阻断)的作用机制,以及它们补充这些方法的潜力。将回顾的例子包括TLR激动剂、STING激动剂、RIG-I激动剂以及减毒或工程化的病毒和细菌。我还将回顾有效原位免疫激活的常见关键要求,讨论各种策略之间的差异,包括可能最终限制或排除抗肿瘤疗效的机制,并提供相关临床数据的总结。
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