Alturki Meshael, Alshehri Abdullah A, Aldossary Ahmad M, Fallatah Mohannad M, Almughem Fahad A, Al Fayez Nojoud, Majrashi Majed A, Alradwan Ibrahim A, Alkhrayef Mohammad, Alomary Mohammad N, Tawfik Essam A
Wellness and Preventative Medicine Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia.
Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia.
Pharmaceuticals (Basel). 2025 Aug 4;18(8):1154. doi: 10.3390/ph18081154.
Conventional immunotherapy, including immune checkpoint blockade and chimeric antigen receptor (CAR)-T cells, has revolutionized cancer therapy over the past decade. Yet, the efficacy of these therapies is limited by tumor resistance, antigen escape mechanisms, poor persistence, and T-cell exhaustion, particularly in the treatment of solid tumors. The emergence of unconventional immunotherapies offers novel opportunities by leveraging diverse immune cell subsets and synthetic biologics. This review explores various immunotherapy platforms, including gamma delta T cells, invariant natural killer T cells, mucosal-associated invariant T cells, engineered regulatory T cells, and universal CAR platforms. Additionally, it expands on biologics, including bispecific and multispecific antibodies, cytokine fusions, agonists, and oncolytic viruses, showcasing their potential for modular engineering and off-the-shelf applicability. Distinct features of unconventional platforms include independence from the major histocompatibility complex (MHC), tissue-homing capabilities, stress ligand sensing, and the ability to bridge adaptive and innate immunity. Their compatibility with engineering approaches highlights their potential as scalable, efficient, and cost-effective therapies. To overcome translational challenges such as functional heterogeneity, immune exhaustion, tumor microenvironment-mediated suppression, and limited persistence, novel strategies will be discussed, including metabolic and epigenetic reprogramming, immune cloaking, gene editing, and the utilization of artificial intelligence for patient stratification. Ultimately, unconventional immunotherapies extend the therapeutic horizon of cancer immunotherapy by breaking barriers in solid tumor treatment and increasing accessibility. Continued investments in research for mechanistic insights and scalable manufacturing are key to unlocking their full clinical potential.
传统免疫疗法,包括免疫检查点阻断和嵌合抗原受体(CAR)-T细胞,在过去十年中彻底改变了癌症治疗方式。然而,这些疗法的疗效受到肿瘤耐药性、抗原逃逸机制、持久性差和T细胞耗竭的限制,尤其是在实体瘤治疗中。非传统免疫疗法的出现通过利用多种免疫细胞亚群和合成生物制剂提供了新的机会。本综述探讨了各种免疫治疗平台,包括γδT细胞、不变自然杀伤T细胞、黏膜相关不变T细胞、工程化调节性T细胞和通用CAR平台。此外,还阐述了生物制剂,包括双特异性和多特异性抗体、细胞因子融合物、激动剂和溶瘤病毒,展示了它们在模块化工程和现成适用性方面的潜力。非传统平台的独特特征包括独立于主要组织相容性复合体(MHC)、组织归巢能力、应激配体感应以及连接适应性免疫和先天性免疫的能力。它们与工程方法的兼容性突出了它们作为可扩展、高效且具有成本效益的疗法的潜力。为了克服诸如功能异质性、免疫耗竭、肿瘤微环境介导的抑制和持久性有限等转化挑战,将讨论新的策略,包括代谢和表观遗传重编程、免疫伪装、基因编辑以及利用人工智能进行患者分层。最终,非传统免疫疗法通过突破实体瘤治疗的障碍并提高可及性,扩展了癌症免疫治疗的治疗范围。持续投入研究以获得机制见解和可扩展制造是释放其全部临床潜力的关键。
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