Onkológia 1/2023

Immunooncology and immunotherapy: principles of function and dysfunction of immune system in malignancies

The importance of immune cells in malignant progression has been appreciated since the early nineteenth century; however, scientific interest in immuno-oncology was reinvigorated over the past decade with the advent of checkpoint blockade therapy. Although it is clear that immune cells are capable of mitigating tumour growth, the exact cellular mechanisms that dictate patient responses to checkpoint blockade and immuno-oncology combination therapies have yet to be defined. The success of checkpoint inhibitors has accelerated the clinical implementation of a vast mosaic of single agents and combination immunotherapies. Oncologic therapy’s standard of care is changing rapidly, and immunotherapy is becoming one of the frontline treatments in modern medicine. Novel therapeutic strategies that consider the dynamic relationship between mononuclear phagocytes, the TME and lymphocyte-dependent cancer cell elimination, as well as factors such as time to treatment, cancer stage and previous therapies, are sure to lead to more appropriate and efficacious immunotherapeutics for patients with cancer. The next chapter of immunotherapy should examine the immuno-oncology therapeutic failures and consider the complexity of immune cell–cancer cell interactions to better design more effective anticancer drugs. The cost of immunotherapy treatments is an additional challenge to be considered. Newer modalities such as adoptive cellular therapy treatments may carry even higher price tags. A solution currently being investigated is targeting biomarkers to isolate specific patient populations that have a chance to experience greater benefits from these treatments and lead to a reduced overall economic burden. There are several challenges that lie ahead for personalized combinatory immunotherapies.

Keywords: immunooncology, immune system, tumor microenvironment, checkpoint inhibitors