Cancer immunology and immunotherapy

7 important questions on Cancer immunology and immunotherapy

In which 2 stages can immunotherapy interfere?

  • Priming and activation (anti-CTLA4)
  • killing of cancer cells (anti-PDL1)

How can blocking CTLA4 be an option for immunotherapy?

Immune checkpoints regulate the immune system. These pathways are crucial for self-tolerance which prevents the immune system from attacking cells indiscriminately. However, some cancers can protect themselves from attack by stimulating these immune checkpoint targets. CTLA4 is a negative cytokine, a protein receptor which functions as an immune checkpoint and downregulates immune responses. CTLA4 is constitutively expressed in regulatory T-cells. Blocking CTLA4 could be an option in immunotherapy. An example of an anti-CTLA4 is ipilimumab.

How can antibodies against PD1 (or its ligand) be used as immunotherapy?

PD1 is a immune checkpoint regulated which guards against autoimmunity through two mechanisms and thereby negatively regulate immune responses. First, it promotes apoptosis of antigen-specific T-cells in lymph nodes. Second, it reduces apoptosis in regulatory T-cells. PD1 can bind two ligands PDL1 AND PDL2, which are present of APVs and on tumor cells. Antibodies against PD1 or its ligand can be used as immunotherapy. PDL1 could also be used as a biomarker to predict if a patient will respond to therapy, however follow up research does not indicate this.
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How can immune-related adverse events (like toxicity) originate?

From a disbalance between immunity (pathogens, cancer) and tolerance (auto-immunity, transplantation).

By which mechanisms can adverse effects (like skin problems, ocular, liver, bone barrow, neuropathies) be caused?

  • Increasing T-cell activity against antigens that are present in tumors and healthy tissue (e.g heart)
  • increasing levels of pre-existing autoantibodies
  • increasing level of inflammatory cytoskines (e.g intestine)
  • enhancing complement-mediated inflammation due to direct binding of an anti-CTLA4 antibody with CTLA4 expressed on normal tissue (e.g brain)

Via which 4 strategies can vaccines work on the immune system by cancer antigen presentation?

  1. Tumor cells (antologous/allogenic)
  2. tumor antigens (peptides, proteins, RNA, DNA)
  3. antigen-presenting cells (antigen-loaded DCs)
  4. effector cells (autologous T-cells, genetically engineered T-cells)

How are DC (dendritic cell) vaccines created?

DC vaccines are created by first isolating mDCs/pDCs (myeloid and plasmacytoid DCs). Then the DCs are loaded and presented with antigens ex vivo and are given directly into the lymph node.

To check such vaccines, there is looked at immunologic responses upon DC vaccination, safety/feasibility, progression-free survival, overall survival and QOL (quality of life).

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