Cancer immunotherapy: broadening the scope of targetable tumours

Abstract

Cancer immunotherapy has experienced remarkable advances in recent years. Striking clinical responses have been achieved for several types of solid cancers (e.g. melanoma, non-small cell lung cancer, bladder cancer and mismatch repair-deficient cancers) after treatment of patients with T-cell checkpoint blockade therapies. These have been shown to be particularly effective in the treatment of cancers with high mutation burden, which places tumour-mutated antigens (neo-antigens) centre stage as targets of tumour immunity and cancer immunotherapy. With current technologies, neo-antigens can be identified in a short period of time, which may support the development of complementary, personalized approaches that increase the number of tumours amenable to immunotherapeutic intervention. In addition to reviewing the state of the art in cancer immunotherapy, we discuss potential avenues that can bring the immunotherapy revolution to a broader patient group including cancers with low mutation burden.

Keywords: checkpoint blockade; combination therapies; immunogenicity; immunotherapy; mutation burden; neo-antigens.

Figure 1.

(Immuno) therapeutic strategies in tumours with ‘hot’ and ‘cold’ immune microenvironments. Checkpoint blockade therapies are mostly applicable to ‘hot’ tumours which present an inflammatory profile as a consequence of their high mutation burden. We propose that ‘cold’ tumours might be sensitized to checkpoint blockade if this is used in combination with radiotherapy, chemotherapy, peptide vaccination or oncolytic viruses, to boost anti-tumour immune responses.