Advances in immunotherapies in ovarian cancer
Immunotherapy acts by promoting the activity of cell-mediated immunity to target and kill cancer cells. It is extremely effective for several cancers, such as melanoma, but thus far has been ineffective for ovarian cancer, which is considered to be immunologically "cold".
This editorial review shows why this is so and suggests targets for more effective treatment in the future. Cell-mediated immunity acts by T cells invading the tumour microenvironment (TME). Ovarian cancer cells prevent this from happening, usually by reinforcing the cell membrane with antigen checkpoints that prevent the infiltration of these T cells.
Immunotherapy helps to overcome this protection either by direct checkpoint blockade or by identifying the relevant antigen and using an antibody drug combination to overcome the resistance and access the TME. Manipulation of T cell activity by genetic re-engineering to produce specific antigen receptivity is also used, especially for certain blood cancers (CART cells).
It is hoped that similar treatments will be developed for ovarian cancer. About half of all ovarian cancers show an immune response, with an increased number of lymphocytes visible on pathological examination. This response increases after neoadjuvant chemo, which offers some hope that immunotherapy may be possible.
A recently approved antibody drug combination (elahere), used for platinum-resistant ovarian cancer, shows some promise. The authors suggest that a better understanding of the TME and cellular protection is required before significant progress is possible.
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