Shahe Boghossian and Alexei Von-Delwig
Immunotherapy has dramatically changed the outcome of many tumours. Whether it is by using antibodies as a humoral form of tumour control and clearance or active vaccines that allow the immune system to mount a response, the methodologies are quite different yet sharing an inherent similarity; finding the right epitope and eliciting the right response within the proper time frame of cellular maturity. The initial enthusiasm of using degraded proteins and priming T-cells against these vaccines has faded away with less than satisfactory outcomes in clinical trials. Albeit our understanding of how Dendritic Cells and T-cells interact and display antigens has been improving, we have not been able to clearly pinpoint a proper way in using peptide vaccines in clinical settings. This eventually prompted the use of whole proteins, necessitating antigen processing inside antigen presenting cells to give to suitable immunogenic epitopes. This has proven successful in a few clinical trials so far; however, recent evidence clearly demonstrates that eradication of a tumour is not just a matter of which protein is most likely to be immunogenic, but a combination of several other factors in its immediate and possibly distant environment. Hence our methodology in tumour clearance by using active vaccines is unlikely to be met with much success until we clearly understand the environment which allows these tumours to be nurtured. Henceforth, a whole cell vaccine in the context of enhanced adoptive T- cell immunotherapy will most likely be successful but still will not be the ultimate way in eradicating tumours. Our discussion will focus on several treatment modalities and success stories as well as possible modalities that will prove to be successful in the not so distant future.