Immune checkpoint inhibitors: The linchpins of modern immunotherapy

Immunol Rev. 2019 Jul;290(1):6-23. doi: 10.1111/imr.12766.

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized our approach to cancer treatment in the past decade. While monoclonal antibodies to CTLA-4 and PD-1/PD-L1 have produced remarkable and durable responses in a subset of patients, the majority of patients will still develop primary or adaptive resistance. With complex mechanisms of resistance limiting the efficacy of checkpoint inhibitor monotherapy, it is critical to develop combination approaches to allow more patients to benefit from immunotherapy. In this review, I approach the current landscape of ICI research from the perspective of sarcomas, a rare group of bone and soft tissue cancers that have had limited benefit from checkpoint inhibitor monotherapy, and little investigation of biomarkers to predict responses. By surveying the various mechanisms of resistance and treatment modalities being explored in other solid tumors, I outline how ICIs will undoubtedly serve as the critical foundation for future directions in modern immunotherapy.

Keywords: CTLA-4; PD-1; T cells; immune checkpoint inhibitors; immunotherapy; sarcomas.

Publication types

  • Review

MeSH terms

  • Animals
  • Antineoplastic Agents, Immunological / administration & dosage
  • Antineoplastic Agents, Immunological / adverse effects
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Biomarkers, Tumor / antagonists & inhibitors*
  • Cancer Vaccines / administration & dosage
  • Cancer Vaccines / immunology
  • Combined Modality Therapy
  • Cytotoxicity, Immunologic
  • Humans
  • Immunomodulation / drug effects*
  • Immunotherapy
  • Neoplasms / diagnosis
  • Neoplasms / drug therapy*
  • Neoplasms / immunology*
  • Neoplasms / metabolism
  • T-Lymphocyte Subsets / drug effects
  • T-Lymphocyte Subsets / immunology
  • T-Lymphocyte Subsets / metabolism
  • Treatment Outcome
  • Tumor Escape / drug effects
  • Tumor Escape / immunology
  • Tumor Microenvironment / drug effects
  • Tumor Microenvironment / immunology

Substances

  • Antineoplastic Agents, Immunological
  • Biomarkers, Tumor
  • Cancer Vaccines