Epidemiologic perspectives on immunosuppressed populations and the immunosurveillance and immunocontainment of cancer

Abstract

The advent in the last several years of effective immunotherapy for cancer has renewed interest in the role of the immune system in controlling cancer. The idea that the immune system can help control cancer has a long history. Solid organ transplant recipients (SOTRs) as well as human immunodeficiency virus (HIV)-infected people are affected by cell-mediated immune dysfunction. Epidemiologic studies of these populations reveal a pattern characterized by a strongly increased incidence of virus-related cancers (eg, Kaposi sarcoma, non-Hodgkin lymphoma, and anogenital cancers). In addition, recent epidemiologic studies have evaluated cancer-specific mortality among SOTRs and HIV-infected people following a cancer diagnosis. For a wider range of cancers-not limited to those caused by viruses, and including melanoma and cancers of the colorectum, lung, and breast-these immunosuppressed cancer patients have higher cancer-specific mortality than other cancer patients. This latter group of cancers somewhat mirrors those for which immunotherapy with checkpoint inhibitors is approved. These epidemiologic observations suggest that there are 2 distinct immune selection processes in humans: immunosurveillance directed against premalignant cells before cancer diagnosis (most relevant for preventing virus-related cancers), and "immunocontainment" directed against established cancers. These processes thus appear relevant for different groups of malignancies and may have different mechanisms. K E Y W O R D Scancer/malignancy/neoplasia, cancer/malignancy/neoplasia: registry/incidence, cancer/ malignancy/neoplasia: risk factors, clinical research/practice, epidemiology, hematology/ oncology, immune deficiency, immunosuppression/immune modulation, translational research/science | INTRODUC TI ONThe advent in the last several years of effective immunotherapy for cancer has renewed interest in the role of the immune system in controlling cancer. 1-3 The field of cancer immunotherapy has long drawn support from the observation that immunosuppressed individuals, including solid organ transplant recipients (SOTRs), have an elevated risk of developing cancer. 2 In this Personal

A multi-center study on safety and efficacy of immune checkpoint inhibitors in cancer patients with kidney transplant

“…ancer is a leading cause of death in kidney transplant patients. [1][2][3] However, the current understanding of treatment outcomes for cancer patients who are also transplant recipients is incomplete due to exclusion of these patients from most clinical trials.…”

Mapping of single-cell landscape of acral melanoma and analysis of molecular regulatory network of tumor microenvironment

“…In view of the important role of TME in tumor progression, it has become an important therapeutic target. Taking the elimination of immunosuppression of CD8+T cells in TME as an example (30), The use of antibodies to block cytotoxic T lymphocyte antigen-4 (CTLA-4) and programmed cell death-1 (PD-1) immunodrugs have been marketed, and have achieved remarkable results in the treatment of melanoma (31), lymphoma (32), Mercer-cell carcinoma (33) and other tumors. Targeted drugs that block the activation of VEGF signaling pathway and inhibit tumor metastasis, such as Sorafenib and bevacizumab, have also been widely developed.…”

Virus-Driven Carcinogenesis

“…Despite rapid progress in therapeutic strategies for HIV-1 [ 27 ], there is no established treatment to eliminate the retrovirus. In this clinical context, HIV-1 carriers and patients with AIDS develop other tumor virus-associated lesions [ 28 ].…”