20. Diseases of the Immune System
20.5 Cancer Immunobiology and Immunotherapy
- Explain how the adaptive specific immune response responds to tumours
- Discuss the risks and benefits of tumour vaccines
Cancer involves a loss of the ability of cells to control their cell cycle, the stages each eukaryotic cell goes through as it grows and then divides. When this control is lost, the affected cells rapidly divide and often lose the ability to differentiate into the cell type appropriate for their location in the body. In addition, they lose contact inhibition and can start to grow on top of each other. This can result in formation of a tumour. It is important to make a distinction here: The term “cancer” is used to describe the diseases resulting from loss of cell-cycle regulation and subsequent cell proliferation. But the term “tumour” is more general. A “tumour” is an abnormal mass of cells, and a tumour can be benign (not cancerous) or malignant (cancerous).
Traditional cancer treatment uses radiation and/or chemotherapy to destroy cancer cells; however, these treatments can have unwanted side effects because they harm normal cells as well as cancer cells. Newer, promising therapies attempt to enlist the patient’s immune system to target cancer cells specifically. It is known that the immune system can recognize and destroy cancerous cells, and some researchers and immunologists also believe, based on the results of their experiments, that many cancers are eliminated by the body’s own defences before they can become a health problem. This idea is not universally accepted by researchers, however, and needs further investigation for verification.
Cell-Mediated Response to Tumours
Cell-mediated immune responses can be directed against cancer cells, many of which do not have the normal complement of self-proteins, making them a target for elimination. Abnormal cancer cells may also present tumour antigens. These tumour antigens are not a part of the screening process used to eliminate lymphocytes during development; thus, even though they are self-antigens, they can stimulate and drive adaptive immune responses against abnormal cells.
Presentation of tumour antigens can stimulate naïve helper T cells to become activated by cytokines such as IL-12 and differentiate into TH1 cells. TH1 cells release cytokines that can activate natural killer (NK) cells and enhance the killing of activated cytotoxic T cells. Both NK cells and cytotoxic T cells can recognize and target cancer cells, and induce apoptosis through the action of perforins and granzymes. In addition, activated cytotoxic T cells can bind to cell-surface proteins on abnormal cells and induce apoptosis by a second killing mechanism called the CD95 (Fas) cytotoxic pathway.
Despite these mechanisms for removing cancerous cells from the body, cancer remains a common cause of death. Unfortunately, malignant tumours tend to actively suppress the immune response in various ways. In some cancers, the immune cells themselves are cancerous. In leukaemia, lymphocytes that would normally facilitate the immune response become abnormal. In other cancers, the cancerous cells can become resistant to induction of apoptosis. This may occur through the expression of membrane proteins that shut off cytotoxic T cells or that induce regulatory T cells that can shut down immune responses.
The mechanisms by which cancer cells alter immune responses are still not yet fully understood, and this is a very active area of research. As scientists’ understanding of adaptive immunity improves, cancer therapies that harness the body’s immune defences may someday be more successful in treating and eliminating cancer.
- How do cancer cells suppress the immune system?
- Describe how the immune system recognizes and destroys cancer cells.
There are two types of cancer vaccines: preventive and therapeutic. Preventive vaccines are used to prevent cancer from occurring, whereas therapeutic vaccines are used to treat patients with cancer. Most preventive cancer vaccines target viral infections that are known to lead to cancer. These include vaccines against human papillomavirus (HPV) and hepatitis B, which help prevent cervical and liver cancer, respectively.
Most therapeutic cancer vaccines are in the experimental stage. They exploit tumour-specific antigens to stimulate the immune system to selectively attack cancer cells. Specifically, they aim to enhance TH1 function and interaction with cytotoxic T cells, which, in turn, results in more effective attack on abnormal tumour cells. In some cases, researchers have used genetic engineering to develop antitumour vaccines in an approach similar to that used for DNA vaccines (see Micro Connections: DNA vaccines). The vaccine contains a recombinant plasmid with genes for tumour antigens; theoretically, the tumour gene would not induce new cancer because it is not functional, but it could trick the immune system into targeting the tumour gene product as a foreign invader.
The first FDA-approved therapeutic cancer vaccine was sipuleucel-T (Provenge), approved in 2010 to treat certain cases of prostate cancer. This unconventional vaccine is custom designed using the patient’s own cells. APCs are removed from the patient and cultured with a tumour-specific molecule; the cells are then returned to the patient. This approach appears to enhance the patient’s immune response against the cancer cells. Another therapeutic cancer vaccine (talimogene laherparepvec, also called T-VEC or Imlygic) was approved by the FDA in 2015 for treatment of melanoma, a form of skin cancer. This vaccine contains a virus that is injected into tumours, where it infects and lyses the tumour cells. The virus also induces a response in lesions or tumours besides those into which the vaccine is injected, indicating that it is stimulating a more general (as opposed to local) antitumour immune response in the patient.
- Explain the difference between preventative and therapeutic cancer vaccines.
- Describe at least two different approaches to developing therapeutic anti-cancer vaccines.
MICRO CONNECTIONS: Using Viruses to Cure Cancer
Viruses typically destroy the cells they infect—a fact responsible for any number of human diseases. But the cell-killing powers of viruses may yet prove to be the cure for some types of cancer, which is generally treated by attempting to rid the body of cancerous cells. Several clinical trials are studying the effects of viruses targeted at cancer cells. Reolysin, a drug currently in testing phases, uses reoviruses (respiratory enteric orphan viruses) that can infect and kill cells that have an activated Ras-signalling pathway, a common mutation in cancerous cells. Viruses such as rubeola (the measles virus) can also be genetically engineered to aggressively attack tumour cells. These modified viruses not only bind more specifically to receptors over-expressed on cancer cells, they also carry genes driven by promoters that are only turned on within cancer cells. Herpesvirus and others have also been modified in this way.
- Cancer results from a loss of control of the cell cycle, resulting in uncontrolled cell proliferation and a loss of the ability to differentiate.
- Adaptive and innate immune responses are engaged by tumour antigens, self-molecules only found on abnormal cells. These adaptive responses stimulate helper T cells to activate cytotoxic T cells and NK cells of innate immunity that will seek and destroy cancer cells.
- New anticancer therapies are in development that will exploit natural adaptive immunity anticancer responses. These include external stimulation of cytotoxic T cells and therapeutic vaccines that assist or enhance the immune response.
Fill in the Blank
- How can tumour antigens be effectively targeted without inducing an autoimmune (anti-self) response?
- National Institutes of Health, National Cancer Institute. "Cancer Vaccines." http://www.cancer.gov/about-cancer/causes-prevention/vaccines-fact-sheet#q8. Accessed on May 14, 2019. ↵