1. Nat. Rev. Urol. doi:10.1038/nrurol.2017.179
Figure 2 Personalized immunotherapy for the treatment of bladder cancer
Figure 2 | Personalized immunotherapy for the treatment of bladder cancer. Many new immunotherapies for the treatment of urothelial bladder cancer exist and research advances have resulted in the introduction of personalized treatments. Adoptive T cell therapy is a treatment that combines synthetic biology (customized engineering of biological systems to perform functions not otherwise conferred by nature) and ex vivo lymphocyte genome engineering (redesign of native T cell receptors to alter their affinities and specificity) to create individualized tumour-targeted lymphocytes. Personalized peptide vaccines are created on the basis of transcriptomics and proteomics data from patient HLA profiling. The data are used to develop vaccine immunogenic combinations customized to each individual patient on the basis of their molecular immune profile. Immune checkpoint inhibitors are targeted, immune-activating agents for which personalized molecular subtyping data, such as the expression level of programmed cell death 1 ligand 1 (PDL1), is increasingly used to assess the likelihood of a response. The lack of a standardized approach to identify patients with the highest chance of response has resulted in the creation of multiple different assays. Further work is needed to identify improved predictive biomarkers for successful immune checkpoint inhibition and to personalize other immunotherapies and identify the patients most likely to benefit from these treatments. As a novel field, immunotherapeutic approaches will need some time to catch up to other areas of molecularly targeted therapy for which response biomarkers have been more clearly defined. Future research will enable increased personalization and provide an improved understanding of the mechanistic underpinnings, off-target effects, and reasons for intrinsic resistance in some patients. IHC, immunohistochemistry; PD1, programmed cell death protein 1; qPCR, quantitative PCR.
Felsenstein, K. M. & Theodorescu, D. (2017) Precision medicine for urothelial bladder cancer: update on tumour genomics and immunotherapy
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