Abstract
The therapeutic approach to advanced or metastatic solid tumors, either with chemotherapy or targeted therapies, is mainly palliative. Resistance to chemotherapy occurs very frequently and is one of the most important reasons for disease progression. Immunotherapy has the potential to mount an ongoing, dynamic immune response that can kill tumor cells for an extended time after the conventional therapy has been administered. Such a long-lasting response is potentially able to completely eradicate tumor cells, rather than producing only a temporary killing of cells. The most promising immune-based treatments are monoclonal antibodies that act as checkpoint inhibitors (e.g. ipilimumab and nivolumab), adoptive cell therapy (e.g. T-cells expressing chimeric antigen receptors) and vaccines (e.g. sipuleucel-T). Ipilimumab is currently approved for the treatment of metastatic melanoma and sipuleucel-T is approved for advanced prostate cancer. There is great interest in immunotherapy in other solid tumors, potentially used alone or in a multimodal fashion with chemotherapy and/or biological drugs. In this paper, we review recent advances in immuno-oncology in solid malignancies (except melanoma) as were discussed at the inaugural meeting of the Campania Society of Oncology Immunotherapy (SCITO).
Highlights
The immune system is able to recognize and eradicate cancer cells via multiple and complex mechanisms
objective response rate (ORR) ranged from 33–47% across treatment arms, with overall survival (OS) and Progression-free survival (PFS) data consistent with those previously reported in patients treated with chemotherapy alone. These results revealed a safety profile reflecting additive toxicities of nivolumab and chemotherapy, with no higher frequency of severe grade adverse events (AEs)
There is an ongoing need for new treatment modalities in patients with advanced solid tumors
Summary
The immune system is able to recognize and eradicate cancer cells via multiple and complex mechanisms. Some AEs have different etiologies compared with those related to chemotherapy (e.g. diarrhea, rash) and require different management These irAEs result from increased activity of the immune system, can involve multiple organs and may be severe or lifethreatening. Anti-CTLA-4 and anti-PD1 moAbs may act regardless of patient characteristics (age, gender, ECOG PS) and disease characteristics (histology, mutation status, type of prior therapies) This was observed with nivolumab in NSCLC [25] and ipilimumab in melanoma [26]. Such considerations imply that tumor assessments should be performed only after completion of the assigned regimen and the results confirmed with a follow-up scan [28] With drugs such as ipilimumab, the planned treatment should be administered regardless of the early appearance of new lesions or volume increase of existing lesions, as immune cell infiltration following immunotherapy may mimic tumor progression.
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