Cancers have multiple mechanisms that prevent the activation of, and evade, the immune response, as described next (Table 20.6). It is likely that a therapeutic vaccine may not be an adequate immunotherapy without the means to overcome immunosuppression. With adequate knowledge of how tumors evade T-cell-mediated rejection, strategies are being developed that should improve the efficacy of cancer immunotherapy.
TABLE 20.6. Mechanisms of immunosuppression in cancer patients.
• Downmodulation of MHC
• Tumor-derived immune inhibition (e.g., transforming growth factor (TGF)-beta, IL-10)
• Th2 dominant T-cell response
• APC dysfunction [e.g., as a result of tumor-derived vascular endothelial growth factor (VEGF)]
• Treg cells (including CD25+ CD4+ and CD25-CD4+ cells), both via direct contact and via secreted factors (such as IL-10 and TGF-beta)
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