Immuno-oncology for surgeons
Cet article présente les processus antitumoraux du système immunitaire ainsi que les différentes modalités des immunothérapies, analyse la sécurité et la faisabilité d'un traitement combinant chirurgie et immunothérapie, puis identifie les futurs axes de recherche
Cancer has traditionally been treated with surgery, cytotoxic chemotherapy and/or radiotherapy. The focus of treatment has been the mutated neoplastic cell. Critical advances in genomic and molecular techniques herald the potential for personalized treatments. Incremental breakthroughs in immunology have translated to a step-change in care by providing a mechanistic understanding of the immune system and how it may be mobilized to target cancer cells. As a result, clinical trials of immune-modifying agents have increased at an exponential rate and are revolutionizing cancer care. It is increasingly likely that the surgical oncologist will find themself caring for patients who have had immuno-oncology therapies as part of their neoadjuvant or adjuvant treatment. This review provides an update on immuno-oncology for the surgeon, covering the mechanisms of action of the agents in use. Emerging and surgically relevant toxicities are discussed, and available data on combining and sequencing cancer surgery with immuno-oncology treatments are summarized.
This article aims to provide a concise guide to IO, with a focus on CD8+ T cells whose cytotoxic ability has been the focus of research in the development of new immunomodulatory drugs. Key concepts in immunoediting and immune escape pathways are introduced, followed by a description of the diverse modalities of immunotherapy, the safety and feasibility of combining immunotherapy with surgery, and what the future is likely to hold.
British Journal of Surgery , résumé, 2019