Immunotherapy for bladder cancer.
TLDR
The clinical aspects of BCG are discussed, including its role in reducing recurrence and progression, the optimal treatment regime, toxicity and, in light of new evidence, whether or not there is a superior BCG strain.Abstract:
It is nearly 40 years since Bacillus Calmette-Guerin (BCG) was first used as an immunotherapy to treat superficial bladder cancer. Despite its limitations, to date it has not been surpassed by any other treatment. As a better understanding of its mechanism of action and the clinical response to it have evolved, some of the questions around optimal dosing and treatment protocols have been answered. However, its potential for toxicity and failure to produce the desired clinical effect in a significant cohort of patients presents an ongoing challenge to clinicians and researchers alike. This review summarizes the evidence behind the established mechanism of action of BCG in bladder cancer, highlighting the extensive array of immune molecules that have been implicated in its action. The clinical aspects of BCG are discussed, including its role in reducing recurrence and progression, the optimal treatment regime, toxicity and, in light of new evidence, whether or not there is a superior BCG strain. The problems of toxicity and non-responders to BCG have led to development of new techniques aimed at addressing these pitfalls. The progress made in the laboratory has led to the identification of novel targets for the development of new immunotherapies. This includes the potential augmentation of BCG with various immune factors through to techniques avoiding the use of BCG altogether; for example, using interferon-activated mononuclear cells, BCG cell wall, or BCG cell wall skeleton. The potential role of gene, virus, or photodynamic therapy as an alternative to BCG is also reviewed. Recent interest in the immune check point system has led to the development of monoclonal antibodies against proteins involved in this pathway. Early findings suggest benefit in metastatic disease, although the role in superficial bladder cancer remains unclear.read more
Citations
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Avelumab, an Anti-Programmed Death-Ligand 1 Antibody, In Patients With Refractory Metastatic Urothelial Carcinoma: Results From a Multicenter, Phase Ib Study.
Andrea B. Apolo,Jeffrey R. Infante,Ani Sarkis Balmanoukian,Manish R. Patel,Ding Wang,Karen Kelly,Anthony Mega,Carolyn D. Britten,Alain Ravaud,Alain C. Mita,Howard Safran,Thomas E. Stinchcombe,Marko Srdanov,Arnold B. Gelb,Michael Schlichting,Kevin M. Chin,James L. Gulley +16 more
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Cancer immunotherapy: a brief review of the history, possibilities, and challenges ahead
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The Role of TLRs in Anti-cancer Immunity and Tumor Rejection.
Zuzanna Urban-Wójciuk,Mohd M. Khan,Mohd M. Khan,Benjamin L. Oyler,Robin Fåhraeus,Natalia Marek-Trzonkowska,Natalia Marek-Trzonkowska,Aleksandra Nita-Lazar,Ted R. Hupp,Ted R. Hupp,David R. Goodlett,David R. Goodlett +11 more
TL;DR: The effects of TLR stimulation in cancer, expression of various TLRs in different types of tumors, and finally the role ofTLRs in anti-cancer immunity and tumor rejection are discussed.
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