Immuno-Oncology: The Next Generation of Cancer Treatment
More than 30 years ago, researchers discovered that the body's own immune system is capable of
curing certain types of cancer itself under certain conditions. This potential is being
exploited in a targeted manner in the context of new types of immune therapies. The strongest
weapon in this regard is certain defense cells of the immune system, the so-called T-cells.
T-cells fight off intruders such as bacteria and viruses in the body. In this way, they help to
prevent and cure diseases. In addition, under certain circumstances, T cells can recognize and
destroy cancer cells that are produced naturally in the body.
Malignant cancer cells very often develop mechanisms by which they can suppress an immune
response or remain undetected by the immune system.
Our immune system protects us not only from bacteria and viruses, but also from degenerated body
cells. Every day, our immune system removes these outliers to prevent the development of cancer.
But cancer cells are adept and can learn to avoid elimination by the immune system. This is
where immuno-oncology comes in: with the help of appropriate methods and active substances, our
own defense cells can recognize and effectively destroy cancer cells again.
Cancer therapy is about to change
Surgery, radiation, chemotherapy – these methods are still the most commonly used procedures in
the fight against cancer today. However, radiation and chemotherapy are associated with numerous
side effects. After all, both are not only effective against malignant cancer cells, but also
against the body's own healthy tissue. Toxic and radioactive substances for example destroy
cancer cells in a more targeted manner if they are conjugated to antibodies that bind to a
specific structure on the surface of tumor cells.1,2
In targeted therapies, researchers identify structures, which occur primarily on cancer cells.
These are created by mutations in the genome of a developing cancer cell. On one hand, this
allows the tumor to be destroyed in a targeted manner, while on the other hand it is increasing
the pressure on cancer cells to adapt further in order to avoid elimination. This can lead to
cancer cells remaining undetected. This is not the case with the methods of
Importance and discovery of immuno-oncology
While targeted cancer therapies affect the tumor cell directly, immuno-oncology activates the
patient's immune system to fight cancer.4
The idea of immuno-oncology was born by coincidence. Back in 1867 in Bonn (Germany), after the
tumor of a female patient shrank after she had been transferred to the bed of a gangrene*
patient, it was already suspected that the body's own defense system could attack and eliminate
cancer.5 The contact with bacteria of the skin infection apparently led to the
activation of the
patient's immune system. More than 140 years later, research in the field had progressed so far
that immuno-oncology was named the scientific breakthrough of the year 2013 by the scientific
*Gangrene refers to the death of body tissue due to either a lack of blood flow or a serious
Mobilizing the body's own immune system
Therapeutic approaches of immuno-oncology can be specifically directed against the tumor or have
an undirected effect. In non-specific immunotherapy, the immune system is generally activated in
order to act more effectively against foreign bodies, pathogens and degenerated
The method of checkpoint inhibition also belongs to non-specific immuno-oncology. It prevents
cancer cells from disguising themselves as healthy tissue and thereby escape their elimination.
For this purpose, specific proteins on the surface of T cells (checkpoints) are blocked.
Otherwise these proteins would bind to tumor cells and classify them as harmless. However,
immune checkpoints are also used to recognize the body's own structures. When checkpoints are
blocked, the immune system may no longer tolerate healthy cells but also eliminate them, which
may lead to autoimmune side effects.8
T cells: an effective weapon against cancer
In contrast to non-specific immunotherapy, the increased immune response of targeted
immunotherapy is specifically directed against cancer cells. Thereby, the focus is on one group
of defense cells: T cells.7
T cells have a strong cytotoxic effect and can eliminate cancer cells naturally. However, tumor
cells can escape recognition by T cells through adaption. Therapeutic approaches in
immuno-oncology therefore aim to enable T cells to identify cancer cells and classify them as a
danger to the organism.
One method is the Chimeric Antigen Receptor therapy (CAR-T cell therapy), in which some of the
patient's own T cells are extracted. Outside of the body, they are genetically modified in order to
recognize and destroy cancer cells more efficiently. They are then returned to the patient, called
adaptive T cell transfer.9 CAR-T cells remain active in the body for a long time and therefore must
act selectively against degenerated cells without destroying healthy tissue. The therapy is part of
personalized medicine and must be adapted to each patient individually.10
Another innovative approach is the BiTE® technology. In this therapy the biotechnologically
produced bispecific molecules bind simultaneously to a cancer cell and to a T cell. They serve
as a bridge between the cells and enable the T cell to attack the tumor cell directly.10,
Viruses can destroy tumor cells
Today, researchers are not only taking advantage of the characteristics of the immune system,
but also of those of viruses in the fight against cancer. This is possible because it is in the
nature of viruses to attack cells and multiply inside them. In laboratory, viruses can be
genetically modified, so they only infect cancer cells and not healthy cells. These oncolytic
viruses can also manipulate the biological processes of cancer cells and stimulate the
production of certain signal molecules and tumor-specific structures of
After being infected, the oncolytic viruses multiply inside the tumor cells until they finally
burst. The viruses are released and able to infect new cancer cells. In addition, immune cells
are attracted by signal molecules. They are supposed to recognize the tumor-specific antigens
and attack cancer cells elsewhere in the body carrying the same antigen.13
Combination of different therapy options
The methods of immuno-oncology are gaining in importance. With growing diversity, the
possibilities to combine different approaches in immuno-oncology are also increasing. This is
constantly being researched as our own body’s defense mechanism, our own weapons to beat cancer,
offer new therapies for cancer patients.
- Akbari, Bahman, et al. "Immunotoxins in cancer therapy: Review and update." International
reviews of immunology 36.4 (2017): 207-219.
- Scott, Andrew M., Jedd D. Wolchok, and Lloyd J. Old. "Antibody therapy of cancer." Nature
reviews cancer 12.4 (2012): 278-287.
- Shekarian, Tala, et al. "Paradigm shift in oncology: targeting the immune system rather than
cancer cells." Mutagenesis 30.2 (2015): 205-211.
- Hughes, Paul E., Sean Caenepeel, and Lawren C. Wu. "Targeted therapy and checkpoint
immunotherapy combinations for the treatment of cancer." Trends in immunology 37.7 (2016):
- Busch, W. "Aus der Sitzung der medicinischen Section vom 13 November 1867." Berl Klin
Wochenschr 5 (1868): 137.
- Couzin-Frankel, J. “Cancer Immunotherapy” Science (2013)
- Monjazeb, Arta M., et al. "The role of antigen-specific and non-specific immunotherapy in
the treatment of cancer." Journal of immunotoxicology 9.3 (2012): 248-258.
- Thallinger, Christiane, et al. "Review of cancer treatment with immune checkpoint
inhibitors." Wiener Klinische Wochenschrift 130.3-4 (2018): 85-91.
- Wang, Xiaoping, et al. "Humanized anti-EGFR antibody panitumumab inhibits tumor growth of
inflammatory breast cancer by inducing antitumor immunity." (2019): 4492-4492.
- Choi, Bryan D., et al. "Bispecific antibodies engage T cells for antitumor immunotherapy."
Expert opinion on biological therapy 11.7 (2011): 843-853.
- Gregory, Richard C., et al. "The anti-TGFβ neutralizing antibody, SAR439459, blocks the
immunosuppressive effects of TGFβ and inhibits the growth of syngeneic tumors in combination
with anti-PD1." (2018): 2790-2790.
- Gujar, Shashi A., and Patrick WK Lee. "Oncolytic virus-mediated reversal of impaired tumor
antigen presentation." Frontiers in oncology 4 (2014): 77.
- Lawler, Sean E., et al. "Oncolytic viruses in cancer treatment: a review." JAMA oncology 3.6