Traditional treatments for liver cancer are surgical resection and hepatic artery interventional embolization chemotherapy, which tend to occur with intrahepatic recurrence or intrahepatic/extrahepatic metastases over time. Drug therapy has been approved as an indication for sorafeinib, but the clinical evaluation is not high. In the past 1-2 years, the use of anti-angiogenesis targeted drugs such as lenvatinib (lenvatinib), apatinib (apatinib) combined with PD-1 antibodies, can make about one-third of liver cancer patients achieve objective efficacy, becoming a milestone event in the treatment of liver cancer drugs.
Here's a literature review from Germany on in situ vaccine therapies for liver cancer. The so-called in situ vaccine is to promote the death of immune tumors by injecting immune activators into tumor tissues to release antigens; recruit and activate dendritic cells to make them phagocytic tumor antigens and present them to T lymphocytes; recruit and activate T lymphocytes to obtain specific anti-tumor ability. In short, it is to change the tumor tissue from the source of all evil to the anti-tumor battlefield, and to make the immune anti-tumor ability in the local or even the whole body to play.
This paper first describes the characteristics of the immune microenvironment in liver cancer tissues; then describes the methods of causing immunogenic cell death, including oncolytic virus, local radiotherapy, interventional embolism therapy, etc.; then introduces several key factors for recruiting and activating DC, including FLT3L, GM-CSF, TLRs; and factors that promote T cell function such as IL-12, IL-2, etc. Finally, PD-1 antibodies are mentioned as immune promoting effects that relieve negative regulation. In the summary and prospect, the authors believe that the in situ vaccine treatment strategy of liver cancer is expected to play its due role as an important means of comprehensive treatment of liver cancer in the future.
Principles of in situ vaccines
Impressions: In view of the fact that liver cancer is mostly life-threatening due to local factors, local treatment is particularly important; given that the site of liver cancer is close to the chest wall, the puncture operation is relatively easy, which is conducive to the implementation of local treatment. The injection of immune activators in tumor tissues, together with local measures to promote tumor immune death, such as immune radiotherapy, makes it an in situ vaccine and exerts immune anti-tumor effects, which is reasonable and feasible.
Written by: Shen Jie (Ph.D., Deputy Chief Physician, Cancer Center, Gulou Hospital, Nanjing University School of Medicine)
Revised: Liu Baorui (Chief Physician, Chief Physician, Cancer Center, Gulou Hospital, Nanjing University School of Medicine)
Lurje I, Werner W, Mohr R, Roderburg C, Tacke F and Hammerich L (2021) In Situ Vaccination as a Strategy to Modulate the Immune Microenvironment of Hepatocellular Carcinoma. Front. Immunol. 12:650486. doi: 10.3389/fimmu.2021.650486