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Immunotherapy (IT) has emerged as a groundbreaking approach in the field of oncology, offering new hope in the fight against cancer. However, the true power of IT lies in its precise application, which is where pathology comes into play. This chapter utilizes a dual approach, providing a comprehensive overview of the immune system, immune cells, and IT modalities and delving into the practical application of pathological techniques—immunohistochemistry (IHC), polymerase chain reaction (PCR), and next-generation sequencing (NGS), especially in the context of immune checkpoint inhibitors (ICIs). Genetic changes within cancer cells have the potential to stimulate an effective immune response, but tumors often develop mechanisms to evade the immune system. IT emerges as a beacon of hope, capitalizing on the immune system’s prowess to detect and eliminate aberrant cells. Among several IT approaches, ICIs have garnered significant attention, with a primary focus on blocking inhibitory immune checkpoints such as PD-1/PD-L1 and CTLA-4, thereby reinvigorating the response of the immune system against tumors. Indications for ICI treatment prove complex, and include the assessment of PD-L1 expression, microsatellite instability (MSI), and tumor mutational burden (TMB). Analysis of MSI encompasses methods such as IHC, PCR, and NGS. Additionally, PD-L1 expression assessment through IHC has emerged as a critical determinant in patient selection. However, its applicability varies depending on the clinical context, tumor type, specific antibodies, and the intended drug regimen. The diversity of PD-L1 scoring methods and cutoff thresholds further complicates the decision-making process. This chapter explores the intricate field of IT from a pathological perspective. Pathological techniques, such as IHC, PCR, and NGS, contribute to the precision of IT strategies. The understanding of the basics, advantages, disadvantages, and limitations of these techniques is essential to improve patient selection and outcomes in the realm of cancer IT.

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Immunotherapy in Oncology: A Comprehensive Overview from a Pathological Perspective

  • 章节

  • 发表日期：

    2024年

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  • Cristina Díaz del Arco

摘要

Immunotherapy (IT) has emerged as a groundbreaking approach in the field of oncology, offering new hope in the fight against cancer. However, the true power of IT lies in its precise application, which is where pathology comes into play. This chapter utilizes a dual approach, providing a comprehensive overview of the immune system, immune cells, and IT modalities and delving into the practical application of pathological techniques—immunohistochemistry (IHC), polymerase chain reaction (PCR), and next-generation sequencing (NGS), especially in the context of immune checkpoint inhibitors (ICIs). Genetic changes within cancer cells have the potential to stimulate an effective immune response, but tumors often develop mechanisms to evade the immune system. IT emerges as a beacon of hope, capitalizing on the immune system’s prowess to detect and eliminate aberrant cells. Among several IT approaches, ICIs have garnered significant attention, with a primary focus on blocking inhibitory immune checkpoints such as PD-1/PD-L1 and CTLA-4, thereby reinvigorating the response of the immune system against tumors. Indications for ICI treatment prove complex, and include the assessment of PD-L1 expression, microsatellite instability (MSI), and tumor mutational burden (TMB). Analysis of MSI encompasses methods such as IHC, PCR, and NGS. Additionally, PD-L1 expression assessment through IHC has emerged as a critical determinant in patient selection. However, its applicability varies depending on the clinical context, tumor type, specific antibodies, and the intended drug regimen. The diversity of PD-L1 scoring methods and cutoff thresholds further complicates the decision-making process. This chapter explores the intricate field of IT from a pathological perspective. Pathological techniques, such as IHC, PCR, and NGS, contribute to the precision of IT strategies. The understanding of the basics, advantages, disadvantages, and limitations of these techniques is essential to improve patient selection and outcomes in the realm of cancer IT.