Tumor Microcirculation: Abnormalities and Normalization
摘要
Blood and lymphatic vessels in tumors are structurally and functionally abnormal resulting in aberrant and immunosuppressive tumor microenvironment (TME). We postulated that judicious doses of antiangiogenic therapy, such as anti-vascular endothelial growth factor (VEGF) therapies, could transiently normalize tumor vasculature—improvement of vessel morphology and function, closer to normal vessels but not completely normal—and hence TME. In both preclinical models and clinical settings, normalization of vasculature and TME has shown improvement of the delivery and efficacy of various therapeutic agents including chemotherapy and immunotherapy. Immunotherapy, such as immune checkpoint blockade (ICB), has revolutionized cancer therapy recently. It now emerged as a major therapeutic modality in oncology and is providing hope for cure to a fraction of cancer patients. However, currently, the majority of cancer patients do not derive benefit from these treatments. Aberrantly elevated levels of proangiogenic factors, such as VEGF and angiopoietin-2 (Ang-2), significantly contribute to the tumor vascular abnormalities and resultant TME. Judicious use of agents targeting these pathways can transiently normalize vasculature and TME, improve therapeutic responsiveness, increase the infiltration of immune effector cells into tumors, and convert the intrinsically immunosuppressive TME to an immune-supportive TME. Thus, judiciously combining antiangiogenic therapies and immunotherapies might enhance the efficacy of immunotherapy. In this chapter, we outline the roles of VEGF and Ang-2 in tumor immune evasion and progression and discuss the evidence indicating that antiangiogenic agents can normalize the TME. We also introduce the application of normalization strategies for CAR-T-cell immunotherapy as well as systemic conditions compromising (obesity) or improving (exercise) vessels/TME. Overall, this chapter discusses that antiangiogenic agents could be combined with immune checkpoint blockade and other treatments/conditions to potentially improve patient outcomes.