This approach has stood the test of time for prognostication however, the TNM-staging system provides incomplete prognostic information beyond the tumor cell and does not provide insights into the immune status of a tumor and therefore may not predict response to a variety of therapeutic modalities ( Fig.
Clinical outcome can vary significantly among patients within the same histologic tumor stage. Although powerful, the AJCC/UICC-TNM classification fails to provide complete prognostic information.
Additional tumor cell parameters are utilized as an indication of the intrinsic biology of the tumor and provide an estimation of tumor progression at the time of the surgical resection. The Immunoscore may translate to provide a tumor agnostic method to define immune fitness of a given tumor and predict and stratify patients who will benefit from certain therapies (in particular immune therapies) and, ultimately, help save the lives of patients with cancer.Ĭurrent cancer classification is provided by the American Joint Committee on Cancer/Union Internationale Contre le Cancer (AJCC/UICC) and strictly relies on tumor characteristics, such as the extent of the primary tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastases (M) (TNM staging). The overlay of immune quantification with the molecular segments of disease and how this may benefit identification of patients at high risk of tumor recurrence will be discussed. In this review, we discuss the Immunoscore and its probable universal characteristic. To better inform clinical studies, we must first strive to understand the multifaceted elements of the tumor-immune interaction, the spatiotemporal interplay of numerous different immune cell types, in conjunction with an understanding of the oncogenic drivers and mutations that may lead to presentation of neoepitopes and could drive changes within the tumor microenvironment. Understanding the contribution of the immune contexture, in addition to the molecular subtype across different tumor indications, is a significant knowledge gap with limited sagacity to drive rational immunotherapy combinations.
Clinical trials have shown that appropriate enhancement of a tumor immune response can lead to long-lasting clinical responses and patient benefit. Tumors evolve in close interaction with their microenvironment, which encompasses a continual tension between the developing tumor and the host immune system.
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