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KMID : 0942820070060010003
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Journal of Korean Brain Tumor Society
2007 Volume.6 No. 1 p.3 ~ p.9
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Combined Chemotherapy and Immunotherapy
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Chung Dong-Sup
Hong Yong-Kil
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Abstract
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Cytotoxic chemotherapy has been an important treatment modality in human malignancy as well as surgery and radiotherapy. Chemotherapeutic agents have continued to improve in efficacy, but there are few cases in which a single drug or treatment modality has sufficien+t activity to cure the malignancy by itself. The active immunotherapeutic strategy to induce an immune response against tumors is quite attractive because it offers the potential for high tumor-specific toxicity, minimal side effects, and a durable antitumor effect. However, its clinical effects on patients with malignancy have not been up to the expectation because of immune tolerance, sheer physical burden of tumor antigens, tumor escape mechanisms from the immune surveillance system and so on. Although the combined chemotherapy and immunotherapy would seem to be contradictory, preclinical and clinical data have shown that many chemotherapeutic agents such as cyclophosphamide, gemcitabine and temozolomide enhance the efficacy of immunotherapy when used prior to immunotherapy. Explainable mechanisms of action are lessening of inhibitory immune effect by tumors, improvement of the effector T cell：tumor ratio, inhibition of regulatory T cells, enhancement of antigen presentation by tumors, alteration of tumor microenvironment, or some yet unknown method. Recent developed targeted therapies such as the monoclonal antibodies cetuximab, bevacizumab and trastuzumab, seem to be more effective when given with chemotherapy or other targeted therapies. More experimental and clinical trials are needed to evoke the full potential of the synergistic antitumor effects of chemotherapy combined with immunotherapy.
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KEYWORD
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Chemotherapy, Immunotherapy, Combined chemotherapy and immunotherapy, Synergy
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