CardioVascular and Interventional Radiology

, Volume 42, Issue 9, pp 1221–1229 | Cite as

Cancer Immunotherapy: A Simple Guide for Interventional Radiologists of New Therapeutic Approaches

  • A. DigkliaEmail author
  • R. Duran
  • K. Homicsko
  • L. E. Kandalaft
  • A. Hocquelet
  • A. Orcurto
  • G. Coukos
  • A. Denys


The therapeutic options in the treatment of cancer therapy have been recently significantly increased with systemic immune-targeted therapies. Novel immunotherapy approaches based on immune checkpoint blockade or engineered cytotoxic T lymphocytes have reached late-stage clinical development, with highly encouraging results. The success of cancer immunotherapy has generated a tremendous interest in further developing and exploring these strategies in combination with other approaches such as radiotherapy and local ablative therapies in oncology. The goal of this review is to discuss current approaches in immunotherapy and provide simple and constructive explanations on their mechanisms of action as well as certain more common and serious toxicities.


Cancer Immunotherapy Interventional radiology 


Compliance with Ethical Standards

Conflict of interest

G. Coukos reports grants from Bristol‐Myers‐Squibb, Roche, the National Institutes of Health, Celgene and Boehringer–Ingelheim; personal fees from Roche and Genentech; and support for clinical trials from Bristol‐Myers‐Squibb, Merck and Roche. A. Denys is a contracted consultant for BTG, Farnham, UK. Patent WO 2012/073188 A1 was issued and licensed to BTG by A. Denys. K. Homicsko reports grant from Roche and is a consultant/advisory board member for BMS, Merck Serono, Roche and AMGEN. L.E. Kandalaft reports that she is a consultant/advisory board member of Geneos. A. Digklia and A. Hocquelet have nothing to disclose. R. Duran reports grant from BTG.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    McCarthy EF. The toxins of William B. Coley and the treatment of bone and soft-tissue sarcomas. Iowa Orthop J. 2006;26:154–8.Google Scholar
  2. 2.
    Malmberg KJ. Effective immunotherapy against cancer: a question of overcoming immune suppression and immune escape? Cancer Immunol Immunother. 2004;53:879–92.CrossRefGoogle Scholar
  3. 3.
    Hodi FS, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363:711–23.CrossRefGoogle Scholar
  4. 4.
    Couzin-Frankel J. Breakthrough of the year: cancer immunotherapy. Science (80). 2013;342:1432–3.CrossRefGoogle Scholar
  5. 5.
    Kloke BP, et al. Cancer immunotherapy achieves breakthrough status: 12th annual meeting of the association for cancer immunotherapy (CIMT), Mainz, Germany, May 6–8, 2014. Cancer Immunol Immunother. 2015;64:923–30.CrossRefGoogle Scholar
  6. 6.
    Ribatti D. The concept of immune surveillance against tumors. The first theories. Oncotarget. 2015. Scholar
  7. 7.
    González S, et al. Conceptual aspects of self and nonself discrimination. Self Nonself. 2011;2:19–25.CrossRefGoogle Scholar
  8. 8.
    Bhatia A, Kumar Y. Cellular and molecular mechanisms in cancer immune escape: a comprehensive review. Expert Rev Clin Immunol. 2014;10:41–62.CrossRefGoogle Scholar
  9. 9.
    Kyi C, Postow MA. Immune checkpoint inhibitor combinations in solid tumors: opportunities and challenges. Immunotherapy. 2016;8:821–37.CrossRefGoogle Scholar
  10. 10.
    Hickey RM, et al. Immuno-oncology and its opportunities for interventional radiologists: immune checkpoint inhibition and potential synergies with interventional oncology procedures. J Vasc Interv Radiol. 2017.Google Scholar
  11. 11.
    Robert C, Ghiringhelli F. What is the role of cytotoxic T lymphocyte-associated antigen 4 blockade in patients with metastatic melanoma? Oncologist. 2009;14:848–61.Google Scholar
  12. 12.
    Lipson EJ, Drake CG. Ipilimumab: an anti-CTLA-4 antibody for metastatic melanoma. Clin Cancer Res. 2011;17:6958–62.CrossRefGoogle Scholar
  13. 13.
    Zou W, Wolchok JD, Chen L. PD-L1 (B7-H1) and PD-1 pathway blockade for cancer therapy: mechanisms, response biomarkers, and combinations. Sci. Transl. Med. 2016;8:328rv4.CrossRefGoogle Scholar
  14. 14.
    Mu CY, Huang JA, Chen Y, Chen C, Zhang XG. High expression of PD-L1 in lung cancer may contribute to poor prognosis and tumor cells immune escape through suppressing tumor infiltrating dendritic cells maturation. Med Oncol. 2011;28:682–8.CrossRefGoogle Scholar
  15. 15.
    Kim HR, et al. PD-L1 expression on immune cells, but not on tumor cells, is a favorable prognostic factor for head and neck cancer patients. Sci Rep. 2016;6:36956.CrossRefGoogle Scholar
  16. 16.
    Nduom EK, et al. PD-L1 expression and prognostic impact in glioblastoma. Neuro-Oncol. 2016;18:195–205.CrossRefGoogle Scholar
  17. 17.
    Maly J, Alinari L. Pembrolizumab in classical Hodgkin’s lymphoma. Eur J Haematol. 2016;97:219–27.CrossRefGoogle Scholar
  18. 18.
    Reck M, et al. Pembrolizumab versus Chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med. 2016;375:1823–33.CrossRefGoogle Scholar
  19. 19.
    Ornstein MC, Rini BI. The safety and efficacy of nivolumab for the treatment of advanced renal cell carcinoma. Expert Rev Anticancer Ther. 2016;16:577–84.CrossRefGoogle Scholar
  20. 20.
    Wolchok JD, et al. Overall survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2017;377:1345–56.CrossRefGoogle Scholar
  21. 21.
    Markham A. Atezolizumab: first global approval. Drugs. 2016;76:1227–32.CrossRefGoogle Scholar
  22. 22.
    Fehrenbacher L, et al. Atezolizumab versus docetaxel for patients with previously treated non-small-cell lung cancer (POPLAR): a multicentre, open-label, phase 2 randomised controlled trial. Lancet. 2016;387:1837–46.CrossRefGoogle Scholar
  23. 23.
    Inman BA, Longo TA, Ramalingam S, Harrison MR. Atezolizumab: a PD-L1-blocking antibody for bladder cancer. Clin Cancer Res. 2017;23:1886–90.CrossRefGoogle Scholar
  24. 24.
    Kotsakis A, Georgoulias V. Avelumab, an anti-PD-L1 monoclonal antibody, shows activity in various tumour types. Lancet Oncol. 2017;18:556–7.CrossRefGoogle Scholar
  25. 25.
    Anderson AC, Joller N, Kuchroo VK. Lag-3, Tim-3, and TIGIT: co-inhibitory receptors with specialized functions in immune regulation. Immunity. 2016;44:989–1004.CrossRefGoogle Scholar
  26. 26.
    Pikor LA, Bell JC, Diallo JS. Oncolytic viruses: exploiting cancer’s deal with the devil. Trends Cancer. 2015;1:266–77.CrossRefGoogle Scholar
  27. 27.
    Andtbacka RHI, et al. Talimogene laherparepvec improves durable response rate in patients with advanced melanoma. J Clin Oncol. 2015;33:2780–8.CrossRefGoogle Scholar
  28. 28.
    Harrington KJ, et al. Efficacy and safety of talimogene laherparepvec versus granulocyte-macrophage colony-stimulating factor in patients with stage IIIB/C and IVMIa melanoma: subanalysis of the phase III OPTiM trial. OncoTargets Ther. 2016;9:7081–93.CrossRefGoogle Scholar
  29. 29.
    Kohlhapp FJ, Kaufman HL. Molecular pathways: mechanism of action for talimogene laherparepvec, a new oncolytic virus immunotherapy. Clin Cancer Res. 2016;22:1048–54.CrossRefGoogle Scholar
  30. 30.
    Breitbach CJ, et al. Intravenous delivery of a multi-mechanistic cancer-targeted oncolytic poxvirus in humans. Nature. 2011;477:99–102.CrossRefGoogle Scholar
  31. 31.
    Kershaw MH, Westwood JA, Darcy PK. Gene-engineered T cells for cancer therapy. Nat Rev Cancer. 2013;13:525–41.CrossRefGoogle Scholar
  32. 32.
    Sadelain M, Brentjens R, Rivière I. The basic principles of chimeric antigen receptor design. Cancer Discov. 2013;3:388–98.CrossRefGoogle Scholar
  33. 33.
    Prasad V. Immunotherapy: tisagenlecleucel—the first approved CAR-T-cell therapy: implications for payers and policy makers. Nat Rev Clin Oncol. 2017. Scholar
  34. 34.
    Jackson HJ, Rafiq S, Brentjens RJ. Driving CAR T-cells forward. Nat Rev Clin Oncol. 2016;13:370–83.CrossRefGoogle Scholar
  35. 35.
    Neelapu SS, et al. Chimeric antigen receptor T-cell therapy—assessment and management of toxicities. Nat Rev Clin Oncol. 2017. Scholar
  36. 36.
    Zhang C, et al. Phase I escalating-dose trial of CAR-T therapy targeting CEA + metastatic colorectal cancers. Mol Ther. 2017;25:1248–58.CrossRefGoogle Scholar
  37. 37.
    Cohen JE, et al. Adoptive cell therapy: past, present and future. Immunotherapy. 2017;9:183–96.CrossRefGoogle Scholar
  38. 38.
    Chandran SS, et al. Treatment of metastatic uveal melanoma with adoptive transfer of tumour-infiltrating lymphocytes: a single-centre, two-stage, single-arm, phase 2 study. Lancet Oncol. 2017;18:792–802.CrossRefGoogle Scholar
  39. 39.
    Rosenberg SA, et al. Durable complete responses in heavily pretreated patients with metastatic melanoma using T-cell transfer immunotherapy. Clin Cancer Res. 2011;17:4550–7.CrossRefGoogle Scholar
  40. 40.
    Koh S, Bertoletti A. Cancer immunotherapy: targeting the difference. J Hepatol. 2014;61:1175–7.CrossRefGoogle Scholar
  41. 41.
    Ye Z, Li Z, Jin H, Qian Q. Therapeutic cancer vaccines. Adv Exp Med Biol. 2016;909:139–67.CrossRefGoogle Scholar
  42. 42.
    van der Burg SH, Arens R, Ossendorp F, van Hall T, Melief CJM. Vaccines for established cancer: overcoming the challenges posed by immune evasion. Nat Rev Cancer. 2016;16:219–33.CrossRefGoogle Scholar
  43. 43.
    Kantoff PW, et al. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med. 2010;363:411–22.CrossRefGoogle Scholar
  44. 44.
    Ott PA, et al. An immunogenic personal neoantigen vaccine for patients with melanoma. Nature. 2017;547:217–21.CrossRefGoogle Scholar
  45. 45.
    Sahin U, et al. Personalized RNA mutanome vaccines mobilize poly-specific therapeutic immunity against cancer. Nature. 2017;547:222–6.CrossRefGoogle Scholar
  46. 46.
    Phan GQ, et al. Cancer regression and autoimmunity induced by cytotoxic T lymphocyte-associated antigen 4 blockade in patients with metastatic melanoma. Proc Natl Acad Sci. 2003;100:8372–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of OncologyCHUVLausanneSwitzerland
  2. 2.Department of Oncology, Ludwig Institute for Cancer ResearchUniversity of LausanneLausanneSwitzerland
  3. 3.Department of Radiology and Interventional RadiologyLausanne University HospitalLausanneSwitzerland
  4. 4.University of LausanneLausanneSwitzerland

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