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The Neuroimmunology of Cancer

  • Enrico C. Lallana
  • William F. Hickey
  • Camilo E. Fadul
Chapter
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Decreased immune surveillance is thought to be one of the mechanisms by which neoplastic cells are able to thrive. When cancer is located in the nervous system, an immune privileged site, its ability to evade detection, and targeting by immune cells may contribute to its aggressive behavior. Furthermore, high-grade gliomas, the most frequent and lethal primary brain tumors, induce both a local and systemic state of immune suppression that hampers efforts to manipulate the immune system as an effective therapeutic modality. On the other hand, there are rare instances when the immune response elucidated against systemic cancer causes nervous system injury without direct spread of the tumor. Although the neural injury is thought to be mediated by an autoimmune process, in most cases it is uncertain if it is caused by a humoral response, a cellular response, or a combination of both. This chapter reviews concepts related to the unique relationship between the nervous and immune systems, when cancer is present, as well as immune therapeutic modalities employed when the neural structures are affected directly by a primary tumor or indirectly in the case of paraneoplastic neurologic syndromes. The distinct immunologic characteristics of the central nervous system (CNS) become more unique and complex in the setting of neoplastic disease. In 2008, approximately 1,437,180 new cancer cases, including 21,810 arising from the nervous system, were diagnosed in the USA [1]. Gliomas, the most frequent type of brain tumors, are characterized by the infiltration of normal cerebral tissue, but this rarely results in systemic metastases. The tumor microenvironment shows a meager inflammatory response often accompanied by systemic immune suppression. These alterations might be considered epiphenomena unrelated to tumor pathogenesis, but experimental and clinical observations suggest that the immune system plays an important role in glioma biology. Our current concept of glioma immunobiology lends strong support to the idea of manipulating the immune system as a therapeutic approach for primary brain tumors. Glioma immunotherapy has evolved over the years, unfortunately as yet, without a major success. Nevertheless, extraneural or systemic neoplasms can trigger an immune response that in rare instances have repercussions in the nervous system. These interactions indirectly cause clinical syndromes that are aptly termed paraneoplastic neurologic syndromes. In some cases, antibodies have been identified as the element responsible for the phenomenon, but as primary tumors of the brain and spinal cord, the role that the immune system plays in the pathogenesis of these syndromes has not been clearly elucidated.

Keywords

Gliomas Immunology Nervous system Paraneoplastic syndromes 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Enrico C. Lallana
    • 1
  • William F. Hickey
    • 2
  • Camilo E. Fadul
    • 1
  1. 1.Neuro-Oncology Program, Norris Cotton Cancer Center, Departments of Medicine and NeurologyDartmouth Medical School, Dartmouth-Hitchcock Medical CenterLebanonUSA
  2. 2.Department of PathologyDartmouth Medical School, Dartmouth-Hitchcock Medical CenterLebanonUSA

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