The Role of Different Immunocompetent Cell Populations in the Pathogenesis of Head and Neck Cancer—Regulatory Mechanisms of Pro- and Anti-Cancer Activity and Their Impact on Immunotherapy
Abstract
:Simple Summary
Abstract
1. Introduction
1.1. Emerging Key Immune Cells in the Immune Evasion of Cancer—Tumour Infiltrating Lymphocytes (TILs) and Tumour-Associated Immunocompetent Cells in the TME
1.1.1. Tumour Infiltrating Lymphocytes (TILs)
1.1.2. Tumour-Associated Immunocompetent Cells in the Tumour Microenvironment (TME)
Antigen-Presenting Cells (APCs)—Dendritic Cells (DCs)
Regulatory T Cells (CD4+CD25+Foxp3+Tregs)
Tumour-Associated Macrophages (TAMs/MФ)
Myeloid-Derived Suppressor Cells (MDSCs)
Tumour-Associated Neutrophils (TANs)
Carcinoma-Associated Fibroblasts (CAFs)
Natural Killer Cells (NK)
T Helper 17 Cells (Th17)
HPV Infection as a Pivotal Modulator of the Immune Response in HNSCC
2. Materials and Methods
3. Results
3.1. Immunoediting and Immune Surveillance, Biological Mechanisms of Tumour Immune Escape
3.1.1. Immunoediting and Immune Surveillance
3.1.2. Biological Mechanisms of Tumour Immune Escape
Deficiency in the Tumour Antigen Release from the Tumour Cells (TM)
Disturbances in the Maturation and Function of Dendritic Cells (DCs)
Defects in Immunocompetent Cell Priming and Activation of T cells in Local Lymph Nodes
Disturbed Trafficking of T Cells to the Tumour Microenvironment (TME) and Defect in the Recognition of Tumour Cells by Immunocompetent Cells
Lack of T Cell Mediated Immune Response and Deficiency in the Killing of Tumour Cells
3.2. Current Perspectives and Future Prospects of Immunotherapeutic Strategies for Overcoming Immune Escape of HNSCC
3.2.1. HNSCC Immune Checkpoints Receptors and Their Targeting by Immunotherapy (Immune Checkpoint Inhibitors, ICIs)
PD-1/PD-L1 Inhibitors
CTLA-4 Inhibitors
ICI Combination Therapy
Other Checkpoint Modulator Inhibitors
3.2.2. Therapeutic Strategies for TME-Directed Therapy—Targeting TAMs, MDSCs, Tregs, CAFs and NK Cells
Strategies for TAMs
Strategies for MDSCs
Strategies for CD4+CD25+Foxp3+Tregs
Strategies for CAFs
Strategies for NK Cells
3.2.3. Adoptive Cell Therapy (ADP) and CAR-T Cell Therapy in Patients with HNSCC
3.2.4. Therapeutic Vaccines in Patients with HNSCC
3.2.5. Immunotherapy Based on Nanotechnology in Patients with HNSCC
3.3. Summary of Key Recommendations for HNSCC Immunotherapy According to the Society for Immunotherapy of Cancer (SITC), The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO)
- Integration of immunotherapy with PD-1 inhibitors in the treatment of relapsed/metastatic head and neck squamous cell cancer (R/M HNSCC):
- Frontline therapy: The FDA approved pembrolizumab (Keytruda, Merck), the anti-programmed cell death protein (PD-1) monoclonal antibody, for the first-line treatment of patients with unresectable R/M HNSCC;
- Pembrolizumab has been approved for mono immunotherapy in HNSCC patients with naïve R/M HNSCC, whose tumours express a PD-L1 biomarker with a combined positive score, CPS ≥ 1 confirmed by IHC staining (or positivity for PD-L1 is ≥1% tumour proportion score, TPS), as defined by the FDA-approved test;
- Pembrolizumab has been approved for immunotherapy in combination with platinum and fluorouracil (FU) in HNSCC patients with R/M HNSCC, whose tumours express a PD-L1 biomarker with a combined positive score, CPS < 1 confirmed by IHC staining), as defined by the FDA-approved test;
- Pembrolizumab has been approved for immunotherapy in combination with platinum and fluorouracil (FU) in all naïve R/M HNSCC patients, regardless of PD-L1 biomarker specifications;
- The FDA also expanded the use of the PD-L1 IHC 22C3 pharmDx kit for selecting patients with HNSCC for pembrolizumab treatment as a single immunotherapeutic agent.
- Second-line therapy: The FDA approved two immunotherapeutic agents, the anti-programmed cell death protein (PD-1) monoclonal antibodies, nivolumab (Opdivo, Bristol-Myers Squibb) and pembrolizumab (Keytruda, Merck), for the treatment of patients with R/M HNSCC unresponsive to platinum-based treatment:
- Pembrolizumab or nivolumab monotherapy may be proposed for the treatment of patients with R/M HNSCC without a clinical response to six months of platinum-based chemotherapy (if TPS ≥ 50);
- Option: best supportive care if not eligible for the treatment of patients with R/M HNSCC without a clinical response to six months of platinum-based chemotherapy and prior immunotherapy;
- Pembrolizumab or nivolumab monotherapy may be proposed for the treatment of patients with any PD-L1 CPS status and platinum-refractory R/M HNSCC.
- HPV status and the use of immunotherapy in HNSCC: HPV status (based on the p16 biomarker IHC overexpression) should be taken into account in the selection of therapy, but it has no influence on the decisions for patients with R/M HNSCC treatment with the use of immunotherapy.
- Evaluation of immune treatment response and further treatment recommendations for patients with advanced HNSCC:
- Initial clinical follow-up after one month of treatment with assessment of immune-related symptoms and adverse events (AEs);
- Each subsequent assessment of immune-related symptoms and AEs should be evaluated at least monthly;
- For initial assessment, a baseline clinical exam of the patient with imaging via CT or PET-CT scan following, should be performed. In monitoring patients for signs of response, patient evaluation (via radiographic imaging) should occur every three months. If radiographic progression is observed early in treatment, and the patient is clinically stable, treatment continuation until progression is confirmed on a second scan is recommended;
- If clinical response after treatment and six months of maintenance immunotherapy is observed, continue treatment for at least two years or until disease progression or toxicity;
- If disease progression on or after treatment with a PD-1 inhibitor is observed, enrolment in a clinical trial, treat with palliative radiotherapy and/or chemotherapy is recommended;
- Combination therapy (notably chemotherapy + immunotherapy IO) for rapidly growing disease due to the need for an enhanced response rate is recommended;
- In the first line setting for patients with R/M HNSCC with rapid/symptomatic progression, whose tumours express the PD-L1 biomarker, extreme chemotherapy regimen is recommended/Option: TPeX regimen or pembrolizumab + chemotherapy (FDA);
- In the first line setting for patients with R/M HNSCC with rapid/symptomatic progression, but without PD-L1 assessment, pembrolizumab + chemotherapy (FDA) or extreme chemotherapy regimen are recommended/Option: TPeX regimen;
- TMB (tumour mutational burden) testing if CPS is not available or in patients with rare tumours; TMB ≥ 10 interpreted as high; correlating with a clinical benefit to PD1 inhibitors
3.4. Latest Immunotherapies for HNSCC
4. Conclusions and Future Directions
Supplementary Materials
Funding
Data Availability Statement
Conflicts of Interest
References
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