Immune Biomarkers and Checkpoint Inhibitors: Advancing Immunotherapy in Gynecologic Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Immunology and Immunotherapy".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 448

Special Issue Editors


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Guest Editor
Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
Interests: gynecologic malignancies; immunotherapy; biomarkers; tumor microenvironment

E-Mail Website
Guest Editor
Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
Interests: gynecological cancer; ovarian cancer; cervical cancer; uterine cancer; robotic surgery; hereditary cancer

Special Issue Information

Dear Colleagues,

Advanced and recurrent gynecologic cancers, including endometrial, cervical, and ovarian carcinomas, have shown poor prognoses and high cancer-related mortality rates over the past decades. In recent years, targeted therapy has emerged as an adjuvant or combination treatment alongside traditional approaches. Immunotherapy and immune checkpoint inhibitors (ICIs) are among the emerging advancements that have been newly studied, and some of the associated agents were approved by the FDA in patients with recurrent or advanced-stage cervical and endometrial cancers. Consequently, treatment options for gynecologic malignancies are becoming more diverse, with a strong emphasis on multimodal strategies for effective tumor eradication.

Tumor cells evade immunity by creating an immunosuppressive microenvironment through inhibitory pathways notably involving cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed death-ligand 1 and its receptor (PD-1/PD-L1), and other ligands. Novel immunotherapy approaches aim to inhibit these immune checkpoints, counteracting negative regulation between tumor cells and T cells, thereby enhancing antitumor immune responses.

The exploration of immunology in gynecologic cancer is extensive and holds the potential for identifying novel diagnostic, therapeutic, and prognostic markers. In addition to the development of new ICIs to treat advanced recurrent gynecologic cancers, some cytokines or ligands of immune cells have the potential to serve as biomarkers for both disease diagnosis and prognosis. As a result, ongoing research is warranted for new immune biomarkers and therapeutic targets, ultimately enhancing survival outcomes for gynecologic cancer patients in the future.

This Special Issue will highlight the role of immunology in gynecologic cancers, focusing on biomarkers and their applications in gynecologic tumors from both preclinical and clinical perspectives. It will advance our understanding of targeting this complex pathway in gynecologic malignancies.

Dr. Ting-Tai Yen
Dr. Eugene Patrick Toy
Guest Editors

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Keywords

  • immune checkpoints
  • checkpoint inhibitors
  • PD-1/PD-L1 pathway
  • immune biomarkers
  • tumor microenvironment
  • immunosuppressive pathways
  • T-cell activation in solid tumors
  • gynecologic tumors

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Published Papers (1 paper)

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Research

14 pages, 895 KiB  
Article
Divergent Immune–Metabolic Profiles in Endometriosis and Ovarian Cancer: A Cross-Sectional Analysis
by Manuela Neri, Elisabetta Sanna, Paolo Albino Ferrari, Clelia Madeddu, Eleonora Lai, Valerio Vallerino and Antonio Macciò
Cancers 2025, 17(14), 2325; https://doi.org/10.3390/cancers17142325 - 12 Jul 2025
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Abstract
Background/Objectives: Endometriosis and high-grade serous ovarian cancer (HGS-OC) share common features within the peritoneal immune microenvironment, yet they exhibit divergent clinical outcomes. This study aimed to dissect the immune–metabolic landscape of the peritoneal cavity in patients with endometriosis and ovarian cancer by evaluating [...] Read more.
Background/Objectives: Endometriosis and high-grade serous ovarian cancer (HGS-OC) share common features within the peritoneal immune microenvironment, yet they exhibit divergent clinical outcomes. This study aimed to dissect the immune–metabolic landscape of the peritoneal cavity in patients with endometriosis and ovarian cancer by evaluating macrophage polarization, intracellular signaling pathways, and iron-driven oxidative stress. Methods: A prospective cohort study enrolled 40 patients with endometriosis, 198 with ascitic ovarian cancer (178 HGS-OC), and 200 controls with benign gynecological conditions. Peritoneal and peripheral blood samples were analyzed via flow cytometry for macrophage (M1/M2) polarization markers, mTOR/AKT expression, and glucose uptake. Inflammatory markers (IL-6, CRP), oxidative stress (ROS), and iron metabolism parameters (hepcidin, ferritin, transferrin, serum/free iron) were quantified. Results: HGS-OC displayed a predominance of M1-polarized tumor-associated macrophages (TAMs) (CD14⁺/CD80⁺/Glut1⁺) and a high M1/M2 ratio (2.5 vs. 0.8 and 0.9; p = 0.019), correlating positively with IL-6 (p = 0.015), ROS (p = 0.023), hepcidin (p = 0.038), and ferritin (p = 0.043). Conversely, endometriosis showed a dominant M2 profile (CD14⁺/CD163⁺), elevated intracellular mTOR and AKT expression in both TAMs and epithelial cells (p < 0.01), and significantly higher ascitic ROS and free iron levels (p = 0.047 and p < 0.0001, respectively). In endometriosis, the M1/M2 ratio correlated inversely with free iron (p = 0.041), while ROS levels were directly associated with iron overload (p = 0.0034). Conclusions: Endometriosis exhibits a distinct immune–metabolic phenotype characterized by M2 macrophage predominance and iron-induced oxidative stress, contrasting with the inflammatory, M1-rich profile of HGS-OC. These findings suggest that iron metabolism and macrophage plasticity contribute to disease persistence in endometriosis and may inform future immunomodulatory strategies. Full article
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