Immunotherapeutics: Immune Checkpoint Inhibitors, Vaccines, Bispecifics, and Engineered T Cells

Over the past decade, novel immunotherapeutics have become firmly established as a major pillar of cancer therapy. This chapter provides a review of the ways in which cancers learn to evade the immune system by coopting specific pathways that induce immune tolerance. Cancer immunotherapies aim to reverse tumor immune evasion, leading to durable immune-mediated tumor regression. Immune checkpoint inhibitors, including monoclonal antibodies targeting the programmed cell death protein 1 pathway, are cancer immunotherapies that reverse immune exhaustion in T cells. These therapies are widely used in clinical practice and have demonstrated improved survival for patients with many different forms of cancer. Bispecific T cell engaging antibodies, chimeric antigen receptor T cells, and therapeutic cancer vaccines are cancer immunotherapies that activate the immune system against specific tumor antigens. The chapter also reviews the mechanism of action, present status, and future potential of these therapeutic modalities in the care of patients with cancer.