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Resistance to systemic immune checkpoint inhibition in the peritoneal niche

Authors :
Raghav Sundar
Daryl Kai Ann Chia
Yong Xiang Gwee
Source :
Journal for ImmunoTherapy of Cancer, Vol 10, Iss 6 (2022)
Publication Year :
2022
Publisher :
BMJ Publishing Group, 2022.

Abstract

Immune checkpoint inhibition (ICI) is an established therapeutic option for patients with deficient mismatch repair or high levels of microsatellite instability tumors. Yet, response to ICI among this group is varied, with nearly one-third of patients exhibiting primary resistance. Initial efforts in studying mechanisms of resistance to ICI have focused on intrinsic tumor factors. Host factors such as metastatic niches have unique biological properties that may mediate resistance to ICI but have been less studied date. Patients with metastatic d-MMR/MSI-H gastrointestinal cancers and peritoneal metastases (PM) who had concurrent ascites have been recently shown to have worse outcomes with ICI therapy compared with patients with PM without ascites and patients with non-PM metastases. The juxtaposition of tumors with an intrinsic sensitivity to ICI failing to respond by virtue of the presence of ascites within the peritoneum, brings to the forefront the critical role of the metastatic niche. In this commentary, we discuss mechanisms for ICI resistance that may arise from the immunoprivileged state of the peritoneal cavity, paracrine factors within malignant ascites or tumor-peritoneum interactions. An improved understanding of the peritoneal microenvironment and the use of peritoneal-directed therapies may ameliorate the modest benefit of ICIs in this unique clinical entity.

Details

Language :
English
ISSN :
20511426
Volume :
10
Issue :
6
Database :
Directory of Open Access Journals
Journal :
Journal for ImmunoTherapy of Cancer
Publication Type :
Academic Journal
Accession number :
edsdoj.f1a43e0ace9a49c99a536fdea56301b8
Document Type :
article
Full Text :
https://doi.org/10.1136/jitc-2022-004749