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JAMES H. Finke, Ronald M. Bukowski Humana Press: Totowa, New jersey. 2004 386 pp. $135.00 1-58829-183-9.
It is now appreciated that the immune system plays a critical role in the body’s defense against both the formation and the establishment of cancer. Research over the last twenty years has led to a significant understanding of the specificity and complexity of the cellular and molecular interactions involved in the antitumor immune response. This enhanced understanding has in turn led to an upsurge in immune-based treatments for preclinical cancer models, as well as for human cancer patients. One important observation that has emerged from these studies, though, is that the ability to initiate a tumor-specific immune response does not necessarily translate to clinical efficacy. One major limitation to immune-based therapies is the ability of the tumor to circumvent immune responses. The mechanisms by which histologically distinct cancers evade the immune response differ extensively, ranging from cellular alterations that modulate expression of the major histocompatibility complex and cell death to the secretion of soluble factors that inhibit lymphocyte and antigen-presenting cell function. Much of this work was originally described in preclinical cancer models and is now being investigated in human cancer patients.
Cancer Immunotherapy at the Crossroads, edited by James H. Finke and Ronald M. Bukowski, is a timely reference for tumor immunologists, cancer biologists, and clinical researchers in the field. We are indeed at a crossroads in cancer immunotherapy—tumor immunology has progressed to a point at which it is widely accepted that antitumor immune responses can be generated and measured, but the interpretation of such immunological responses, as well as the translation of this progress to actual clinical benefit, has yet to be achieved. For those in the field who want to explore new avenues of cancer immunotherapy research at this juncture, this book is certainly worthwhile. Drs. Finke and Bukowski have assembled for the reader an impressive amount of up-to-date information about immune defects associated with cancer. They bring together an impressive panel of internationally renowned authorities on cancer immunology, both basic scientists and clinical researchers, to create a very informative text. The editors’ remark at the beginning of the book is an excellent, concise, and insightful commentary on how the understanding of mechanisms underlying immune escape could help future immunotherapeutic trials for cancer.
The book is organized into two parts. Part I covers the basic mechanisms of immune evasion, and Part II presents clinical case scenarios of immune evasion. Part I includes 12 chapters that are loosely grouped around distinct issues that can contribute to immune evasion. However, the chapters are not formally organized in any thematic way, and some of the chapters seem somewhat out of order. For instance, Chapters 1, 8, 9, and 12 deal primarily with issues intrinsic to the tumor cell, while intervening chapters deal with issues related to T cells or dendritic cells. This loose organization detracts somewhat from the readability of the first part of the book. Nevertheless, a great deal of worthwhile information is provided in these chapters by authors who have contributed seminal studies to the field. For instance, Ochoa and coauthors (Chapter 2) and Derweesh and coauthors (Chapter 7) outline the compelling evidence for signaling defects present in T cells of tumor-bearing animal models and cancer patients. They provide plausible mechanistic explanations for how these defects can impair the antitumor immune response. Similarly, Tatsumi and coauthors (Chapter 4) discuss how antitumor immunity can be generated by enhancing CD4+ T-cell responses, while Cohen and coauthors (Chapter 11) describe useful principles for optimizing adaptive immunotherapy.
Part II includes 7 chapters that review the clinical relevance of immune defects in cancer patients. Written by experts in the field, these chapters greatly strengthen both the readability and clinical significance of the book. For instance, Chapters 13 and 14 re-emphasize one of the critical themes of this book—that although tumor antigen-specific T lymphocytes can be easily found in tumor-bearing patients, these immune cells do not necessarily control the progression of malignant tumors. The remaining chapters of Part II describe immune defects found in distinct types of cancers, including renal cell carcinoma, lymphoma, lung cancer, and brain tumors. These chapters point to evidence that diverse cancers can harbor similar host defects in the cellular immune system.
Overall, Cancer Immunotherapy at the Crossroads is interesting, accurate, and timely. During the past decade, much attention has been focused on developing sophisticated immune-based therapies for the treatment of cancer, but with inconsistent clinical benefit to date. This book affords a look at some of the critical defects in the antitumor immune response that may explain the therapeutic limitations of cancer immunotherapy, and it proposes possible strategies to overcome them. While this book will not provide medical oncologists with practical information on how to administer immunotherapeutic treatments to patients with cancer, it does offer a comprehensive, broad overview of the successes and failures of cancer immunotherapy, which may help to enlighten readers about the current challenges and opportunities in the field. The book will appeal particularly to clinical and laboratory professionals who are actively involved in the area of cancer immunotherapy research, as well as others who want to expand their repertoire of knowledge about issues pertinent to the topic.
The price of $135.00 is appropriate for this comprehensive review on a topic that is quickly becoming important to oncologists. Overall, the chapters are succinct, well written, and informative. While the organization of the book might have been improved by better thematic grouping of the chapters into distinct subparts, the content is presented in a style that is both comprehensible and interesting.