The immune response to major gastrointestinal cancer surgery and potential implications for adjuvant immunotherapy. (July 2022)

• Record Type: Journal Article
• Authors: Donlon, Noel E.; Davern, Maria; Hayes, Conall; Power, Robert; Sheppard, Andrew D.; Donohoe, Claire L.; Lysaght, Joanne; Reynolds, John V.
• Is Part Of: Critical reviews in oncology/hematology. Volume 175(2022)
• Publication Date: 2022-07
• Subjects: ALA Alpha linolenic acid -- APC Antigen presenting cell -- CAFs Cancer-associated fibroblasts -- COX Cyclooxygenase -- CTC Circulating tumour cell -- CTLA4 Cytotoxic T-lymphocyte associated protein 4 -- DAMP Danger-associated molecular patterns -- DC Dendritic cell -- DHA Docosahexaenoic acid -- DTCs Disseminated tumour cells -- EMT Epithelial to mesenchymal transition -- EPA Eicosapentaenoic acid -- ESPEN European Society for Clinical Nutrition and Metabolism -- HR Hazards ratios -- ICB Immune checkpoint blockade -- IL Interleukin -- IL-1Ra IL-1 receptor antagonist -- LCN2 Lipocalin2 -- MDSCs Myeloid-derived suppressor cells -- MSI-H/dMM Microsatellite instability-high/deficiency mismatch repair -- NET Neutrophil extracellular trap -- NK Natural killer -- NSCLC Non-small cell lung cancer -- OS Overall survival -- PD-1 Programmed cell death protein 1 -- PFS Progression-free survival -- PGE2 Prostaglandin E2 -- PUFA Polyunsaturated fatty acids -- SIRS Systemic inflammatory immune response -- TDLN Tumour-draining lymph node -- TGF-β Transforming growth factor β -- Th1 T helper type 1 -- Th2 T helper type 2 -- TLR9 Toll-like receptor 9 -- TMB Tumour mutational burden -- TME Tumour microenvironment -- TNF-α Tumour necrosis factor α -- Tregs Regulatory T cells; Perioperative immunosuppression -- Immunotherapy -- Surgery -- Neoadjuvant -- Esophageal cancer; Oncology -- Periodicals; Hematology -- Periodicals; 616.994
• DOI: 10.1016/j.critrevonc.2022.103729
• Languages: English
• ISSNs: 1040-8428

Abstract

Abstract: The perioperative period theoretically is a critical time of opportunity for the progression of pre-existing tumour micrometastasis. Therefore, the timing of introducing cancer therapies including chemotherapy, radiation therapy and immunotherapies in the postoperative period is important. A thorough exploration of the perioperative immune events at a cellular level in combination with an intricate review of available clinical rials was conducted to extrapolate the effects of oncological surgery on the perioperative immune milieu.This is timely in view of the recently published Checkmate-577 trial which demonstrated significant disease-free survival in carcinoma of the gastroesophageal junction with the use of adjuvant anti-programmed cell deathprotein 1(PD-1) immunotherapy.This review focusing in particular on perioperative immunosuppression, identifies potential modifiable factors, the effects of perioperative conditioning and optimisation, the most recent trials in the curative setting for Gastrointestinal malignancies and the new treatment avenues possible in the context of the combination of immunotherapy and major oncological gastrointestinal surgery. Highlights: Major oncological surgery constitutes an immunosuppressive milieu perioperatively. Th1 to Th2 switch. Therapeutic potential to offset the immunosuppressive tumour microenvironment perioperative with immune checkpoint inhibition. Immunotherapy and conventional therapies may propagate anti-tumour responses.