Dr. Gandara on the Impact of Immunotherapy on the Tumor Microenvironment in Lung Cancer

David R. Gandara, MD, director of the Thoracic Oncology Program, professor, and senior advisor to director of University of California Davis Comprehensive Cancer Center, as well as a 2017 Giant of Cancer Care^® in Lung Cancer, discusses the impact of immunotherapy on the tumor microenvironment in lung cancer.

Immunotherapy and the immune microenvironment in cancer are extraordinarily complex when compared with a mutation, fusion, or translocation in cancer, such as EGFR or ALK; there is much more to consider here, says Gandara.

It is not only about what is going on in the tumor; the immune system must also be accounted for, the T-cell infiltration that occurs or does not occur, facilitating the body's immune response to that cancer. Cancers can produce proteins, such as PD-L1, which mask the ability of the immune system to recognize the disease. The PD-L1 and PD-1 blockers interfere with pathways to encourage immune recognition. 

The problem in many cases is that even though that interference occurs, if there are not immune-infiltrating lymphocytes in the locality of the cancer that can be brought in to affect the killing of the cancer cells, removing that blockade is not enough, concludes Gandara.