Cited by 445Cancer Immunotherapy and BiomarkersImmunotherapy and Immune ResponsesT-cell and B-cell Immunology

Is autoimmunity the Achilles' heel of cancer immunotherapy?

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June, Carl H, Warshauer, Jeremy T, Bluestone, Jeffrey A·2017·Nature Medicine

Abstract

The emergence of immuno-oncology as the first broadly successful strategy for metastatic cancer will require clinicians to integrate this new pillar of medicine with chemotherapy, radiation, and targeted small-molecule compounds. Of equal importance is gaining an understanding of the limitations and toxicities of immunotherapy. Immunotherapy was initially perceived to be a relatively less toxic approach to cancer treatment than other available therapies-and surely it is, when compared to those. However, as the use of immunotherapy becomes more common, especially as first- and second-line treatments, immunotoxicity and autoimmunity are emerging as the Achilles' heel of immunotherapy. In this Perspective, we discuss evidence that the occurrence of immunotoxicity bodes well for the patient, and describe mechanisms that might be related to the induction of autoimmunity. We then explore approaches to limit immunotoxicity, and discuss the future directions of research and reporting that are needed to diminish it.

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  • Immune monitoring is not standard practice for long-term survivors after immunotherapy or cytokine release syndrome, although these patients may still experience late effects and immune-related adverse events.

    “For long-term survivors who received immunotherapy or following CRS, immune monitoring is not yet standard of care, despite evidence that such patients may continue to experience secondary effects of treatment and irAEs [1, 3].”

    From Immune reconstitution and clinical recovery following anti-CD28 antibody (TGN1412)-induced cytokine storm (2021) · cites this paper as [1]

    The opening discussion (page not supplied) says cancer trials typically follow patients for only about six months and that immunotoxicity can have delayed onset. “Efforts to predict and understand toxicity” (page not supplied) calls for better long-term tracking of irAEs. These passages support concern about late effects, but do not establish that immune monitoring is not standard of care for long-term survivors or for patients following cytokine release syndrome. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Clinical-pathologic correlation in these individuals resulted in valuable observations that may be instructive in understanding mechanisms of immune-induced pathologies, including those of checkpoint inhibitors, CAR-T cells, and infections such as COVID-19.

    “Clinical–pathologic correlation in these individuals resulted in valuable observations that may be instructive in understanding mechanisms of immune-induced pathologies, including those of checkpoint inhibitors, CAR-T cells, and infections such as COVID-19, known to target mucosal tissues and cause severe CRS [1, 5, 8, 18, 19].”

    From Immune reconstitution and clinical recovery following anti-CD28 antibody (TGN1412)-induced cytokine storm (2021) · cites this paper as [1]

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  • Autoimmune colitis, vitiligo, and autoantibody production are now included in CTCAE grading of immune-related adverse events due to immunotherapy.

    “Autoimmune colitis, vitiligo, and autoantibody production are now included in CTCAE grading of irAEs due to immunotherapy [1, 4, 6, 20, 22, 34].”

    From Immune reconstitution and clinical recovery following anti-CD28 antibody (TGN1412)-induced cytokine storm (2021) · cites this paper as [1]

    The section on efforts to predict and understand toxicity describes vitiligo and colitis following immunotherapy. The autoimmune consequences section discusses autoantibodies, but not their production as a graded adverse event. Neither section establishes that these conditions are included in CTCAE grading. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • In some cancer patients, immune checkpoint blockade produces immune-related adverse events during short-term follow-up, but reliable immune biomarkers for these effects remain under study.

    “Immune checkpoint blockade induces irAEs during short-term follow-up of some patients with cancer, though robust immune biomarkers correlating with adverse effects of therapy are still being investigated [1, 4, 7, 20–25].”
  • Cancer immunotherapies based on antibodies or cells carry intrinsic risks of activating bystander immune responses beyond their intended anti-tumor action.

    “Antibody or cell-based immunotherapeutics for cancer carry inherent risks of bystander immune activation, in addition to the effects of treating the intended tumor target [1–5].”

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Authors
June, C. H., Warshauer, J. T., & Bluestone, J. A.
Affiliations
  • Parker Institute for Cancer Immunotherapy (US)
  • University of California, San Francisco (US)
Corresponding author
June, Carl H
Venue
Nature Medicine
Published
2017-05
Volume
23
Issue
5
Pages
540-547
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W2610389172
Cited by
445
References
105
Citations by year
2026: 13 · 2025: 31 · 2024: 39 · 2023: 56 · 2022: 46 · 2021: 64 · 2020: 72 · 2019: 46 · 2018: 63 · 2017: 14
FWCI
23.50
Type
journal article
Language
en
Update notices
erratum (2017-08-01)
Open access
Locations
  • Nature Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • University of Pennsylvania
  • Parker Institute for Cancer Immunotherapy
  • National Institute of Allergy and Infectious Diseases (R01AI046643, R21AI107328)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK063720)
Topics
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Life Sciences › Immunology and Microbiology › Immunology › Immunotherapy and Immune Responses
  • Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
Keywords
autoimmunity, cancer immunotherapy, immunotoxicity, immune checkpoint inhibitors, immune-related adverse events, reporting practices
MeSH terms
Autoimmune Hypophysitis, Ipilimumab, Antibodies, Monoclonal, Antineoplastic Agents, Autoimmune Diseases, Humans, Immunologic Factors, Immunotherapy, Neoplasms, T-Lymphocytes, Autoimmunity, Tumor Escape, Adoptive Transfer, CTLA-4 Antigen, Programmed Cell Death 1 Receptor

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