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Immunotherapies targeting tumor vasculature: challenges and opportunities

Dianat-Moghadam, Hassan, Nedaeinia, Reza, Keshavarz, Mohsen, Azizi, Mehdi, Kazemi, Mohammad, Salehi, Rasoul·2023·Frontiers in Immunology
DOI 10.3389/fimmu.2023.1226360PMC PMC10506263
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Abstract

Angiogenesis is a hallmark of cancer biology, and neoadjuvant therapies targeting either tumor vasculature or VEGF signaling have been developed to treat solid malignant tumors. However, these therapies induce complete vascular depletion leading to hypoxic niche, drug resistance, and tumor recurrence rate or leading to impaired delivery of chemo drugs and immune cell infiltration at the tumor site. Achieving a balance between oxygenation and tumor growth inhibition requires determining vascular normalization after treatment with a low dose of antiangiogenic agents. However, monotherapy within the approved antiangiogenic agents’ benefits only some tumors and their efficacy improvement could be achieved using immunotherapy and emerging nanocarriers as a clinical tool to optimize subsequent therapeutic regimens and reduce the need for a high dosage of chemo agents. More importantly, combined immunotherapies and nano-based delivery systems can prolong the normalization window while providing the advantages to address the current treatment challenges within antiangiogenic agents. This review summarizes the approved therapies targeting tumor angiogenesis, highlights the challenges and limitations of current therapies, and discusses how vascular normalization, immunotherapies, and nanomedicine could introduce the theranostic potentials to improve tumor management in future clinical settings.

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Figure 1 Switching the abnormal and leaky tumor blood vessels to normal function to improve angiogenesis-based cancer therapies. (A) High dose of antiangiogenic agents (mAb and TKIs) resulted in complete vascular disruption and hypoxia, and immunosuppressive TME, which support cancer cell survival, limit drug delivery and induce drug resistance. Furthermore, the abnormal TME is associated with increased infiltration of immunosuppressive Tregs, TAMs, MDCSs, and immature DCs. Hypoxic conditions also impair the therapeutic efficacy of radiotherapy and chemotherapy (6, 38, 39). (B) Low doses of antiangiogenic agents lead to transient restoration of blood flow and perfusion. This reduces hypoxic TME and increases drug delivery to tumor sites (40). (C) Anti-angiogenic agents combined with immunotherapies could expand the normalization window, enhance drug delivery and immune effector cell infiltration, and thus reprogram the immunosuppressive tumor microenvironment to an immunosupportive one (41). DC, dendritic cell; MQ, macrophage; mAb, monoclonal antibodies; MDSC, myeloid-derived suppressor cells; TAMs, tumor-associated macrophages; TKI, tyrosine kinase inhibitor; TIL, tumor infiltration lymphocyte; TME, tumor microenvironment; Tregs, regulatory T cells.
Figure 1 Switching the abnormal and leaky tumor blood vessels to normal function to improve angiogenesis-based cancer therapies. (A) High dose of antiangiogenic agents (mAb and TKIs) resulted in complete vascular disruption and hypoxia, and immunosuppressive TME, which support cancer cell survival, limit drug delivery and induce drug resistance. Furthermore, the abnormal TME is associated with increased infiltration of immunosuppressive Tregs, TAMs, MDCSs, and immature DCs. Hypoxic conditions also impair the therapeutic efficacy of radiotherapy and chemotherapy (6, 38, 39). (B) Low doses of antiangiogenic agents lead to transient restoration of blood flow and perfusion. This reduces hypoxic TME and increases drug delivery to tumor sites (40). (C) Anti-angiogenic agents combined with immunotherapies could expand the normalization window, enhance drug delivery and immune effector cell infiltration, and thus reprogram the immunosuppressive tumor microenvironment to an immunosupportive one (41). DC, dendritic cell; MQ, macrophage; mAb, monoclonal antibodies; MDSC, myeloid-derived suppressor cells; TAMs, tumor-associated macrophages; TKI, tyrosine kinase inhibitor; TIL, tumor infiltration lymphocyte; TME, tumor microenvironment; Tregs, regulatory T cells.CC BY · PubMed Central
Figure 2 Nanomedicine improves angiogenesis-based cancer therapy. (A) Low doses of antiangiogenic agents induce transient normalization and reduce hypoxic condition (9). (B) Nanoparticles (NPs) loaded with lower doses of anti-angiogenic agents enhance their delivery while protecting them in vivo, provide passive targeting, and promote the EPR effect while promoting vascular normalization (89). (C) Therapeutic ligand-targeted NPs (e.g., mAb) deliver drugs to specific tumor cells, prolong vascular normalization, and induce antitumor immune responses through CTL infiltration or reprogramming of the immunosuppressive TME (90). (D) mAb-targeted theranostic NPs provide antitumor efficacy, while conjugated imaging probes enable angiogenesis visualization, monitoring of therapies, and determining the optimal dosage of therapeutic agents in vivo for clinical setting of vascular normalization and tumor eradication (91).
Figure 2 Nanomedicine improves angiogenesis-based cancer therapy. (A) Low doses of antiangiogenic agents induce transient normalization and reduce hypoxic condition (9). (B) Nanoparticles (NPs) loaded with lower doses of anti-angiogenic agents enhance their delivery while protecting them in vivo, provide passive targeting, and promote the EPR effect while promoting vascular normalization (89). (C) Therapeutic ligand-targeted NPs (e.g., mAb) deliver drugs to specific tumor cells, prolong vascular normalization, and induce antitumor immune responses through CTL infiltration or reprogramming of the immunosuppressive TME (90). (D) mAb-targeted theranostic NPs provide antitumor efficacy, while conjugated imaging probes enable angiogenesis visualization, monitoring of therapies, and determining the optimal dosage of therapeutic agents in vivo for clinical setting of vascular normalization and tumor eradication (91).CC BY · PubMed Central

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Authors
Dianat-Moghadam, H., Nedaeinia, R., Keshavarz, M., Azizi, M., Kazemi, M., & Salehi, R.
Venue
Frontiers in Immunology
Publisher
Frontiers Media SA
Published
2023-09-01
Volume
14
ISSN
1664-3224
DOI
10.3389/fimmu.2023.1226360
PMC
PMC10506263
Cited by
36
References
9
Licence
creativecommons.org/licenses/by/4.0/ (vor)

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