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How to evaluate the immune status of lung cancer patients before immunotherapy

Joanna Domagala-Kulawik, Agata Raniszewska
Breathe 2017 13: 291-296; DOI: 10.1183/20734735.001917
Joanna Domagala-Kulawik
1Dept of Internal Medicine, Pulmonology and Allergology, Medical University of Warsaw, Warsaw, Poland
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  • For correspondence: domagalakulawik@gmail.com
Agata Raniszewska
2Dept of Pathology, Medical University of Warsaw, Warsaw, Poland
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    Figure 1

    Markers of cancer cell and lymphocytes in inflammatory infiltration around a tumour as potential markers of immunomodulatory treatment response. Dendritic cells (DCs) recognise cancer cell antigens and display them to cytotoxic lymphocytes (CTLs), which destroy the tumour cell by apoptosis (long arrow). Interferon (IFN)-γ is capable of supporting this reaction. The process is inhibited by type-2 macrophages (M2), myeloid-derived suppressor cells (MDSCs) and regulatory T-cells (Tregs). Suppression and regulation processes are enhanced by cytokines: transforming growth factor (TGF)-β, interleukin (IL)-10 and IL-17. The following antigens are expressed the most commonly: melanoma antigen MAGE-A3, glycoprotein antigen MUC-1, PD-1 ligand (PD-L1) and PD-L2, Fas ligand (FasL) and thyroid transcription factor (TTF)-1. CTLs express CD3, CD8, apoptotic factor (Fas), checkpoint molecules cytotoxic T-lymphocyte antigen (CTLA)-4 and programmed cell death protein (PD)-1, and LAG-3 (lymphocyte activation gene 3). The markers of Tregs are CD25, the Foxp3 transcription factor, PD-1, CTLA-4 and GITR (glucocorticoid-induced TNF receptor).

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  • Table 1

    Reasons for the use of BAL fluid analysis as a method of evaluation of immune status of lung cancer patients

    The material is available in each state of advancement and in different histological types of lung cancer, both non-small cell lung cancer and small cell lung cancer
    BAL may be performed during diagnosis, before treatment, and may be used to monitoring of treatment and complications
    The method is well standardised and reproducible, and the results can be compared between different centres
    The different types of inflammatory cells and their mediators can be recognised in BAL material, and may be used for immunoscoring
    Cancer cells may be identified in BAL fluid in the case of peripheral tumours
    The results of many studies confirm the significance of that method

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    J. Domagala-Kulawik EDU-0019-2017_Domagala-Kulawik

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How to evaluate the immune status of lung cancer patients before immunotherapy
Joanna Domagala-Kulawik, Agata Raniszewska
Breathe Dec 2017, 13 (4) 291-296; DOI: 10.1183/20734735.001917

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How to evaluate the immune status of lung cancer patients before immunotherapy
Joanna Domagala-Kulawik, Agata Raniszewska
Breathe Dec 2017, 13 (4) 291-296; DOI: 10.1183/20734735.001917
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  • Article
    • Abstract
    • Abstract
    • Introduction
    • Cancer microenvironment
    • The premises of immunotherapy
    • Detailed characteristics of infiltration around a tumour: the “immunogram”
    • Usefulness of BAL fluid analysis in the assessment of the lung cancer microenvironment
    • Conclusion
    • Disclosures
    • Footnotes
    • References
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  • Respiratory clinical practice
  • Lung cancer
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