The use of cancer vaccines to induce anti-tumor immune responses holds huge potential to complement traditional cancer therapies. Cancer vaccines are designed to re-calibrate the existing host-tumour interaction, tipping the balance from tumor acceptance towards tumor control to the benefit of the cancer patient. Additionally, the highly specific character of the host immune response minimizes the risk for unattractive adverse effects associated with most other cancer therapies in use today. It is now well recognized that the immune system is in fact capable of recognizing spontaneous cancers. Thus, even in the absence of treatment, cells of the immune system in the cancer patients specifically recognize cancer cells. This review will focus on various strategic considerations in the development of therapeutic cancer vaccines. We will especially address the following five aspects of therapeutic vaccination against cancer: 1) Targets that elicit immune responses against tumors with the focus on proteins that are essential for function, survival and growth of cancer cells. 2) Adjuvants that enhance the efficiency of cancer vaccines either by eliciting cellular or humoral immunity. 3) The activation of appropriate immune responses in patients. Various effector mechanisms of both the innate and the adoptive immune system contribute to effective eradication of cancer cells in many different ways. 4) Combination therapy. Therapeutic vaccination can be combined with standard as well as experimental therapies, such as chemotherapy and adoptive immunotherapy, with synergistic effect. 5) Commercial cancer vaccines in clinical phase III testing. The results of several clinical phase II and III studies leaves little doubt that cancer vaccines will be part of standard anticancer treatment in the future. However, several challenges remain to explore the full potential of therapeutic vaccination against cancer.
Keywords: Cancer, vaccine, targets, adjuvants, combination therapy, phase III trials
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