Mutation Mix-Up: Why Some Immunotherapies for Cancer Don’t Always Work As Predicted

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Mutation Mix-Up: Why Some Immunotherapies for Cancer Don’t Always Work As Predicted
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The findings could help doctors identify cancer patients who would benefit the most from drugs called checkpoint blockade inhibitors. Cancer drugs known as checkpoint blockade inhibitors have proven effective for some cancer patients. These drugs work by taking the brakes off the body’s T c

In this colon tumor, which has a mutation that gives it a high degree of DNA mismatch repair deficiency, T cells have accumulated primarily in the supportive tissues , while very few have infiltrated tumor cells . Credit: Courtesy of the researchers

Some studies have shown that these drugs work better in patients whose tumors have a very large number of mutated proteins, which scientists believe is because those proteins offer plentiful targets for T cells to attack. However, for at least 50 percent of patients whose tumors show a high mutational burden, checkpoint blockade inhibitors don’t work at all.reveals a possible explanation for why that is.

However, subsequent studies of patients who received this drug found that more than half of them did not respond well or only showed short-lived responses, even though their tumors had a high mutational burden. The MIT team set out to explore why some patients respond better than others, by designing mouse models that closely mimic the progression of tumors with high TMB.

In further experiments, the researchers explored what happened as they changed the heterogeneity of lung tumors in mice. They found that in tumors with clonal mutations, checkpoint blockade inhibitors were very effective. However, as they increased the heterogeneity by mixing tumor cells with different mutations, they found that the treatment became less effective.

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