Neuro-Oncology
book review
Cancer Immunotherapy at the Crossroads: How Tumors Evade Immunity and
What Can Be Done. Edited by James H. Finke and Ronald M. Bukowski. Humana Press, Totowa,
New Jersey, 2004, 386 pp. $135.00 ISBN 1-58829-183-9
It is now appreciated that the immune system plays a crit-
ical role in the body’s defense against both the formation
and the establishment of cancer. Research over the last
twenty years has led to a significant understanding of the
specificity and complexity of the cellular and molecular
interactions involved in the antitumor immune response.
This enhanced understanding has in turn led to an
upsurge in immune-based treatments for preclinical can-
cer models, as well as for human cancer patients. One
important observation that has emerged from these stud-
ies, though, is that the ability to initiate a tumor-specific
immune response does not necessarily translate to clini-
cal efficacy. One major limitation to immune-based ther-
apies is the ability of the tumor to circumvent immune
responses. The mechanisms by which histologically dis-
tinct cancers evade the immune response differ exten-
sively, ranging from cellular alterations that modulate
expression of the major histocompatibility complex and
cell death to the secretion of soluble factors that inhibit
lymphocyte and antigen-presenting cell function. Much
of this work was originally described in preclinical can-
cer models and is now being investigated in human can-
cer patients.
Cancer Immunotherapy at the Crossroads, edited by
James H. Finke and Ronald M. Bukowski, is a timely ref-
erence for tumor immunologists, cancer biologists, and
clinical researchers in the field. We are indeed at a cross-
roads in cancer immunotherapy — tumor immunology
has progressed to a point at which it is widely accepted
that antitumor immune responses can be generated and
measured, but the interpretation of such immunological
responses, as well as the translation of this progress to
actual clinical benefit, has yet to be achieved. For those
in the field who want to explore new avenues of cancer
immunotherapy research at this juncture, this book is
certainly worthwhile. Drs. Finke and Bukowski have
assembled for the reader an impressive amount of up-to-
Copyright © 2004 by the Society for Neuro-Oncology
date information about immune defects associated with
cancer. They bring together an impressive panel of inter-
nationally renowned authorities on cancer immunology,
both basic scientists and clinical researchers, to create a
very informative text. The editors’ remark at the begin-
ning of the book is an excellent, concise, and insightful
commentary on how the understanding of mechanisms
underlying immune escape could help future immuno-
therapeutic trials for cancer.
The book is organized into two parts. Part I covers the
basic mechanisms of immune evasion, and Part II presents
clinical case scenarios of immune evasion. Part I includes
12 chapters that are loosely grouped around distinct
issues that can contribute to immune evasion. However,
the chapters are not formally organized in any thematic
way, and some of the chapters seem somewhat out of
order. For instance, Chapters 1, 8, 9, and 12 deal pri-
marily with issues intrinsic to the tumor cell, while inter-
vening chapters deal with issues related to T cells or den-
dritic cells. This loose organization detracts somewhat
from the readability of the first part of the book. Never-
theless, a great deal of worthwhile information is pro-
vided in these chapters by authors who have contributed
seminal studies to the field. For instance, Ochoa and
coauthors (Chapter 2) and Derweesh and coauthors
(Chapter 7) outline the compelling evidence for signaling
defects present in T cells of tumor-bearing animal mod-
els and cancer patients. They provide plausible mecha-
nistic explanations for how these defects can impair the
antitumor immune response. Similarly, Tatsumi and
coauthors (Chapter 4) discuss how antitumor immunity
can be generated by enhancing CD4+ T-cell responses,
while Cohen and coauthors (Chapter 11) describe use-
ful principles for optimizing adaptive immunotherapy.
Part II includes 7 chapters that review the clinical rel-
evance of immune defects in cancer patients. Written by
experts in the field, these chapters greatly strengthen both
Book Review
the readability and clinical significance of the book. For
instance, Chapters 13 and 14 re-emphasize one of the
critical themes of this book — that although tumor anti-
gen-specific T lymphocytes can be easily found in tumor-
bearing patients, these immune cells do not necessarily
control the progression of malignant tumors. The remain-
ing chapters of Part II describe immune defects found in
distinct types of cancers, including renal cell carcinoma,
lymphoma, lung cancer, and brain tumors. These chap-
ters point to evidence that diverse cancers can harbor sim-
ilar host defects in the cellular immune system.
Overall, Cancer Immunotherapy at the Crossroads is
interesting, accurate, and timely. During the past decade,
much attention has been focused on developing sophis-
ticated immune-based therapies for the treatment of can-
cer, but with inconsistent clinical benefit to date. This
book affords a look at some of the critical defects in the
antitumor immune response that may explain the thera-
peutic limitations of cancer immunotherapy, and it pro-
poses possible strategies to overcome them. While this
book will not provide medical oncologists with practical
information on how to administer immunotherapeutic
treatments to patients with cancer, it does offer a com-
prehensive, broad overview of the successes and failures
of cancer immunotherapy, which may help to enlighten
266 Neuro-Oncology ■ J U LY 2 0 0 4
readers about the current challenges and opportunities
in the field. The book will appeal particularly to clinical
and laboratory professionals who are actively involved
in the area of cancer immunotherapy research, as well as
others who want to expand their repertoire of knowledge
about issues pertinent to the topic.
The price of $135.00 is appropriate for this compre-
hensive review on a topic that is quickly becoming
important to oncologists. Overall, the chapters are suc-
cinct, well written, and informative. While the organi-
zation of the book might have been improved by better
thematic grouping of the chapters into distinct subparts,
the content is presented in a style that is both compre-
hensible and interesting.
Robert M. Prins and Linda M. Liau
University of California, Los Angeles
Neuro-Oncology 6, 265–266, 2004 (Posted to Neuro-
Oncology [serial online], Doc. 03-007BR, May 26, 2004.
URL http://neuro-oncology.mc.duke.edu;
DOI: 10.1215/S1152851703200077)