Future perspectives

Over the last 5 years, cancer immunotherapy has come of age. In particular, a new class of monoclonal antibodies has emerged, revolutionizing the treatment of many tumour types, and changing the paradigm of treatment in oncology by targeting immune cells rather than cancer cells. Antagonistic antibodies blocking immunosuppressive pathways such as PD-1/PD-L1 have shown anti-tumor activity in patients with advanced relapsed and refractory cancers that have failed conventional treatments. By enhancing their anti-tumor immunity, these drugs can help the patient’s own immune system to take control of their cancer. Although this new class of antibodies has already show considerable benefit in adult cancers, their role in treating paediatric malignancies is as yet relatively unexplored and uncertain. In principle these antibodies are a ‘generic’ immunotherapy, and the same mechanisms of action should be applicable in paediatric and adult cancers. However, although the PD-1 and PD-L1 pathway is clearly active in paediatric cancers, there are other differences in the paediatric immune environment compared to cancers, which may make it more challenging to establish therapeutic immune responses. Realizing the full benefit of these exciting agents, as well as that of other cancer immunotherapeutics, in the paediatric population will depend on a number of factors, including identification of biomarkers and establishing how best to use these agents in combination with other therapies.