Figure 2 Neoantigen presentation in the tumour microenvironment

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Figure 2 Neoantigen presentation in the tumour microenvironment Figure 2 | Neoantigen presentation in the tumour microenvironment. a | Tumour cells can avoid elimination by immunoediting because of low neoantigen presentation (neoAglow). This occurs as a result of a low level of somatic mutations, or because tumour cells might downregulate antigen processing or presentation. NeoAglow tumours might escape detection by endogenous CTLs early in tumorigenesis, and therefore would expand without the pressure to co-evolve within an immunosuppressive microenvironment. This is the ideal setting for CAR T cells to direct a robust antitumour response. b | Tumours that present a high neoantigen burden (neoAghigh) can be eliminated during the immunoediting process (far right). Alternatively, neoAghigh tumour cells might co-evolve within an immunosuppressive tumour microenvironment (TME) that mediates avoidance of T-cell surveillance. This setting is the ideal situation for immune-modulating therapies with monoclonal antibodies to direct a robust antitumour response. c | Tumour types can be ranked by their relative presence of somatic mutations209, and this classification can be used to indirectly estimate neoantigen burden. Tumours can be stratified on the basis of somatic mutation prevalence; tumour types with the most robust clinical responses to CAR T-cell therapy (red) or immune modulating mAbs (blue) are stratified by somatic mutation prevalence. ALL, acute lymphoblastic leukaemia; AML, acute myeloid leukaemia; CAR, chimeric antigen receptor; CLL, chronic lymphocytic leukaemia; CTL, cytotoxic T cell; mAb, monoclonal antibody; MDSC, myeloid-derived suppressor cell; neoAg, neoantigen; PD-1, programmed cell death 1; PD-L1, programmed cell death 1 ligand 1; TAA, tumour-associated antigen; TAM, tumour-associated macrophage; TCR, T-cell receptor; TIL, tumour infiltrating lymphocyte; TREG, regulatory T cell. Image reproduced from Alexandrov, L. B. et al. Signatures of mutational processes in human cancer. Nature 500, 415–421 (2013). Khalil, D. N. et al. (2016) The future of cancer treatment: immunomodulation, CARs and combination immunotherapy Nat. Rev. Clin. Oncol. doi:10.1038/nrclinonc.2016.25