Abstract

Background: Despite the significant improvement of survival outcomes in childhood cancers over the last four decades, the decline of mortality has slowed down and the intensity of using chemotherapeutic combinations has reached maximum tolerable level. To further improve outcomes, there has been increasing focus on immunotherapy.

Objective: We will review the various immunotherapeutic options for pediatric malignancies, with their current issues, and assess future directions for the field.

Methods: Literature review of the field of immunology and immunotherapies for pediatric and adult cancers.

Results: Monoclonal antibodies and chimeric antigen receptor (CAR) T cell therapies are demonstrating promising clinical activity but there are lags in development and clinical application of other specific immunotherapies for pediatric patients.

Conclusion: The robust immunological responsiveness of pediatric patients constitutes a unique opportunity for maximum therapeutic impact but additional investigation needs to be directed toward further understanding the operational mechanisms of immune suppression in pediatric tumors and alternative approaches for antigenically bland tumors.

Keywords: Immunotherapy, monoclonal antibody, cancer vaccine, chimeric antigen receptor T cell, NK cell, checkpoint inhibitor, immunosuppression, immune escape.

Graphical Abstract