Immunotherapy during the Immediate Perioperative Period: A Promising Approach against Metastatic Disease

Abstract

Tumor excision is a necessary life-saving procedure in most solid cancers. However, surgery and the days before and following it, known as the immediate perioperative period (IPP), entail numerous prometastatic processes, including the suppression of antimetastatic immunity and direct stimulation of minimal residual disease (MRD). Thus, the IPP is pivotal in determining long-term cancer outcomes, presenting a short window of opportunity to circumvent perioperative risk factors by employing several therapeutic approaches, including immunotherapy. Nevertheless, immunotherapy is rarely examined or implemented during this short timeframe, due to both established and hypothetical contraindications to surgery. Herein, we analyze how various aspects of the IPP promote immunosuppression and progression of MRD, and how potential IPP application of immunotherapy may interact with these deleterious processes. We discuss the feasibility and safety of different immunotherapies during the IPP with a focus on the latest approaches of immune checkpoint inhibition. Last, we address the few past and ongoing clinical trials that exploit the IPP timeframe for anticancer immunotherapy. Accordingly, we suggest that several specific immunotherapies can be safely and successfully applied during the IPP, alone or with supporting interventions, which may improve patients’ resistance to MRD and overall survival.

Perioperative Immunosuppressive Factors during Cancer Surgery: An Updated Review

“…Like chemotherapy, immunotherapy has been avoided close to surgery, as its side effects can increase postoperative complications, some of them due to an increased risk of infection or sterile inflammation. However, the benefits may outweigh the risks [73]. Perioperative immunotherapy could potentially increase the therapeutic benefit during this time frame, in contrast to a later use during the course of cancer management.…”