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Intratumoural immunotherapy plus focal thermal ablation for localized prostate cancer

Nature Reviews Urology volume 21, pages 290–302 (2024)Cite this article

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Abstract

Major advances have been made in the use of immunotherapy for the treatment of solid tumours, including the use of intratumourally injected immunotherapy instead of systemically delivered immunotherapy. The success of immunotherapy in prostate cancer treatment has been limited to specific populations with advanced disease, which is thought to be a result of prostate cancer being an immunologically ‘cold’ cancer. Accordingly, combining intratumoural immunotherapy with other treatments that would increase the immunological heat of prostate cancer is of interest. Thermal ablation therapy is currently one of the main strategies used for the treatment of localized prostate cancer and it causes immunological activation against prostate tissue. The use of intratumoural immunotherapy as an adjunct to thermal ablation offers the potential to elicit a systemic and lasting adaptive immune response to cancer-specific antigens, leading to a synergistic effect of combination therapy. The combination of thermal ablation and immunotherapy is currently in the early stages of investigation for the treatment of multiple solid tumour types, and the potential for this combination therapy to also offer benefit to prostate cancer patients is exciting.

Key points

  • Intratumourally delivered immunotherapy has less systemic adverse effects than systemically delivered immunotherapy. The structure of the prostate seems well-suited to the intratumoural delivery of immunotherapy.

  • Prostate cancer is typically an immunologically cold tumour, but thermal ablation treatment could make prostate cancer an immunologically hot tumour.

  • The combination of intratumoural immunotherapy with thermal ablation therapy for the treatment of prostate cancer could work synergistically because ablation therapy reveals prostate cancer-specific antigens to the immune system.

  • Animal models and early clinical trials have been used to investigate the combination of immunotherapy and thermal ablation for solid tumours, but further investigation is needed for the treatment of prostate cancer.

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Fig. 1: Comparison of immunologically cold tumours and immunologically hot tumours. This figure delineates the distinct immunological landscapes characteristic of cold and hot tumours.
Fig. 2: Benefits of intratumoural immunotherapy injection combined with ablation.

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Authors and Affiliations

  1. Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA

    Denis Séguier, Eric S. Adams, Srinath Kotamarti, Vincent D’Anniballe, Zoe D. Michael, Sriram Deivasigamani & Thomas J. Polascik

  2. Department of Urology, Lille University, Lille, France

    Denis Séguier, Jonathan Olivier & Arnauld Villers

  3. Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER; UMR9020-U1277), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France

    Denis Séguier, Jonathan Olivier & Arnauld Villers

  4. Department of Medicine, Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, 27708, USA

    Christopher Hoimes

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  1. Denis Séguier
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Contributions

D.S., E.S.A. and S.K. researched data for the article. D.S., E.S.A., S.K., V.D.’A., Z.D.M., C.H. and T.J.P. contributed substantially to discussion of the content. D.S., E.S.A., S.K., V.D.’A., Z.D.M. and C.H. wrote the article. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Denis Séguier.

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Thomas J. Polascik is a consultant for AngioDynamics. The other authors declare no competing interests.

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Nature Reviews Urology thanks Susan F. Slovin, Matthijs Scheltema, Stephanie Glavaris, Andre Abreu and Masatomo Kanekofor their contribution to the peer review of this work.

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Séguier, D., Adams, E.S., Kotamarti, S. et al. Intratumoural immunotherapy plus focal thermal ablation for localized prostate cancer. Nat Rev Urol 21, 290–302 (2024). https://doi.org/10.1038/s41585-023-00834-y

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