The complexity of cancer immunotherapy illustrated through skin tumors

Background: Skin tumours are among the cancer types most sensitive to immunotherapy, due to their unique immunogenic features including skin-associated lymphoid tissue, high mutational load, overexpression of tumour antigens, and high frequency of viral antigens. Despite this high immunotherapy response rate, however, ultimately most skin tumours develop similar treatment resistance to most other malignant tumours, which highlights the need for in-depth study of mechanisms of response and resistance to immunotherapy. Methods: A bibliographic review of the most recent publications regarding currently in use and emerging biomarkers on skin tumors has been done. Results: Predictive biomarkers of treatment response, biomarkers that warn of possible resistance, and emerging markers, the majority of a systemic nature, are described. Including factors affecting not only genomics, but also the immune system, nervous system, microbiota, tumour microenvironment, metabolism and stress. Conclusions: For accurate diagnosis of tumour type, knowledge of its functional mechanisms and selection of a comprehensive therapeutic protocol, this inclusive view of biology, health and disease is fundamental. This field of study could also become a valuable source of practical information applicable to other areas of oncology and immunotherapy.

Automated summary

Skin tumours are highly responsive to immunotherapy, but drug resistance is still a challenge. It is crucial to study the mechanisms of response and resistance to immunotherapy. Currently, there are predictive biomarkers for treatment response and warning biomarkers for possible resistance, as well as emerging markers. Comprehensive understanding of the biology, health, and disease of skin tumours is fundamental for accurate diagnosis and selection of therapeutic protocols.