Immunomodulation in cancer

• Chess-playing skills are important for clinicians in the fight against cancer.
• Know your cancerous opponent: identify all pieces on the board.
• Study the opponent's evolution in time and have an eye for its weaknesses.
• Adapt the strategy to new situations and to counteract changes of the opponent.
• Using these skills, we will become better in exploiting immunotherapeutic approaches.

We have to strengthen our ‘chess-playing skills’ when using immunotherapeutic approaches in cancer treatment: know the cancerous opponent, study its evolution and have an eye for its weaknesses. Besides tumor cells, other pieces on the board are stromal cells, endothelial cells and different immune cells. Some of these immune cells, like helper and cytotoxic T cells, natural killer (T) cells and mature dendritic cells are of help, others like regulatory T cells and myeloid-derived suppressor cells belong to the opponent, while macrophages and neutrophils can belong to both. A personalized approach, by selecting the optimal treatment from the myriad of possibilities based on biomarker findings, is essential to attack that particular cancer at that moment. We have to adapt the strategy to the changing positions created by the opponent. Using all these skills, we might control cancer growth in the future.