Cancer Genetics and Epigenetics 2024, Vol.12, No.1, 15-26 http://www.medscipublisher.com/index.php/cge 23 Clinical trials are a key method for evaluating the efficacy of immunotherapy. Randomized grouping and double-blind designs allow comparison of treatment effects between immunotherapy and control groups. Clinical trials provide high-quality evidence to assess immunotherapy efficacy. Case-control studies retrospectively compare treatment effects in patients receiving immunotherapy and those who did not, offering preliminary evidence supporting the effectiveness of immunotherapy. Follow-up observations involve long-term monitoring of patient efficacy. Regular check-ups and follow-ups allow for the evaluation of long-term efficacy and survival duration of immunotherapy in practical clinical settings. Imaging assessments are crucial in evaluating tumor treatment effects. Common imaging techniques include CT scans, MRI, and PET-CT scans. Comparing changes in lesion size, number, and metabolic activity before and after treatment assesses the efficacy of immunotherapy. It's essential to note that different evaluation metrics and methods have their pros, cons, and applicability. Therefore, comprehensive consideration of multiple indicators and methods is necessary for a more accurate assessment of immunotherapy efficacy. Moreover, specific evaluation strategies may be required for different tumor types and immunotherapy methods, emphasizing the need for tailored evaluation strategies based on specific circumstances. Selecting appropriate evaluation strategies according to specific circumstances enables a more accurate assessment of immunotherapy efficacy. Continuous advancements in immunotherapy research may introduce more effective evaluation metrics and methods, offering greater choices for evaluating immunotherapy efficacy (Connor and Rose, 2018). 4 Challenges and Future Prospects of Immunotherapy 4.1 Mechanisms of immune tolerance and resistance Immunotherapy has made significant breakthroughs in the field of cancer treatment; however, challenges of immune tolerance and resistance persist. Immune tolerance refers to how tumor cells evade attacks from the immune system, while resistance signifies tumor cells developing resistance to immunotherapeutic drugs. Tumor cells can achieve immune tolerance through various mechanisms, altering antigen expression to reduce recognition opportunities by immune cells. For instance, tumor cells might decrease expression of tumor-associated antigens or inhibit immune cell recognition by altering expression pathways. Tumor cells can modify immune cell functions, suppressing their activity or inducing immune cell tolerance. These mechanisms enable tumor cells to evade immune system attacks, limiting the effectiveness of immunotherapy. Resistance poses another challenge for immunotherapy. Tumor cells can gain resistance to immunotherapeutic drugs through multiple mechanisms. They might diminish the effects of immunotherapy drugs by mutations or alterations in gene expression, affecting aspects like antigen presentation, immune cell recognition, or immune cell activity. Tumor cells can also generate resistance by altering the tumor microenvironment, where immune suppression factors or immune evasion mechanisms disrupt immune cell functions, weakening the efficacy of immunotherapy. Further research and understanding are needed regarding the mechanisms of immune tolerance and resistance. A deeper understanding of these mechanisms could lead to the development of new strategies to overcome immune tolerance and resistance, thereby enhancing the effectiveness of immunotherapy. One approach involves enhancing treatment efficacy by combining immunotherapeutic drugs. Different types of immunotherapeutic drugs might attack tumor cells through distinct mechanisms, reducing the risk of resistance. For example, immune checkpoint inhibitors relieve immune cell suppression, while CAR-T cell therapy modifies a patient's T cells to attack tumor cells. The combined application of these different immunotherapeutic drugs can enhance the effectiveness of immunotherapy on multiple fronts. Another strategy involves personalized immunotherapy to address immune tolerance and resistance. Personalized immunotherapy relies on individual patient differences, analyzing their immune and tumor characteristics to select the most suitable treatment. For instance, genetic sequencing and proteomics analysis can determine a patient's tumor mutation burden and immune evasion mechanisms, guiding treatment selection. Personalized
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