Vaccines in urologic malignancies

The prospect of activating the immune system to combat neoplastic disease h as stimulated the interest of clinicians and scientists for over 100 years. Despite a few notable exceptions (especially with urologic malignancies), immunotherapy has not fully reached its considerable therapeutic potential for the treatment of cancer. Tumors undoubtedly express antigens that may a ct as targets for antitumor immunity, and advances in molecular biology and tumor immunology have recently revived the possibility of a cancer vaccine . This improved understanding has resulted in numerous successes with activ e immunotherapy in animal models and has facilitated the clinical testing o f cancer vaccines. Ongoing advances in the identification of unique, tumor- specific antigens and their presentation to stimulate T cells will be neces sary for the emergence of these novel vaccine therapies for cancer patients . Herein we review the current concepts of tumor immunology, including obse rvations on cell types probably involved with the immune surveillance of tu mors, the presentation and recognition of "foreign" antigens, and possible mechanisms of tumor escape from the immune response, all of which are criti cal to the understanding of new initiatives for cancer vaccine therapy. Fin ally, we review some of the successes and limitations of vaccine therapy fo r urologic malignancies.