There are effects related to immunotherapy.
So shown on the left hand side
is a squamous cell carcinoma.
The large cells in the right hand
side of that panel, that's the cancer.
The smaller round blue cells that are
seem to be invading into the cancer,
that's an impressive lymphocyte
immune response to the tumor.
All those are cytotoxic T-lymphocytes, helper
T-cells, and there's also a population of macrophages.
You can see that those cells have a very
prominent CD8 killer T-cell population
by the immunohistochemistry, shown on the right.
All of the brown cells represent killer
T-cells that are going after the tumor,
which are the larger kind of blue cells that
you see on the right hand side of that panel.
We can give therapies that will increase the
ability of the host immune system to go after tumor,
but we're taking the break off
the immune response to do that,
so you can have autoimmune disease.
Here's a patient who was
getting checkpoint inhibitors.
These are the inhibitors that are basically
set loose the immune system to go after tumor.
In this patient, there were
without any knowledge on our part,
there were previously circulating cells that
had some reactivity against cardiac myocytes.
Oops, now we've taken the
break off the immune response.
When that happens, this patient
developed a fatal myocarditis.
So it was an appropriate therapy, actually
quite effective against the tumor,
but elicited a secondary autoimmune
phenomena and the patient died of myocarditis.