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Solid tumours are complex ecosystems comprising many different cell types with spatially structured arrangement. The authors of the Review describe how single-cell and spatial profiling tools have been applied to understand the cellular architecture of the tumour microenvironment. These approaches have potential to improve the way cancer is diagnosed and treated.

Anti-HER2 therapy has revolutionized the treatment of HER2-positive breast cancer. However, HER2 has emerged as a driver of various other cancers and the indications for HER2-targeted therapy have expanded to include diverse HER2-overexpressing as well as HER2-mutant tumour types beyond breast cancer, facilitated by the advent of novel agents with greater potency and distinct mechanisms of action. Some of these agents have demonstrated promising activity even against HER2-low cancers. Herein, Yoon and Oh describe the landscape of HER2 alterations and HER2-targeted drug development beyond breast cancer. They also discuss new insights into mechanisms of resistance and potential strategies by which they might be overcome.

BCMA-directed chimeric antigen receptor T cell therapies and bispecific T cell engagers are moving to earlier lines of therapy in multiple myeloma. In addition, combination therapy with the BCMA-targeting antibody–drug conjugate belantamab mafodotin at first or subsequent relapse has the potential to improve survival of patients with this disease. This increasing number of therapeutic options makes treatment selection and sequencing increasingly complex.

Chromosomal instability (CIN) is a dynamic phenotype characterized by changes in chromosome number and structure and is a hallmark of clinically aggressive malignancies. Nonetheless, the ability of cancer cells to tolerate CIN creates several potential therapeutic vulnerabilities. In this Review, the authors describe the development of CIN and how this phenotype promotes carcinogenesis and tumour progression as well as describing the various attempts to develop targeted therapies based on the specific vulnerabilities of these tumours.

The NETTER-2 trial provides the first phase III evidence that ¹⁷⁷Lu-dotatate is active as first-line therapy in patients with gastroenteropancreatic neuroendocrine tumours with a Ki-67 proliferative index of 10–55%. This approach is an important addition to the first-line therapeutic armamentarium, although treatment selection based on patient-specific and tumour-specific characteristics remains appropriate.

Traditionally, patients with small-cell lung cancer (SCLC), a malignancy with a dismal prognosis, have had limited treatment options. Over the past few years, advances in the molecular characterization of SCLC have revealed novel therapeutic targets. The authors of this Review summarize these findings and discuss emerging opportunities and challenges for their translation into new treatment approaches.

Novel immunotherapeutic strategies based on targeting specific tumour-associated antigens with antibody–drug conjugates (ADCs), chimeric antigen receptor (CAR) T cells and bispecific T cell engagers (BTEs) are revolutionizing the treatment of multiple myeloma. In this Review, the authors describe the clinical experience to date with ADCs, CAR T cells and BTEs targeting B cell maturation antigen, G protein-coupled receptor family C group 5 member D and Fc receptor-like protein 5. In addition, they discuss the mechanisms of resistance to such therapies, and potential strategies by which resistance could be overcome to improve patient outcomes.

Artificial intelligence (AI) has the potential to dramatically change several aspects of oncology including diagnosis, early detection and treatment-related decision making. However, many of the underlying algorithms have been or are being trained on datasets that do not necessarily reflect the diversity of the target population. For this, and other reasons, many AI tools might not be suitable for application in less economically developed countries and/or in patients of certain ethnicities. In this Perspective, the authors discuss possible sources of inequity in AI development, and how to ensure the development and implementation of equitable AI tools for use in patients with cancer.

Increasing evidence indicates that intratumoural bacteria can have crucial roles in both the pathogenesis and treatment of cancer. In this Review, the authors discuss the characteristics of intratumoural bacteria and the emerging understanding of their tumour-promoting and antitumour activities. They also describe a range of innovative strategies that are being used to engineer bacteria for use in the treatment of cancer and summarize clinical trials of various bacteria-mediated cancer immunotherapies.

Following the introduction of blinatumomab in 2014, the past 4 years have seen the approval of a further ten bispecific antibodies, reflecting substantial research effort and clinical interest in these agents. In this Review, the authors describe the developments leading to the approval of these novel agents and highlight important future research directions, including clinical optimization as well as innovative antibody engineering approaches.