Tumor-associated immunosuppression is little understood, yet clinicians must learn to control this mechanism and develop means of dealing with it. Helpful investigatory areas would include characterization of the underlying mechanisms, implications for the natural history of the tumor, and consequences of the immunosuppressive reaction for the immunotherapy of the tumor. Tumors are heterogeneous with regard to antigen expression. Heterogeneity needs to be understood in each tumor so that as many as three or four individual molecular antigenic species may be targeted at one time. Similar clinical consortia for immunotherapy, especially for Phase I and II trials, are needed to expedite and standardize approaches.
Human trials are more important than animal studies.
For example, cytokines are species specific, and human cytokines can be evaluated only in primate systems. Workshops may be necessary for implementation. Centralized transgenic and scientific model shared resources are needed. Such mice can be used for production of fully human monoclonal antibodies for repetitive administration to patients with brain tumors and other cancers. Clinical trial support mechanisms are needed to cover the cost of research activities, including immunological assays, scanning, and autopsies, not covered by third-party payers.