Cancer in adults with a couple of exceptions, glioma and uh sarcomas, just to name them out loud. Cancer in adults is associated with an immune reactivity in virtually every cancer, and fundamentally cancer in adults is the end stage. Of chronic inflammation. And so as a consequence, it's not like the immune response is a rare event associated with uh just a couple of tumors. It's virtually every tumor, and that includes lung cancer, esophageal cancer, gastric cancer, liver cancer, cutaneous, uh neoplasms, bladder cancer, etc. and um the reason why it appears that there are emergently only some. Immunologically responsive tumors is because many of these tumors know more about immunology than I ever will, because they've been studying the immune response for the 7 to 10 years that they've evolved in a patient in concert with the immune editing capabilities of immune cells. And so my, my friend and colleague Robert Schreiber, who elegantly described something called immune editing. The initial response of immune cells to what is obviously uh cells that have taken on these properties that emerge as uh tumor cells or cancers, that the first response of the immune uh cell is to eliminate that uh tumor or a subset of the tumors, but as they continue to grow, they acquire additional. Uh, insights how to limit the effectiveness of those immune cells, and this is what uh Bob Driver would call. Um, equilibrium. And then with additional time, uh, what happens with additional selection, uh, pressure and genomic instability in the tumor is you end up with, uh, escape. And unfortunately, when we see patients in our clinic, uh, even with the earliest of tumors, a Um, Microcalcifications on a mammogram in a woman with breast cancer or a uh um Bleeding tumor in a uh uh rectal or colonic uh tumor. Those are really quite late tumors that have already encountered the immune response and much of our Um, role is to reestablish um elimination, or at least equilibrium. Uh, with the immune response, and the hope is at least some of these novel immune relations were developing, including Nemvolleukin, can restore immune response that had been limited through its interaction with with the uh tumor over years and years.
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