PD-1 Targeting, Macrophage Infiltration, and IDO Pathway Activation in Patients With Sarcomas—Reply

In Reply We agree with Drs Macciò and Madeddu that a combination of both metronomic chemotherapy and immune checkpoint inhibitors would be a promising approach to improve outcomes of patients with cancer. This is based on the following reasons: (1) Both immune checkpoint inhibitors and metronomic chemotherapy favor immune cell activation. While metronomic chemotherapy can promote tumor-specific immune activation, concomitant administration of immune checkpoint inhibitors may play a crucial role in maintaining the activation status of T lymphocytes. (2) Administration of metronomic chemotherapy would remove metabolic competition between tumor and immune cells. This would facilitate tumor infiltration by cytotoxic immune cells, which has been associated with improved clinical outcome.

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