Peritoneal metastasis (PM) is an advanced stage malignancy largely refractory to modern\ntherapy. Intraperitoneal (IP) immunotherapy offers a novel approach for the control of regional\ndisease of the peritoneal cavity by breaking immune tolerance. These strategies include heightening\nT-cell response and vaccine induction of anti-cancer memory against tumor-associated antigens.\nEarly investigations with chimeric antigen receptor T cells (CAR-T cells), vaccine-based therapies,\ndendritic cells (DCs) in combination with pro-inflammatory cytokines and natural killer cells\n(NKs), adoptive cell transfer, and immune checkpoint inhibitors represent significant advances\nin the treatment of PM. IP delivery of CAR-T cells has shown demonstrable suppression of tumors\nexpressing carcinoembryonic antigen. This response was enhanced when IP injected CAR-T cells were\ncombined with anti-PD-L1 or anti-Gr1. Similarly, CAR-T cells against folate receptor ... expressing\ntumors improved T-cell tumor localization and survival when combined with CD137 co-stimulatory\nsignaling. Moreover, IP immunotherapy with catumaxomab, a trifunctional antibody approved in\nEurope, targets epithelial cell adhesion molecule (EpCAM) and has shown considerable promise with\ncontrol of malignant ascites. Herein, we discuss immunologic approaches under investigation for\ntreatment of PM.
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