Preface

*"In the depths of your hopes and desires lies your silent knowledge of the beyond; and like seeds dreaming beneath the snow your heart dreams of spring. Trust the dreams, for in them is hidden the gate to eternity."*

*– Kahlil Gibran-The Prophet*

Recent advances in precision medicine and immuno-oncology have led to highly specific and efficacious cancer therapies. Most notably, immune checkpoint inhibitors (ICIs) are monoclonal antibodies engineered to release the brakes on the patient's own immune system so it can mount a robust immune response against cancer cells. ICIs have emerged as powerful treatments for patients with several types of solid tumors, such as melanoma, mesothelioma, lung, kidney, ovarian, and bladder cancers. Targets of ICIs include the programmed death-ligand 1 (PD-L1), the programmed cell death protein 1 (PD-1), and the cytotoxic T-lymphocyteassociated protein 4 (CLTA-4), which are major factors in tumor evasion of immune surveillance. It is crucially important to identify biomarkers to predict the response to ICIs as well as combination therapies with other targeted mechanisms such as targeted gene blockade and cell cycle checkpoint inhibitors. It is important to note, however, that the use of ICIs in cancer immunotherapy is frequently followed by inflammatory and autoimmune diseases, known as immune-related adverse events (irAEs), which include endocrine adverse effects. Other types of genetically engineered anti-cancer monoclonal antibodies work in a multitude of ways, including flagging cancer cells, blocking cell growth, directly attacking cancer cells, and bridging cancer and killer immune cells. Additionally, conjugated monoclonal antibodies exert their function by carrying a drug or radioactive substance that can destroy cancer cells.

In the field of chemotherapy, doxorubicin is considered one of the most powerful FDA-approved therapeutic agents. Doxorubicin is an anthracycline antibiotic extracted from the bacterium *Streptomyces peucetius*. It causes cancer cell death by intercalating with DNA leading to DNA breakage. It has been successfully used to treat patients with breast cancer, ovarian cancer, lung cancer, bladder cancer, sarcoma, and leukemia. However, the administration of doxorubicin is often limited because of its toxic side effects and drug resistance, which necessitate a clear understanding of the molecular mechanisms behind the emergence of doxorubicin's drug resistance and critical side effects.

It is an exciting time to be in the field of precision medicine and immuno-oncology, as the next generation of targeted therapies holds the promise of better survival rates for cancer patients.

I would like to thank everyone at IntechOpen publishing who helped with this publication. Finally, I dedicate this book to my family, my colleagues, my mentors, and students throughout my career.

> **Hilal Arnouk MD Ph.D.** Midwestern University (Department of Pathology), Downers Grove, IL, United States

> > **Bassam Abdul Rasool Hassan** Al-Rafidain University College, Iraq

> > > **1**

Section 1

Advances in

Immuno-Oncology

Section 1
