Effective γδ T-cell clinical therapies: current limitations and future perspectives for cancer immunotherapy

gamma delta T cells are a unique subset of T lymphocytes, exhibiting features of both innate and adaptive immune cells and are involved with cancer immunosurveillance. They present an attractive alternative to conventional T cell-based immunotherapy due, in large part, to their lack of major histocompatibility (MHC) restriction and ability to secrete high levels of cytokines with well-known anti-tumour functions. To date, clinical trials using gamma delta T cell-based immunotherapy for a range of haematological and solid cancers have yielded limited success compared with in vitro studies. This inability to translate the efficacy of gamma delta T-cell therapies from preclinical to clinical trials is attributed to a combination of several factors, e.g. gamma delta T-cell agonists that are commonly used to stimulate populations of these cells have limited cellular uptake yet rely on intracellular mechanisms; administered gamma delta T cells display low levels of tumour-infiltration; and there is a gap in the understanding of gamma delta T-cell inhibitory receptors. This review explores the discrepancy between gamma delta T-cell clinical and preclinical performance and offers viable avenues to overcome these obstacles. Using more direct gamma delta T-cell agonists, encapsulating these agonists into lipid nanocarriers to improve their pharmacokinetic and pharmacodynamic profiles and the use of combination therapies to overcome checkpoint inhibition and T-cell exhaustion are ways to bridge the gap between preclinical and clinical success. Given the ability to overcome these limitations, the development of a more targeted gamma delta T-cell agonist-checkpoint blockade combination therapy has the potential for success in clinical trials which has to date remained elusive.