Figure 3. Neoantigen-specific T cell therapy.

Patient tumor cells and normal tissue are subjected to whole-exome sequencing and RNA-Seq to identify expressed nonsynonymous somatic mutations. These mutations are pipelined into MHCI epitope prediction algorithms to prioritize a list of candidate antigens and/or may be expressed as minigenes used for the identification and expansion of mutant neoantigen–specific autologous T cells isolated from blood or tumor of the same patient. Ex vivo–expanded T cells are then infused back into the cancer patient. Alternatively, expressed mutations predicted to form neoantigens by MHCI epitope–binding algorithms are confirmed and then used to generate neoantigen vaccines.