Fig. 2.

Combination strategies of surgery and immunotherapy. The perioperative time-frame provides a therapeutic window, which can be exploited to reduce postoperative immunosuppression and tumor growth. Perioperative use of Propranolol (β-Adrenergic inhibitor) in combination with Etodolac (COX-2 inhibitor) has been shown to reduce pro-metastatic and pro-inflammatory pathways while enhancing expression of NK-cell activation marker CD11a. Perioperative use of oncolytic viruses demonstrates lytic capability towards tumor cells, while restoring and enhancing NK- and T-cell immune cell function postoperatively. Use of PD-1/CTLA-4 inhibitors (with or without combination with microbiota) have also shown promising effects on postoperative T-cell dysfunction. Similar postoperative beneficial immune effects were observed following DC and tumor cell-based vaccines and TLR agonists. Abbreviations: PD-1, programmed cell death protein 1; DC, dendritic cells; COX-2, Prostaglandin-endoperoxide synthase 2; CTLA-4, cytotoxic T lymphocyte associated protein 4; TLR, toll like receptor