The landscape of neoantigens and its clinical applications: From immunobiology to cancer vaccines

Since millions of cancer-related deaths and diagnoses exist yearly, malignant tumors are a primary worldwide health concern. A promising method for treating cancer is tumor immunotherapy, which focuses on neoantigens. Neoantigens are tumor-specific antigens expressed on cancer cells due to genetic changes, viral infections, or other biological processes. They serve as excellent immune system targets to identify and attack cancerous cells. Neoantigens are more immunogenic than tumor-associated antigens (TAAs) because they lack central tolerance. Successful clinical trials of neoantigen-based vaccines have raised interest in individualized tumor immunotherapy. Furthermore, neoantigens represent a significant advancement in cancer immunotherapy, offering the potential for personalized and effective tumor treatments. The identification, synthesis, and application of neoantigen-based vaccines hold promise for improving patient outcomes and revolutionizing cancer treatment approaches. This review focuses on the significance of neoantigens in cancer immunotherapy, their classification and identification, the synthesis of neoantigen vaccines, clinical trials and the principles underlying their therapeutic efficacy.