Bu it is worth asking a question: why bother with the candidate list at all? Can’t we just be maximalist about it and stuff thousands of candidates into the vaccine? It only takes one (or maybe a few) to hit. It’s not like there are any downsides to being aggressive here.
Sadly, there is a downside to being aggressive.
Namely, a concept called “immunodominance”, which is the observation that when you present the immune system with a mixture of antigens, the resulting T-cell response tends to concentrate on one or a small handful of “winners,” with the remaining antigens getting ignored or generating responses so weak they might as well not be there.
I am confused: aren’t the T cells already exposed to all the neoantigens anyway ? Or we are wrapping the neoantigens into an adjuvant that will tell them they are dangerous, and immunodominance happens when the adjuvant wraps many peptides at once ? I guess this is it but since all my oncology knowledge is basically this post, I’m not sure
Also, since all the peptides that we are showing them are produced by cancer cells, why is it so bad that the T-cells “pick a handful” of winners ? Since the winners will point them to cancerous cells anyway