Releasing the brakes on T cells
Immune checkpoints are molecular brakes that normally stop T cells from attacking healthy tissue. Tumors exploit them to hide. PD-1 on a T cell, when it binds PD-L1 displayed by a tumor or surrounding cells, sends an off signal that quiets the T cell. CTLA-4 acts earlier, dampening T cell activation in lymph nodes. Checkpoint inhibitors are antibodies that block these interactions, lifting the brake so existing T cells can recognize and attack the tumor.
Crucially, these drugs do not kill cancer directly; they unleash the patient's own immune response. That is why some patients have deep, durable responses while others do not respond at all, and why biomarkers like PD-L1 expression and tumor mutational burden are studied to predict who benefits.
The cost of removing a brake
Because checkpoints restrain immunity throughout the body, blocking them can let the immune system attack normal tissue, producing immune-related adverse events affecting the skin, gut, endocrine glands, lungs, and elsewhere. These can be serious and sometimes need to be managed with immunosuppression. Combining PD-1 and CTLA-4 blockade can increase both efficacy and toxicity.
Where the checkpoint block acts in the diagram
This is general educational information, not medical advice. Checkpoint inhibitors are used in specific cancers under specialist care, and response and side effects vary widely between individuals.