T lymphocytes are important mediators of cancer immunosurveillance. This hypothesis, which describes a role of immune cells in preventing the progression of neoplastic cells into cancer, was first formulated independently by Burnet and Thomas more than 60 years ago (reviewed in
[1]). Since then, the importance of T cells in fighting tumors has been demonstrated in many studies with epidemiological and experimental evidence. For instance, mice lacking mature T lymphocytes are more susceptible to spontaneous tumor development and chemically induced tumors (reviewed in
[2]). Furthermore, there is an increased incidence of malignancies in tissue transplant patients receiving immunosuppressive drugs. In addition, depletion of T lymphocytes, particularly CD8+ cytotoxic T lymphocytes (CTL), leads to impaired tumor rejection
[3] and the control of dormant disseminated metastatic cells
[4][5][6]. Consistent with these findings, an increased number of tumor-infiltrating T lymphocytes (TILs) were found to be associated with better survival prognosis
[7]. TILs are a heterogeneous group with regard to the kind of T lymphocyte subsets they comprise, differentiation stage and activation status. CD8
+ CTLs are considered the key effectors of anti-tumor immunity associated with favorable clinical outcomes since they have the capacity to directly kill tumor cells, for instance, by perforin and granzyme B release. The role of CD4
+ TILs is rather ambiguous depending on the phenotype and, consequently, the quality of their response. Thus, Th1 cells contribute either directly, by killing MHC-class II
+ tumors
[8][9], or indirectly, through IFNγ secretion, to boosting the anti-tumor function of innate immune cells such as M1 tumor-associated macrophages
[10]. Furthermore, CD4
+ T lymphocytes increase MHC-class I and II expression on antigen-presenting cells (APC) and provide help, for instance, via IL-2 secretion, to CD8
+ T cells to support the duration and magnitude of CTL responses. In contrast, CD4
+ regulatory T cells (Treg) within the TME, which can suppress, for example, CTL or Th1 responses, are thought to interfere with effective anti-tumor immunity and therefore considered as indicators of a poor clinical outcome
[11]. Of note, not only the mere number of cells of each T lymphocyte subtype but also their ratio in relation to the other subsets within the TME (e.g., CD8
+/Treg cell ratio) is of great significance for predicting the survival outcome, which was shown to be the case in cervical cancer
[12]. Thus, local Treg depletion is considered as one strategy to tip the balance among TILs towards effective anti-tumor immunity
[13]. Another immune modulatory intervention, already used in clinics, aims to re-activate the anti-tumor response of exhausted T lymphocytes by checkpoint blockade therapy (ICB), which targets inhibitory receptors on T cells and thus releases the brake from these dysfunctional T cells. Moreover, the aim of vaccination strategies is to expand tumor antigen-specific T lymphocytes and increase their activation status and effector function. Furthermore, adoptive transfer of cells (ACT) such as chimeric antigen receptor (CAR)-engineered T cells, along with modifications in the T cell signaling cascade, provides a promising approach to harness T cell-mediated anti-tumor responses.