Immunotherapy strategies targeting immune checkpoints such as the CTLA4 and CD274 (programmed cell death 1 ligand 1, PD-L1)/PDCD1 (programmed cell death 1, PD-1) T-cell coreceptor pathways are revolutionising oncology. 

The approval of pembrolizumab use for solid tumors with high-level microsatellite instability or mismatch repair deficiency by the US Food and Drug Administration highlights promise of precision immuno-oncology. 

However, despite evidence indicating influences of exogenous and endogenous factors such as diet, nutrients, alcohol, smoking, obesity, lifestyle, environmental exposures and microbiome on tumor-immune interactions, integrative analyses of those factors and immunity lag behind. 

Immune cell analyses in the tumor microenvironment have not adequately been integrated into large-scale studies. 

Dr Shuji Ogino and colleagues performed an integrative analysis of exogenous, endogenous, tumor and immune factors for precision medicine.

Addressing this gap, the transdisciplinary field of molecular pathological epidemiology (MPE) offers research frameworks to integrate tumor immunology into population health sciences, and link the exposures and germline genetics to tumor and immune characteristics. 

Multilevel research using bioinformatics, in vivo pathology and omics technologies is possible with use of tissue, peripheral blood circulating cells, cell-free plasma, stool, sputum, urine and other body fluids. 

This immunology-MPE model can synergize with experimental immunology, microbiology and systems biology. 

GI neoplasms represent exemplary diseases for the immunology-MPE model, given rich microbiota and immune tissues of intestines, and the well-established carcinogenic role of intestinal inflammation. 

Proof-of-principle studies on colorectal cancer provided insights into immunomodulating effects of aspirin, vitamin D, inflammatory diets and omega-3 polyunsaturated fatty acids. 

Dr Ogino's team concludes, "The integrated immunology-MPE model can contribute to better understanding of environment-tumor-immune interactions, and effective immunoprevention and immunotherapy strategies for precision medicine."