However, tumors are still able to evade this system, leading to immune surveillance failure [10]. is supported by enhancing the number, functions, and activity of the immune effector cells, including the natural killer (NK) lymphocytes, NKT-lymphocytes, T-lymphocytes, cytotoxic T-lymphocytes, directly or indirectly through vaccines particularly with neoantigens, and by lowering the functions of the immune suppressive cells. Beyond these new therapeutics and their personalized usage, new considerations Nicotinuric acid have to be taken into account, such as epigenetic regulation particularly from microbiota, evaluation of transversal functions, particularly cellular metabolism, and consideration to the clinical consequences at the body level. The aim of this review is to discuss some practical aspects of immune therapy, giving to clinicians the concept of immune effector cells balancing between control and tolerance. Immunological precision medicine is a combination of modern biological knowledge and clinical therapeutic decisions in a global vision of the patient. Keywords: Precision therapy, Immunotherapy, NK lymphocytes, T-lymphocytes, Dendritic cells, Vaccination, Cancer Introduction The development of a disease in each individual is an inherently heterogeneous process that is determined by a unique combination of CD163L1 exogenous and Nicotinuric acid endogenous factors. Molecular pathological epidemiology (MPE) Nicotinuric acid provides a novel insight in underlying the causal mechanisms of Nicotinuric acid a disease, to find an approach for individualized treatment [1C3]. According to the definition of the National Institutes of Health, precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person [4]. Precision medicine has become a generic term referring to techniques that evaluate either the host or the disease to enhance the likelihood of beneficial treatment outcomes from medical interventions [5]. Immune precision medicine is not only when immune therapy merges with precision medicine [6], but it also encompasses a better biological understanding of the tumor cells and its microenvironment; a better evaluation of the mechanisms implicated in immune control, immune senescence, and the different crossroads within a bio-clinical overview, in order to define a personalized therapeutic strategy [7]. Based on the concept of immune surveillance, the immune system should ideally work to eradicate cancer cells [8, 9]. However, tumors are still able to evade this system, leading to immune surveillance failure [10]. Cancer immunotherapy can be envisaged by the following four strategies to block the tumor immune evasion and to restore immune surveillance: (1) increasing the number of immune effector cells (IECs) by infusing ex vivo expanded IECs to improve the effector/tumor ratio; (2) increasing the IECs recognition affinity to tumor antigens or tumor-associated antigens (TAA); (3) improving the homing of killer IECs to the cancer cells through its microenvironment by amplifying their trafficking and homing mechanisms; (4) blocking the immune suppression ability of cancer cells. These strategies may restore the immune surveillance by not only killing the tumor cells but also preventing the emergence of new tumor cell clones which may result due to gene mutation after anti-tumor therapy. Immune therapy was initiated in the early nineties through attenuated bacteria to create inflammatory stimuli [11]. After the Second World War, allogeneic transplantation (AlloT) was developed as a rescue strategy for radiation-induced bone marrow injury and was then introduced in the treatment for leukemias [12]. The presentation of the new immune component from the donor to a recipient made it possible to control the tumoral Nicotinuric acid residual disease. The efficacy of AlloT has demonstrated in hematological malignancies, particularly for acute leukemias, and post-transplantation, where the administration of donor lymphocyte infusion (DLI) has improved the efficacy of immune therapy [13]. However, despite a modest therapeutic benefit was observed when specifically-activated and amplified immune cells were administered in certain solid tumors, AlloT failed to demonstrate major responses in solid cancers [14]; probably due to the poor accessibility of IEC to target the cancer cells. The development of immunological research has lead clinicians to directly use IEC-drugs that have been activated ex vivo to treat malignancies, and different immune adjuvants to reinforce cellular activity or inhibit specific immune checkpoints. The aim of this review is to discuss how and when to use the different available immune therapeutic tools.