I wish I could give you a scientific answer to what I perceive to be the question. There are several theories why Direct appears to be better than L. Your inquiry about potential mutation after resection being one of them.
1. The perfectly staged dendritic cells, loaded by direct injection into the tumor are more potent because they uptake and present biomarkers/antigens better than preloaded/ex vivo dendritic cells.
2. The perfectly staged dendritic cell injection into a tumor better/naturally orients (perhaps through chemical signals) the dendritic cell after uptake so that it can move more efficiently to the lymphs.
3. Dead Tumor versus Live Tumor. While I believe the dead tumor would still be displaying pd-L1, I think the live tumor would be displaying it within a tumor cell pre-emersion, emersion and post-emersion. This might in fact allow the dendritic cell to uptake and then display the biomarker/antigen to B-cells (which make antibodies) much more specifically.
Likewise, think of all the things that might happen to a dendritic cell during maturation after injection into a tumor cell versus maturing that same dendritic cell outside the body. There are all kinds of potential actuators, like hormones, that may be involved in orienting the dendritic cell, increasing dendritic mobility to the lymphs, improving uptake and/or presentation to T and B cells. I think of it like trying to grow a baby in a womb versus a test tube.
The same goes for uptaking tumor biomarkers/antigens. That live tumor (or its interactive environment) may do something we have not even thought about yet. For instance, it may temporarily display some blocking proteins then quickly withdraw them….I made that example up, but you get the picture.
