Experts weigh in: immunotherapy in earlier stages of cancer

October 28, 2021     

A decade ago, immunotherapy was just beginning to shape the cancer treatment landscape by providing new options for certain patients who previously had a poor prognosis and limited treatment options. Fast forward to today, and research is seeking to transform the treatment landscape in new ways through exploring the potential of immunotherapy in earlier stages of cancer.

Initial focus in metastatic cancers and exploration in earlier-stage disease 

The introduction of immune checkpoint inhibitors marked the beginning of a new era of cancer research that spurred rapid development across multiple difficult-to-treat metastatic cancers. Research in metastatic disease deepened the scientific understanding of the interaction between cancer and the immune system and led to the exploration of the use of immunotherapies, as monotherapy or in combination with the existing standard of care, earlier in the disease course. 

Earlier-stage cancer is an area of significant unmet need, as many patients face a high risk of recurrence following surgery. For cancers like hepatocellular carcinoma, lung cancer, muscle-invasive bladder cancer and esophageal cancer, the risk of recurrence ranges from 40 to 70 percent.  Currently, treatment in earlier stages of cancer may consist of chemotherapy, radiation, targeted therapy, chemoradiation therapy, and increasingly in a subset of tumors, immunotherapy.

“From a biological and immunological viewpoint, earlier stages of disease may be a favorable environment for treatment with immunotherapy,” said Michele Maio, M.D., Ph.D., Director, Center for Immuno-Oncology, University Hospital of Siena.

Research has demonstrated that the immune system may be more responsive and more intact in earlier disease, and ongoing research seeks to determine whether administering immunotherapy before and/or after surgical resection will lead to additional benefits. Before surgery, the goal is to destroy cancer cells that may have spread without detection and the presence of a tumor may also enable a stronger immune response. Following surgery, there is an increased need to activate immune cells to help eradicate cancer cells that may remain to lower the risk of relapse. The ongoing investigation into the role of immunotherapy in these settings is critical, as relapse often marks the transition between curable and incurable disease.

Experts weigh in

Bristol Myers Squibb ESMO 2021 Virtual Media Event speakers (left to right): Eric Van Cutsem, M.D., Ph.D. Head of Digestive Oncology, University Hospitals Gasthuisberg/Leuven & KULeuven, Belgium, Nicolas Girard, M.D. Professor and Head of Department, Medical Oncology, Institute Curie, Michele Maio, M.D., Ph.D., Director, Center for Immuno-Oncology, University Hospital of Siena, Marc-Oliver Grimm, M.D. Professor of Medicine and Urology Department Head, Jena University Hospital, Bettina Ryll, M.D., Ph.D. Chair, Melanoma Patient Network Europe, Kald Abdallah, M.D., Ph.D. Senior Vice President and Head of Worldwide Medical Oncology, Bristol Myers Squibb, Jonathan Cheng, M.D. Senior Vice President and Head of Oncology Development, Bristol Myers Squibb

To discuss the potential need for immunotherapy in this setting, Bristol Myers Squibb gathered a group of leading experts from across the world to discuss current developments for immunotherapy in earlier stages of cancer. The discussion was part of a virtual event during the annual European Society for Medical Oncology (ESMO) Congress in September 2021.

Participants, including Professor Maio and Bettina Ryll, M.D., Ph.D., chair, Melanoma Patient Network Europe, discussed the approach of using immunotherapy, specifically checkpoint inhibitors, being explored in earlier stages of cancer, given the potential for stronger immune response and opportunity to improve long-term survival for patients.

Dr. Ryll said, “In advanced disease, less tumor burden tends to correlate with better response, so moving treatments earlier seems like a logical next step.”

“We are optimistic that surgery and early treatment can provide hope for a longer life,” said Professor Maio.

Catherine Owen, senior vice president and general manager, US Commercial

Catherine Owen, senior vice president and general manager, US Commercial

Bristol Myers Squibb also commissioned Ipsos MORI to undertake a survey  of 256 healthcare practitioners (including oncologists, surgeons and specialists) across five countries, which showed the vast majority express enthusiasm for the potential use of immunotherapy in earlier settings. Participants in the survey expect immunotherapy to have a positive impact on the earlier-stage cancer treatment landscape, and selecting from a list, cite longer overall survival, increased disease-free or recurrence-free survival, maintenance of quality of life and potential for cure as the top most important potential benefits of immunotherapy in early settings.

Research is ongoing at Bristol Myers Squibb to continue to shed light on the potential of treatment on long-term and overall survival outcomes for patients in the earlier setting across various cancers. 

“Building on our leadership in metastatic disease and collective goal to empower people with cancer to have a better future, we are driving innovative science by exploring immunotherapy in earlier stages of cancer with the goal of disrupting the course of the disease,” said Catherine Owen, senior vice president and head of Major Markets, Bristol Myers Squibb.

To learn more about the potential of immunotherapy in earlier stages of cancer, click here.


On behalf of Bristol Myers Squibb, Ipsos MORI carried out an online survey on treatment perceptions and practices in earlier stages of cancer. A total of 256 healthcare providers across five countries (France n=50, Germany n=50, Italy n=50, U.S. n=56 and Japan n=50) chose to take part in the online survey. Fieldwork took place between June 3 and July 2, 2021. Respondents included medical oncologists, surgeons (specifically, general, thoracic, breast, respiratory and gastroenterological surgeons) and specialists (specifically, urologists, dermatologists, pulmonologists, gastroenterologists, otolaryngologists) who treat patients across one to eight different cancer types specifically, bladder/urothelial cancer, breast cancer, gastroesophageal cancers, head and neck cancer, kidney cancer, liver cancer, lung cancer, melanoma, across stages I to III. A quota was set to obtain a minimum of 25 medical oncologists in France (n=28), Germany (n=29), Italy (n=29) and U.S. (n=25). The sample included a mix of hospital-, university- and community-based HCPs. The respondents were sampled from pre-existing panels of self-selecting HCPs, managed by M3 and SHC.

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