Adecade 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