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Immunotherapy is Not a Cure-all for Cancer Treatment

Immunotherapy for Cancer Treatment: What the Otolaryngologist Needs to Know

On-Demand Session

Clint T. Allen, MD

Immunotherapy, which has the capability of restoring the patient’s own anti-tumor immunity as a potential strategy in combatting cancer, is a major breakthrough in cancer therapy.

To understand how immunotherapy works, we must first understand how anti-tumor immunity should work, said Clint T. Allen, MD, of the National Institutes of Health in Bethesda, Maryland.

“The underlying principle of how the immune system detects and eliminates a cancer cell is really based on the T-cell,” said Dr. Allen. “That’s one cell type of the adaptive arm of the immune system. And it’s based on the ability of this T-cell to recognize an antigen and kill tumor cells that express that antigen.”

If everything works as it should, a person’s antigen-specific T-lymphocytes should ultimately eradicate antigen-presenting target tumor cells. Unfortunately, said Dr. Allen, “There’s lots of ways in which this circle of antitumor immunity gets derailed or suppressed.”

Whether it’s a lack of activation signals from antigen-presenting cells or the presence of immunosuppressive cells in the tumor environment, things can go awry.

“There’s a war going on in the tumor,” said Dr. Allen. “Pembrolizumab, or an immune checkpoint blockade, addresses this one particular way that tumors will suppress antitumor immunity, and they bind and block the function of these immune checkpoints.”

Pembrolizumab and nivolumab are two immunotherapy options currently approved by the U.S. Food and Drug Administration for the treatment of head and neck cancer, although varied studies demonstrate that immunotherapy may not be a one-size-fits-all option for every patient. Physicians are tasked with determining who will benefit from immunotherapy and who may be better served by sticking to a more traditional regiment of care.

“We need to select patients better,” said Ravindra Uppaluri, MD, PhD, of Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, in Boston, Massachusetts. “These things are expensive, they do have some side effects, and they’re not a cure-all for everybody.”

That should not, however, deter physicians from keeping immunotherapy in their arsenal. “More and more surgeons should get engaged in these because it really is about advanced care for our patients and not being afraid. This is not some sort of black box approach.”

This session was originally presented live on Sunday, September 13, but is now available in the on-demand library of education content.