Immunotherapy of cancer

Abstract

Background For 50 years, cancer physicians have relied on just three primary treatment modalities: surgery, radiation therapy and chemotherapy. Over that time, enormous progress has been made in understanding cancer biology, targeted anticancer drugs have emerged, and thousands of clinical trials have taught us how best to craft treatment combinations that improve clinical outcomes. Only five years ago, a fourth and radically different form of therapy finally emerged: immune-based cancer therapies. Objective This review briefly outlines the history and theoretical framework underpinning cancer immunotherapy, and recent progress on several immunotherapeutic approaches. Discussion Immune-based cancer therapies are already revolutionising the management of several types of hitherto intractable cancer, while offering immense hope that the burden of personal suffering and community cost due to cancer will diminish appreciably over the coming decades. At least two immunotherapeutic approaches, checkpoint inhibition and cellular therapy with autologous ('self') chimeric antigen receptor T cells (CAR T cells), now show indisputable evidence of efficacy in several cancer types, and promise yet more rapid progress as they are refined and we learn to combine them with existing conventional therapies and each other.