Immunotherapy (immuno-oncology) drugs have few and manageable side effects and are effective against many types of cancer. However, only time will tell whether they will replace chemotherapy and other treatments. While initial studies suggest these drugs are "revolutionary," there are some problematic areas. The main issue is that the drugs do not work for all patients.
The place of immunotherapy drugs in treatment in the near future is not yet clear. How their effectiveness will unfold when used in combination with other treatments is also a separate subject of curiosity and debate. One area of research is the combination of different immunotherapy drugs. The answers to these and other questions will emerge as the studies are completed. It is highly likely that at least a few issues will be clarified at the upcoming ASCO (American Society of Clinical Oncology) meeting.
RESULTS CAN COMPLETELY CHANGE TREATMENTS
Professor Mary O'Brien from the UK's Royal Marsden Hospital, who has conducted numerous studies on four different immunotherapy drugs, states, "We are using some immunotherapy drugs in patient groups with no other treatment options. We have the potential to extend the lifespan of some patients. Much more research is ongoing. New findings could completely transform treatments. Research into their use in combination with radiotherapy and chemotherapy is also ongoing."
We will find the answers to these questions within five years.
Immunotherapies are not only being discussed in terms of traditional methods, but also their combined use. Prof. Dr. O'Brien states, "What we need to pay attention to here is that the use of multiple immunotherapy drugs increases side effects. But research is ongoing. We will see the results." Immunotherapies are currently used in advanced cancers. Will they become routine in earlier stages of cancer in the near future? Prof. Dr. O'Brien says, "We believe they could be used in earlier stages, especially after surgery. Relevant studies are underway. But it's too early to start using them in early-stage cancer right now. I think we'll have the answers to these questions in five years."
Where hope is lost, a new treatment will come into play.
The President of the Immuno-Oncology Association, Prof. Dr. İsmail Çelik, gives a cautious response to our question, "Does immunotherapy replace other treatments?" He states that groundbreaking drugs will "strengthen the hands" of other treatments in the advanced stages of cancer, when almost all other treatments have been exhausted, rather than replacing them.Prof. Dr. Çelik says, "Immunotherapy drugs do not replace surgery. If the tumor needs to be removed, the patient undergoes surgery. Again, despite the risk of the disease spreading, the chemotherapy we administer after surgery for protective purposes (to destroy invisible tumors), which we call adjuvant therapy, will remain in place. This is because adjuvant therapy is particularly effective in breast cancer. The areas of application for radiotherapy are also clear. For example, there is no problem with localized radiotherapy (gamma knife, cyberknife), and there will be no change in their use." However, despite conventional treatment attempts, if the expected regression or improvement is not achieved and the disease recurs, immunotherapy drugs will come into play. Prof. Dr. Çelik says, "We won't be helpless in the most desperate stages. In the first stage of tumors, chemotherapy is still the standard treatment for almost all cancers. Where there is no hope, immunotherapy will come into play. But in the future, this may change."
It is also being tested with targeted drugs.
ROGER Dansey (Senior Vice President, Global Clinical Development, Oncology, MSD): We are also testing other molecules that we have not yet disclosed. We are increasingly understanding the potential of immunotherapy. We are currently using these drugs alone, and later we will look at how we can use them in combination with other treatments.
We want to use immunotherapy alongside standard chemotherapy drugs, radiotherapy, and targeted drug therapies. We don't know yet if it will replace other treatments. But current information suggests it can be used alongside other treatments. We are also running a program on biomarkers that will reveal in which patients the drug will be effective. When drugs are developed, they are first tested on patients who have no other options. As results become available, research moves on to other patients and cancers. We are doing the same. As research progresses, it will guide us.
The patient's biology will be examined rather than the tumor.
Medical oncologist Dr. Süalp Tansan says that these treatments are revolutionary because they give the body a chance to heal itself. He believes they will fundamentally change the way cancer has been treated for years. However, he also points out that immunotherapy drugs are not effective in every cancer patient. Dr. Tansan says:
‘The era of personalized treatment is beginning’
“Let no one be misled. These drugs are not effective for a large number of patients. They are drugs that may help 20% of patients when chemotherapy does not work. Science is trying to determine which patients these drugs will affect. If we can learn who these drugs work for and give them to patients they may affect, our chances of a positive response to treatment will increase.”
The era of personalized treatment is truly beginning now. Genomic and biological structure will take precedence over tumor type. For example, we will no longer say "colon cancer," but rather "MSI-positive" (a condition observed in certain DNA cells). Cancer treatments will no longer be based on the type of disease or organ, but on the patient's biology.
CANCER MAY NO LONGER BE CHRONIC
According to the latest data, when immunotherapy drugs work, they are effective for longer than chemotherapy. Dr. Tansan says, "Time is important for us. Putting the patient to sleep for 18 months means benefiting from new drugs that will be available 18 months later. Immunotherapy drugs may turn cancer into a kind of chronic disease."
PHARMACEUTICAL COMPANIES JOINED FORCES
JOE Eid (Global Medical Director of Oncology at MSD): Not only do we have an immunotherapy agent, but many other companies do too. This is good because more competition means better drugs will be developed faster. And of course, the goal is to help more people. We work with large pharmaceutical and biotechnology companies such as Pfizer and Novartis. These collaborations will bring more science and knowledge. We are testing combinations with both our own drugs and those of other companies. Our drugs are currently used in late-stage cancers. We are trying to bring them into earlier stages.
