With few and manageable side effects, and being effective against a large number of cancers, only time will tell whether immunotherapy (immunooncology) drugs will replace chemotherapy and other treatments. Although initial research indicates these drugs are revolutionary, there are some problematic areas. The main problem is that the drugs do not work in all patients.
The future role of immunotherapy drugs in treatment is not yet clear. How their effects will manifest when used in combination with other treatments is also a subject of curiosity and debate. One area of research is the testing of different immunotherapy drugs together. Answers to these and other questions will emerge as research progresses. It is highly likely that at least a few issues will be clarified at the upcoming ASCO (American Society of Clinical Oncology) meeting.
THE RESULTS COULD COMPLETELY CHANGE TREATMENTS.
Professor Mary O'Brien from the Royal Marsden Hospital in the UK, who has conducted numerous studies on four different immunotherapy drugs, says: “We use some immunotherapy drugs in patient groups who have no other options. We have a chance to extend the lifespan of some patients. Much more research is underway. New results could completely change treatments. Research is also continuing on their use in combination with radiotherapy and chemotherapy.”.
WE WILL FIND THE ANSWERS TO THE QUESTIONS WITHIN 5 YEARS.
Immunotherapies are being considered not only in combination with traditional methods, but also in combination with other methods. Professor O'Brien says, "What we need to be careful about here is that the use of more than one immunotherapy drug increases the side effects. But research is ongoing. We will see the results." Immunotherapies are currently used in advanced cancers. Will they become routine in earlier-stage cancers in the near future? Professor O'Brien says, "We think they can 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 will have the answers to these questions in 5 years.".
WHERE ALL HOPE FADES, A NEW TREATMENT WILL COME INTO PLAY.
The President of the Immuno-Oncology Association, Prof. Dr. İsmail Çelik, gives a cautious answer to our question, "Can immunotherapy replace other treatments?" He says that groundbreaking drugs will not replace other treatments, but rather "strengthen the hand" in advanced stages of cancer when almost all other treatments have been exhausted. Prof. Dr. Çelik says, "Immunotherapy drugs do not replace surgery. If the tumor needs to be removed, the patient will undergo surgery. However, chemotherapy, which we call adjuvant therapy and which we use after surgery for protective purposes (to eliminate tumors that are not visible to the naked eye) against the risk of disease spread, will remain in place. Because adjuvant therapy is very effective, especially in breast cancer. The areas of application for radiotherapy are also well-defined. For example, there are no problems with pinpoint radiotherapy (gamma knife, cyberknife), and their locations will not change." However, if the expected regression or improvement is not achieved despite classical treatment attempts, and the disease recurs, then immunotherapy drugs will come into play. Prof. Dr. Çelik says, "We won't be helpless even in the most desperate stages. In the first stage of tumors, chemotherapy is still the standard treatment for almost all cancers. Immunotherapy will come into play where there is no hope. But perhaps this will change in the future.".
IT IS ALSO BEING TESTED IN COMBINATION WITH TARGETED DRUGS.
ROGER Dansey (MSD Senior Vice President, Global Clinical Development, Oncology): We are also testing other molecules that we haven't yet announced. 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 our current knowledge indicates that it can be used in combination with other therapies. We are also running a program related to biomarkers that will reveal in which patients the drug will be effective. When drugs are developed, they first work with patients who have no other options. As results are seen, research is conducted with other patients and cancers. We are doing the same. As research progresses, it will guide us.
THE FOCUS WILL BE ON THE PATIENT'S BIOLOGY RATHER THAN THE TUMOR.
Medical oncology specialist Dr. Süalp Tansan, He says 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 following:
‘'A PERIOD OF PERSONALIZED TREATMENT IS BEGINNING'’
“Let no one be under any false impression. These drugs are not drugs that will be effective in a large number of patients. They are drugs that may work for about 20% of patients in cases where chemotherapy has not worked. Science is trying to determine which patients will benefit from these drugs. If we can find out who these drugs work for and administer them to the patients they may affect, our chances of a positive response to treatment will increase.’.
The era of patient-specific, or 'personalized treatment,' is truly beginning. Genomic and biological factors will take precedence over tumor type. For example, instead of saying 'colon cancer,' we will say 'MSI (a condition observed in certain DNA cells) positive.' Cancer treatments will no longer be based on the type of disease or organ affected, but rather on the patient's biology.‘
CANCER CAN STOP BECOMING CHRONIC.
According to recent data, immunotherapy drugs, when they are effective, last longer than chemotherapy. Dr. Tansan says, “Time is important for us. Putting the patient in a dormant state for 18 months means benefiting from new drugs that will be available after 18 months. Immunotherapy drugs may well turn cancer into a kind of chronic disease.”.
PHARMACEUTICAL COMPANIES JOINED FORCES.
JOE Eid (Global Medical Director of Oncology at MSD): Many companies, not just ours, have immunotherapy agents. This is good because more competition means faster development of better drugs. And of course, the goal is to help more people. We work with large pharmaceutical and biotechnology companies like Pfizer and Novartis. These collaborations will bring more science and knowledge. We have combinations that we are testing 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 to earlier stages.
