Oncology
The paradigm shift
Checkpoint inhibitors have revolutionised cancer care. Stimulating the immune system is now as much of a focus in oncology as killing or surgically removing cancers. It’s a more holistic approach, but its side-effects can be just as harrowing. Isabel Ellis asks K Dane Wittrup,
Carbon P. Dubbs professor in Chemical Engineering and Biological Engineering at MIT, and David A Scheinberg, head of Experimental Therapeutics at the Memorial Sloan Kettering Cancer Centre, how new targeting strategies can make immunotherapy easier to bear.
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n the 1980s and early 1990s, close to 15% of patients treated with the early immunotherapy Interleuken 2 (IL2) saw their cancers go into remission. “It was amazing,” says K Dane Wittrup, Carbon P. Dubbs professor in Chemical Engineering and Biological Engineering at MIT. “What was not great was that every single patient who was treated with it almost died from it.” Yes, 8% of those whose tumours responded to IL2 left cancer behind for years and even decades afterwards, but, with their blood vessels leaking and their bodies ballooning, the first place anyone went to was intensive care.
Cancers may capitalise on the fact – tricking, suppressing and even recruiting immune cells – but the human immune system limits itself for a good reason. Conditions like sepsis, which can kill in a matter of hours, arise when it doesn’t. Or take the way the body’s defences treat transplanted tissue. Doctors replace organs with the best of intentions, but, to the white blood cells it keeps pumping around the recipient’s body, a donor heart is an alien invasion. “If you take a non-matched organ and just implant it, the immune system can kill off several pounds of tissue remarkably quickly,” notes Wittrup. Without suppression, it’s powerful enough to end the life it
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