Treatment strategies

Cancer immune therapy is still a highly experimental concept. It is too early in its development stage to be in a position to replace any standard treatment. Hence, it is necessary to accommodate the first line standard treatment in the schedules designed for clinical cancer immune therapy trials.

Standard therapy

Typically, the first line treatment of cancer is cytotoxic chemotherapy in various combinations. One side effect of chemotherapy is immune suppression. This affects the combination of cancer immune therapy with cytotoxic chemotherapy. On the other hand, a progressively growing tumour and/or a high tumour load is a disadvantage for cancer immune therapy. The immune system has troubles in keeping up with the cancer cell amplification.

Cancer immune therapy as add-on treatment

In designing treatment schedules for cancer immune therapy a balance needs to be kept between trying to intervene as early as possible, ideally immediately after the diagnosis, and avoiding chemotherapy as much as possible. However, cancer immune therapy is still frequently combined with chemotherapy, which is referred to as add-on treatment, in order to immunise a cancer patient at a minimal residual disease stage. Alternatively, in order to avoid the immune suppressive activities of chemotherapy, cancer immune therapy may be applied when first line immune therapy failed and is replaced with more experimental treatment concepts. However, at this stage, the tumour is progressively growing, which makes it more difficult for the immune system to control tumour cells.

Prospects

These two basic strategies will eventually have to be compared head to head in clinical trials in order to obtain data on their respective efficacy. It might also be conceivable, that cancer immune therapy turns out so highly effective, that it some day will replace chemotherapy. If this is the case, the toxic effects of chemotherapy on the immune system and thus on the effectiveness of cancer immune therapy may be circumvented.