Immunotherapy is considered to be the fourth largest cancer treatment technique after surgery, radiotherapy and chemotherapy, and targeted therapy. It is also considered to be the only emerging therapy that can overcome cancer, but at present, immunotherapy is still used in the last-line treatment of the most advanced cancers. In most clinical trials, immunotherapy is also selected after other treatments have failed.
 
So, is immunotherapy really only used for end-line treatment? Will there be better expectations if we intervene early? Studies have confirmed that the earlier the intervention of immunotherapy, the better the effect!

Based on the function of the immune system to kill tumor cells, immunotherapy is considered to be a living drug for the human body. It is widely accepted by clinical patients with strong targeting, thorough killing of tumors, and few toxic and side effects, and it has shown far in the clinic. Super clinical efficacy of other therapies.

However, due to clinical safety and approval process considerations, immunotherapy is often only used for options after surgery, radiotherapy and chemotherapy. At this time, the immune cells in the patient's body are already damaged or reduced sharply, and many patients have not yet waited for the therapy to work. , Died in the waiting period.

Now, various clinical studies have shown that immunotherapy can also be used for early cancer intervention treatment, or combined with other treatment methods such as surgery, radiotherapy and chemotherapy, and its anti-tumor effect will be even better.

01
Why is immunotherapy as soon as possible?

The principle of immunotherapy determines that the sooner immunotherapy, the better!

Traditional treatment methods usually target cancer cells directly, such as surgery to directly remove the primary lesion, radiotherapy and chemotherapy to directly kill cancer cells, and targeted drugs to block the gene mutation pathway of cancer cells.

But immunotherapy is different from them. Immunotherapy kills cancer cells indirectly by removing the suppression of immune cells or activating the immune cells themselves. For example, ACTL technology and adoptive cell therapy have few side effects on the human body and can inhibit the growth of tumor cells. , Which kills tumor cells, but has no killing effect on normal cells. It uses our body’s own immune system.

Therefore, a very important point in the treatment process is to protect the immune system of cancer patients!

Normally, surgery, radiotherapy and chemotherapy will destroy the immune system to a certain extent. Large doses of chemotherapy drugs kill cancer cells while also destroying normal immune cells. Patients who have received radiotherapy and chemotherapy often have the immune system. Very fragile, which also makes the subsequent immunotherapy effect unsatisfactory.

02
Immunotherapy as first-line treatment reduces the risk of death by 30%

In the face of cancer, many patients still choose immunotherapy when they are helpless. If immunotherapy is applied before surgery, radiotherapy and chemotherapy, and targeted drugs, will the effect really be better?

The answer is yes.

A classic literature published in the JAMA ONC magazine gave an iron proof of the big data of more than 20,000 patients in 25 clinical trials involving patients with non-small cell lung cancer:

Patients who receive immunotherapy first and then other drugs have a lower risk of death by more than 30% than those who receive other drugs first and then immunotherapy!

Regardless of whether targeted drugs are used before or after, the effect is not obvious.

 
△ Comparison of immunotherapy (left) and targeted drugs (right)

This proves that immune drugs are very different from targeted drugs, and there is a difference in effect between first use and second use. Early use of immune drugs will have better survival.

In fact, as early as 2015, drug K relied on the success of head-to-head clinical trials with ipilimumab and was approved as a first-line melanin drug; then in 2017, drug K combined with pemetrexed + carboplatin was used by the FDA First-line medication for non-squamous NSCLC (regardless of PD-L1 expression level); and in 2018, the FDA officially approved K drug combined with chemotherapy as the first-line treatment of metastatic NSCLC (squamous) (regardless of PD-L1 expression level).

It can be said that drug K has entered a number of first-line drug options for cancer treatment with the data that it can hit, which shows that the efficacy of immunotherapy is not worse than the current first-line treatment options.

In the latest issue of JCO, from the comparison of the first-line data of using PD-1 drugs as the first-line treatment and chemotherapy, it can also be seen that anti-PD therapy can enable patients to obtain better disease control, and at the same time, the safety is higher.

 
△ Long-lasting tumor regression and overall survival rate of patients with advanced Merkel cell carcinoma who received PD-1 first-line treatment

Immunotherapy is getting closer and closer to our lives, and due to clinical safety considerations, most immunotherapies cannot be really used for first-line treatments, but we can already see the new dawn it brings to the field of oncology. With the continuous advancement of biological sciences and clinical trials, immunotherapy will also be approved to enter the first-line treatment, bringing hope to more patients.