Immunotherapy Expands to Earlier Cancer Stages Across Multiple Tumor Types

Immunotherapy given before or after surgery is increasingly used across several cancer areas, with researchers showing how the field is moving toward earlier treatment. In a comprehensive review published in the Journal of Internal Medicine, researchers at Karolinska Institutet present findings from studies across seven tumor areas, indicating that immunotherapy in early stages of disease is developing rapidly across many tumor areas.

For several years, immunotherapy has transformed the treatment of advanced cancer that can no longer be removed surgically. It is now used more frequently in earlier stages of disease as well—before surgery, known as neoadjuvant treatment, or after surgery, known as adjuvant treatment.

Several studies in recent years have shown that adjuvant immunotherapy after surgery can reduce the risk of the disease returning. Additional studies indicate that neoadjuvant treatment, given while the tumor is still in place, in many cases can provide the immune system with better conditions to recognize tumor cells. In several tumor areas, the results also suggest that immunotherapy given both before and after surgery may offer advantages compared with adjuvant treatment alone.

The researchers summarize findings from studies on several cancer diagnoses, grouped into seven tumor areas: skin cancer, lung cancer, breast cancer, gastrointestinal cancer, gynecological cancer, head and neck cancer, and urological cancer. The work behind the article is a collaboration between 14 researchers at the Department of Oncology-Pathology, Karolinska Institutet, all of whom also work with cancer treatment in clinical care.

At the same time, the authors emphasize that the results vary between different cancer types and that the treatment involves challenges, such as the risk of side effects and the possibility that some patients may receive more treatment than necessary if surgery alone would have been sufficient. The researchers also point to areas where more knowledge is needed, including the development of biomarkers, measurable characteristics that can help health care determine which patients benefit from immunotherapy, both before and after surgery.

They also discuss how introducing immunotherapy at earlier stages raises questions about costs, side effects, and whether health care resources will be sufficient, questions that current studies do not yet clearly answer. By bringing together studies from many cancer types, it becomes clearer how the field is evolving and what experiences can be shared between different specialties.