Dr. Zamarin on Immunotherapy as a Staple in the Future of Cancer Treatment

Dmitriy Zamarin, MD, PhD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses the ways in which immunotherapy is slated to play a major role in multiple cancer types.

According to Zamarin, once the efficacy of these agents is confidently established in more advanced settings, they will certainly move up into earlier lines of treatment. Oncologists currently strive to enhance the immune response to these cancers in order to prevent the disease from coming back. However, Zamarin speculates that the real value of immunotherapy may lie not necessarily in its ability to prolong survival in patients who already have metastatic disease, but instead in its efficacy in preventing the metastatic disease from developing in the first place.

While checkpoint blockade inhibitors targeting the PD-1/PD-L1 pathway tend to dominate the field, there are several other exciting approaches to anticancer immunotherapy being explored in a range of solid tumors.

For example, anticancer vaccines are rapidly expanding. Vaccines can enhance the recognition of tumor antigens by the immune system through many strategies, including DNA-encoded vaccines and virus-vectored vaccines, as well as through wholly modified tumor cells, tumor-associated antigen or tumor-specific antigen peptides, tumor-associated antigen proteins, dendritic cells loaded with specific antigens, adjuvants, and in situ vaccinations.

With the situ vaccination approach, all of the patient’s antitumor antigens that are present at the tumor site can be exploited. Specifically, in situ vaccination can generate localized tumor lysis and T-cell activation, as well as antigen release and presentation. Treatments in the in situ vaccination category include local ablative therapies (such as radiation and cryotherapy), intratumoral cytokine injections (such as interleukin-2), intratumoral tolllike receptor agonist injections, intratumoral bacteria injections, and intratumoral virus injections.