The Ongoing Issue with Immunotherapy

Over a hundred years on – are immunotherapies really worth their salt?

Immunotherapy is known to have been loosely invented by a New York based doctor, William B. Coley.

By blending a beef broth with Streptococcus bacteria, he formulated the first treatment by injecting it into an Italian-man suffering from an inoperable neck tumour.

Although this man went on to recover, with the tumour reducing in size significantly over the course of a month; during this time he suffered some pretty serious side effects, developing a fever and vomiting frequently during throughout his recovery.

It’s been well over a hundred years since Coley’s first pioneering breakthroughs and despite the development of supporting technologies, the simple fact remains that immunotherapies remain somewhat volatile and risky – even for cancer patients who are suffering from inoperable diseases.

A recent study undertaken by outspoken immunotherapy critic Vinay Prasad has revealed that only 10% of the US population currently dying of cancer would benefit from the treatment. As much as we need to take Mr. Vinay’s  assessments with a pinch of salt, especially when you consider how vocal he has been for a number of years concerning immunotherapy; it’s also worth at least considering his view point, instead of rushing into a decision that could cost a fortune and potentially leave cancer patients much worse off.

The average cost of a US-government sanctioned treatment runs well into six-figures (around $150,000), but with the technology behind the treatment currently considered as ‘poorly understood’. The question remains as to whether companies like Merck and Bristol-Myers Squib are taking advantage of their dubious position, as they’ve already pocketed $9bn from sales of their breakthrough checkpoint inhibitors.

Despite these large sales numbers , it’s still questionable whether or not this form of immunotherapy is truly beneficial for a wider cross-section of cancer patients. A similar thing can also be said for CAR-T treatments. A complex combination of cell and gene therapies, this treatment was considered to be cutting edge when it first broke on to the scene in 2017.

The first CAR-T therapy treatment broke more than a few boundaries when it was cleared by the FDA. It was the first ever gene therapy to be given approval to go to market, with the first treatment focused on cases of leukaemia in children. This breakthrough led to an opening  of the floodgates for similar CAR-T therapies developed by competing firms and focusing on different conditions. These new CAR-T treatments included the more common lymphomas in adults, where trials declared an astonishing 50% rate of complete cancer removal.

These are promising results and will no doubt go some way to diminishing the concerns that potential patients might have, before they lay down the necessary dollar for the treatment. However, with treatments rising in price over the last year (costs for that particular lymphoma treatment have settled at an astonishing $475,000) the question remains as to whether these ‘cures’ are being made for the sake of humanity or the sake of profit alone.

A near half-million dollar price tag is a lot of money, a sum that only a handful of sick people would be able to afford, especially considering the potential risks of the treatment. In 2016, five leukaemia patients died from massive brain swelling in Japan, similar cases have occurred at the University of Pennsylvania, as well as the National Cancer Institute – posing the question as to whether our scientists can really be trusted any more than their dubious forefather, Coley.

The immunotherapy industry has certainly come on leaps and bounds since it’s original incarnation over a century ago, however it might take another century still for it to become both affordable, safe and effective.

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