Technology & Medicine › Internet, genomes & AI
Cancer immunotherapy
2011 (ipilimumab); CAR-T 2017· Invention or discovery· Germs, drugs & genetics
Well documentedSolid records, physical evidence or scientific consensus.
Treatments that free or re-engineer the body's own immune system to attack cancer.
See it on the Technology & Medicine map →How it works
Tumors often survive by pressing 'brakes' on immune T cells, proteins such as CTLA-4 and PD-1. James Allison and Tasuku Honjo showed that antibodies blocking those brakes free T cells to attack; the first such checkpoint drug, ipilimumab, was approved for melanoma in 2011. In CAR-T therapy, first approved in 2017, a patient's own T cells are genetically re-engineered to hunt leukemia cells, then infused back.
Why it mattered
It gave some patients with once-fatal cancers, such as advanced melanoma, lasting remissions; the checkpoint drug Keytruda became the world's best-selling medicine.
Think of it like
Checkpoint drugs work like releasing a parking brake: the immune system could attack all along, but was being held back.
How we know
Randomized trials since 2010 showing longer survival in melanoma and lung cancer; FDA approvals; the 2018 Nobel Prize to Allison and Honjo; Carl June's CAR-T leukemia results.
Still unknown or debated
Most patients still do not respond, for reasons only partly understood; unleashing immunity can also trigger serious autoimmune side effects.
Connections (2)
▸Cancer chemotherapy is increasingly complemented by Cancer immunotherapyWell documented
The connection
Chemotherapy, used since the 1940s, poisons rapidly dividing cells, hitting tumors but also hair, gut and blood cells. Immunotherapy instead unleashes or engineers the immune system to attack cancer. Doctors now often combine them: for advanced lung cancer, a checkpoint drug plus chemotherapy became standard treatment around 2018.
When and how
Sidney Farber's chemotherapy in Boston, 1948; checkpoint drugs from 2011; combinations tested in trials such as KEYNOTE-189 for lung cancer, reported in 2018.
How we know
Randomized trials show combinations extend survival in several cancers; treatment guidelines, such as the US National Comprehensive Cancer Network's, record the shift.
Debates and open questions
Which patients need chemotherapy at all, and whether immunotherapy alone can replace it for some cancers, is being tested in ongoing trials.
▸Genetic engineering (recombinant DNA) made possible the engineered T cells of Cancer immunotherapyWell documented
The connection
CAR-T therapy depends on recombinant DNA. Doctors collect a patient's T cells, then use an engineered virus to insert a gene for a 'chimeric antigen receptor', a designer sensor that latches onto cancer cells. The modified cells multiply and are infused back. Checkpoint drugs, too, are antibodies produced by genetically engineered cells.
When and how
Zelig Eshhar's first CAR designs in Israel, 1989; Carl June's team at the University of Pennsylvania treated leukemia patients from 2010; first approval, Kymriah, August 2017.
How we know
Published trial results, such as young Emily Whitehead's 2012 recovery, and FDA approval documents describe the genetic modification step.
Debates and open questions
Making CAR-T work against solid tumors, not just blood cancers, and lowering its cost of several hundred thousand dollars, remain open challenges.