Rethinking Immunotherapy for Cancer: When Is the Best Time to Stop?
Immune-boosting drugs have revolutionized cancer care. Now doctors are experimenting with cutting them off. Immunotherapies unleash the immune system on tumors.
They have extended the lives of people with melanoma, lung and bladder cancers. They have also been a boon for drugmakers, generating global sales of $44 billion in 2022, according to Leerink Partners analysts. But some patients are getting more of the drugs than they need, exposing them to side effects and costs they could avoid without risking their cancer recurring.
Preliminary research suggests taking the drugs at a lower dose or for a shorter period could be sufficient, but drugmakers haven’t funded the studies needed to confirm the findings. “We don’t know when to stop," said Dr. Jedd Wolchok, an oncologist focused on melanoma at Weill Cornell Medicine in New York.
Immunotherapies are the latest cancer treatment doctors are rethinking. They are doing less chemotherapy, radiation and surgery for lower-risk cancers including breast and prostate. Researchers at a conference in San Antonio this month showed some low-risk breast cancer patients could safely skip radiation or get follow-up screening less often.
Recalibrating care toward less treatment is a fraught undertaking. Drug companies won’t fund studies exploring whether patients can do as well with less of their products, doctors said. Some doctors and patients worry about pulling back before exhausting their best chance to beat the disease.
“There was this dogma that more is better," said Dr. Mark Ratain, an oncologist at the University of Chicago. He is trying to recruit cancer patients to study whether they could do as well with less of Merck’s Keytruda or Bristol-Myers Squibb’s Opdivo, so-called
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