Nicholas DeVito, Assistant Professor of Medicine at the Division of Medical Oncology at Duke University, shared a post on LinkedIn:
” ‘Chemotherapy is immunogenic!’ – is a line I have heard one too many times, and my reply is always the same: based on what evidence?
While there are sparse data indicating that chemotherapy like oxaliplatin induces immunogenic cell death, these studies were done in subcutaneous mouse models and cell cultures with limited human correlates. A new paper further demonstrates the immunosuppressive response to chemotherapy in the tumor microenvironment of liver metastasis, illustrating the compensatory effect that our immune system has on its reaction to mediators of cell death.
This evidence is in parallel to the fact that chemotherapy impairs T memory effector cell formation and blunts the proliferation of T cells, if anything they should at least be given several days apart.
With this evidence we should question the assumption that chemotherapy is inherently immunogenic – after all, if it was, advanced cancers would be cured by our current tools. Combinations, even, are additive at best rather than synergistic (this is true in most of oncology).
Instead, we must face the fact that we have told ourselves this tale of immunogenic chemotherapy because it is convenient to combine immunotherapy and chemotherapy for the purpose of regulatory approvals. As we move forward with more promising immunotherapy agents, I ask that we think mechanistically about sequencing treatments rationally, designing trials where we are replacing chemotherapy in a patient-selected manner, and questioning our previous assumptions about how current agents affect our immune system.”
Other articles featuring Nicholas DeVito on OncoDaily.