57 5.3: Future immunotherapy extensions

Novel clinical research tools

The introduction of ICIs have revolutionized and paved the way for future cancer immunotherapy clinical applications. So far this has been done with the help of new immune parameter tools including T cell infiltration statuses (for both the presence and activation of T cells), tumour mutational burden evaluations, and immune checkpoint expression levels (Robert 3801). There is still work to be done with identifying biomarkers to predict the efficacy and possible toxicity of ICI treatments (Robert 3801).

Important extensions with ICI

There should be a shift to focus more on landmark analyses (such as looking at patients and their progression at later time points) and using restricted mean survival times. This is because the clinical implications of ICI are not captured well enough when using classical endpoints due to possible delayed effects (Robert 3801). This includes measurements like median progression-free-survival and hazard ratios. Additionally, adverse effects of these immune focused therapies must be carefully tracked because if something incoherently happens with the inhibition of a selected target, this could lead to the off-target responses of the immune system (Robert 3801). Examples include sources of tissue/organ inflammation or even rare cases of death.

Additional information describing the side effects of ICI therapies and their treatments

Finally, it is important to consider that ICI has not provided universal benefits across every cancer type (Li et al. 31). Some cancers inherently present great resistance towards using ICI therapy including pancreatic ductal adenocarcinoma, as well as metastatic castration-resistant prostate cancer (Li et al. 31). Future research to identify the reasoning for the variance in ICI therapy response is therefore much needed, along with identifying if certain combination therapies are more successful for specific cancer types and why.