Immunopharmacogenomics by Yusuke Nakamura

Author:Yusuke Nakamura
Language: eng
Format: epub
Publisher: Springer Japan, Tokyo

In general, tumor responses to immunotherapies have shown tendencies to deviate from the internationally recognized Response Evaluation Criteria in Solid Tumors (RECIST). Because the initial biological response is activation of intratumoral infiltrated T lymphocytes and cytokine production, tumors may initially grow in size on radiographic assessment early after therapy initiation [29]. This initial pseudo-progression [32] may explain why overall survival rates in treatment arms exceed the proportion of objective responders. These aspects of immunotherapies require innovative strategies for monitoring patients with institution of new criteria of evaluation and follow-up time on the basis of the mode of action.

In addition, although this is not an issue specific to immunotherapies and often not considered from the clinical perspective of whether to recommend a specific therapy to a patient, the very expensive medical cost of immune checkpoint inhibitors provides good reason to select possible responders. After its FDA approval in 2011, the market cost of ipilimumab was 30,000 USD per dose, for a total of 120,000 USD for a standard four-course dose, as reported by Bristol-Meyers Squib [33]. However, in the context of other systemic treatments for advanced cancer, the cost of ipilimumab is not exceptionally high [34].

In the following sections, we address each of these challenges in turn and present potential solutions that have been discussed and described in the literature.

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