THE 2018 Nobel Prize in Physiology or Medicine was awarded recently to James P. Allison of the United States and Tasuku Honjo of Japan for their work on unleashing the body’s immune system to attack cancer, a breakthrough that has led to an entirely new class of drugs and brought lasting remissions to many patients who had run out of options.
Allison studied a known protein that functions as a brake on the immune system. He realised the potential of releasing the brake and thereby unleashing our immune cells to attack tumours. He then developed this concept into a brand new approach for treating patients.
Honjo discovered a protein on immune cells and, after careful exploration of its function, eventually revealed that it also operates as a brake, but with a different mechanism of action.
Honjo told reporters: “I want to continue my research so that this immune therapy will save more cancer patients than ever.”
Allison said: “It’s a great, emotional privilege to meet cancer patients who’ve been successfully treated with immune checkpoint blockade. They are living proof of the power of basic science, of following our urge to learn and to understand how things work.” Therapies based on his discovery proved to be strikingly effective in the fight against cancer.
Allison and Honjo showed how different strategies for inhibiting the brakes on the immune system can be used in the treatment of cancer.
The seminal discoveries by the two Laureates constitute a landmark in the fight against cancer.
The drugs based on their work belong to a class called checkpoint inhibitors, with tongue-twisting names that have nonetheless become familiar to many patients.
The first ones approved were ipilimumab (brand name Yervoy), nivolumab (Opdivo) and pembrolizumab (Keytruda). Others have since come to market.
Earlier attempts by other researchers to recruit the immune system to fight cancer sometimes worked but more often did not.
Allison and Honjo succeeded where others had failed by deciphering exactly how cells were interacting so they could fine-tune methods to control the immune system.
Checkpoint inhibitors do not work for everyone and they have only been approved for some cancers.
They can have severe side effects, and they are expensive, costing more than $100,000 a year. But the approach, known as immunotherapy, has become a mainstay of treatment for a number of types of cancer, and a great deal of research is underway — including work by Allison and Honjo — to find the best ways of combining checkpoint inhibitors with one another and with standard treatments to help more patients.
The checkpoint inhibitors now on the market are used for cancers of the lung, kidney, bladder, head and neck; for the aggressive skin cancer melanoma; and for Hodgkin lymphoma and other cancers.
The therapy might not work for everyone, but for some patients it worked incredibly well, getting rid of the tumour entirely, even after it had started to spread around the body.
