It was just two years ago when I received a call in my early morning while at was just starting my routing at work in my office in Doha, Qatar. It was from David D’Addona from Demos Medical Publishing: (who knows how he even figure out how to find me there!): “We are interested in publishing something outstanding in your emerging field! What do you suggest?” He said. “What about a Textbook on Cancer Immunotherapy! The field needs it! Too many want to understand the basic principles of immunotherapy as the field is coming of age” Said I.
Well, we did it!!!! Thanks to David and his team! Thanks to Tara Withington (Executive Director) and her Society for the Immunotherapy of Cancer (SITC ) staff the textbook is out! Thank you to the contributors!!! The prominent leaders in the field not only took the time to prepare their respective chapter for the textbook, but they did it according to a tight schedule imposed by the need to produce a contemporary publication!!!!! Thanks to all of you! I am proud and honored to be one of the Editors of this first textbook on Cancer Immunotherapy together with Lisa Butterfield (current President of SITC) and Howard Kaufman (immediate-past President). I thought it, therefore, reasonable, to publish (of course with permission from Demos and SITC) the preface that introduces the book. I want also to recognize the section editors, who accepted to take a big burden working with us toward the timely completion: thank you Tom (Thomas Gajewski), Paolo (Paolo Ascierto) and Raj (Raj Puri). And thank you readers for taking the time to scan over the preface and give us feed back through this blog or when we will see each other at the Annual Meeting!
After a prolonged germination phase, anticancer immunotherapy has blossomed and is producing a plentiful harvest. Just a decade ago, the field consisted of a passionate group of immunologists and a handful of oncologists and surgeons interested in a peculiar phenomenon: the occasional disappearance of advanced cancer in response to immune stimulation. It was reproducible enough to transcend the threshold of anecdotal insignificance and impart sufficient legitimacy to the field to sustain a miniature ecosystem. We were inspired by rare but concrete successes and we pursued the treatment of cancer patients in experimental settings when all other options had failed. There was no need for a textbook then, because we were a selected group of connoisseurs exchanging information at the Annual Meeting of the Society for Immunotherapy of Cancer (SITC, then called the Society for the Biological Therapy) or similar gatherings. And we held a primer at the Annual Meeting to introduce a handful of neophytes to the intricacies of immunologic responses against a tissue that was self and non-self at the same time.
Things have changed recently with rapid developments in terms of scientific understanding and clinical outcomes. The identification of cancer-specific antigens recognized by immune cells and the mechanistic characterization of the interactions that modulate the cross talk between neoplastic and immune cells gave molecular precision to a phenomenological description of cancer regression in mice, and less frequently in humans. The increasing occurrence of clinical responses with the new immunotherapy agents, whether checkpoint inhibitors or adoptively transferred immune effector cells, and the corresponding survival benefit for patients with advanced cancer has awakened the interest of skep- tics, whether scientists, clinicians, or industry partners. Hordes of oncologists, who were never trained in clinical immunology, are embracing this new modality of treatment and they need comprehensive training to deal with the unique pharmacodynamic profile and toxicity management of immunotherapy agents, which are distinct from standard chemotherapy. In addition, a young generation of basic scientists now perceives tumor immunology as a concrete opportunity to pursue a fruitful career
bridging their knowledge with the tangible opportunity of impacting people’s lives.
Moreover, the ever-growing speed of biomedical discovery relevant to anticancer immunotherapy unrelentingly spawns a wealth of candidate therapeutics needing efficient clinical testing as single agents or in combination. Industry, hampered by the exponentially growing pipeline of candidate products that target not only cancer cells directly, but their interactions with the host’s immune environment, faces, therefore, an unrealistic challenge. Drug development and respective clinical testing need prioritization to optimize patient selection and reduce costs by enhancing the probability of successful outcomes. Nowadays, a wealth of candidate targets, resulting from high-throughput biomedical discovery, exacerbates the demand, particularly when innumerable combinations for the treatment of complex disorders such as cancer are contemplated; thus, the need to identify evidence-based tools for prioritization based on discovery of useful concepts that could feed the development of novel precision-guided therapeutics. At the same time, a strategy to identify useful predictive and surrogate biomarkers is needed. The optimization of evidence-based study design will help manage the extraordinary cost of clinical testing by guiding the selection of optimally informed choices. In association with high- quality prospective correlative studies, this strategy will improve the design of novel, second-generation precision-guided therapeutics. In accord with the rapid development within the field, regulatory and payer agencies also need to keep pace so that more rapid approval of promising drugs and patient access to high-quality delivery of such agents is possible. Finally, the ultimate beneficiaries of these efforts, the patients and their families, are becoming increasingly empowered to make their own choices but they will need guidance and a reference to make the best-informed decisions.
SITC is trying to respond to the exponential growth of educational needs from all these sectors by providing primers at the Annual Meeting, itinerant courses to clinicians throughout the United States (and abroad in the near future), expanding with topical meetings addressing specific questions related to the field, providing practical guidelines for patient management and policy development, and informing on other themes as they emerge through the SITC portal to include as many up- to-date educational activities as possible. In this context, the SITC leadership decided to collate into an authoritative compendium as much information as possible, primarily targeting young basic and clinical investigators but open to all other constituencies.
It made sense that the current presidents of SITC, supported by the SITC staff, should take on the initiative. We tried to include many of them as contributors and we cannot thank them enough for their enthusiastic response. Chapters for textbooks can be painstakingly overbearing, but all contributors managed to complete their part, areas in which they are recognized worldwide as experts, to bring together cutting edge insight that every translational investigator and practicing clinician needs to know about tumor immunology and immunotherapy. The textbook is divided into five sections: Basic Principles of Tumor Immunology, Cancer Immunotherapy Targets and Classes, Immune Function in Cancer Patients, Disease-Specific Treatments and Outcomes, and Regulatory Aspects of Cancer Immunotherapy. Each section has its own introduction and we will not dwell on the details here. Suffice to say that we tried to cover in these sections the continuum from basic principles to practical and clinically relevant information that could allow a critical understanding of the development and testing of novel therapeutics, companion diagnostics, or useful biomarkers, and could inform about the regulatory processes that support safe yet efficient commercialization.
In addition, a chapter on the history of immunotherapy was devoted to the recognition of those who pioneered and championed the field when it did not enjoy the current popularity to provide the reader with a better appreciation of its evolution.
We want to emphasize that the book is not meant to cover all aspects of tumor immunology. Indeed, the field is a compound science that includes two over- lapping disciplines: immunology and cancer biology. Plenty of textbooks cover more basic concepts relevant to each of the two areas, while in this textbook we tried to focus on converging concepts and peculiarities relevant to the relationship between the host and the neo- plastic tissue.
Furthermore, we were concerned about producing a contemporary textbook as close as possible to the cur- rent status of the field. However, considering the rapid evolution of anticancer immunotherapy, particularly in the clinics, it is impossible to claim absolute success: The number of successful clinical trials and corresponding regulatory licensing is growing at an accelerating pace. Thus, this textbook aims at guiding the neophyte through a critical interpretation of upcoming results based on a solid understanding of anticancer immunotherapy concepts within the context of alternative treatments and the potential for their combinations. Because some areas are likely to progress more rapidly than others, we are planning to periodically publish ad hoc updates either as reviews in the SITC official journal—the Journal for the Immunotherapy of Cancer (JITC)—or more formal and detailed chapter updates and new editions through this publisher.
We hope that the readers, especially the young ones, will enjoy this book and find useful information to complement other SITC activities and that they will be inspired to become active members of the tumor immunotherapy community.