Predict immune side-effects before they happen and pre-empt them
Immunotherapy can trigger dangerous attacks on the gut, lungs or heart. Use blood, gut bacteria and genetic markers to spot who is at risk and act early.
Immune-related adverse events cause treatment discontinuation and death, and their management is reactive. Autoantibody profiles, HLA types, microbiome composition, baseline cytokines and early T-cell clonal expansion are each associated with specific toxicities in retrospective series. The proposal is a prospective biomarker cohort across checkpoint inhibitor indications to derive and validate a toxicity risk model, followed by trials of pre-emptive strategies (early steroid-sparing agents, microbiome modulation, intensified monitoring) in high-risk patients.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
- No one can predict who responds to immunotherapy · Checkpoint drugs cure some patients and do nothing for most. We still cannot tell the two apart before treating.
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