PD-1 Immunotherapy: It Is Not Easy to Love You
PD-1 immunotherapy has developed rapidly in recent years. As a new therapy for tumor diseases, it is deeply welcomed by clinicians and patients; oncologists, cancer patients, and their families all place great expectations on it, hoping to use immunotherapy to solve the cancer problem. But problems keep emerging in practice.
Under the Zhihu question "How should we view PD-1 immunotherapy?" there are many replies, and some from professionals on the front lines of clinical practice are worth paying attention to, such as the following two.
After I finished writing the previous article "Excessive Immune Reactions Caused by Ipilimumab", I suddenly remembered that a liposarcoma patient named Song, whom I treated last year, had also gone for PD-1 treatment, and I wanted to ask how he was doing. As it turned out, when I asked two other liposarcoma patients who knew his situation, they told me that this liposarcoma patient, whose screen name was "Han Xin," had already passed away around this year's Spring Festival.
This young liposarcoma patient, born in 1981, first came to me for TCM treatment on November 10, 2017, but after one visit did not persist in taking Chinese medicine, probably due to insufficient confidence in TCM. On April 14, 2019 he came to me again; by then he had already relapsed and metastasized. He told me that after the first visit he had taken medicine for only half a month and stopped; this time he wanted TCM treatment. But after TCM treatment, although his tumor stopped growing, this efficacy did not satisfy him; he wanted to shrink the tumor as quickly as possible. Because his tumor was nearly ten centimeters, he worried that if it could not be controlled later it would endanger his life.
I understood his feelings very well, so he later had surgery at a Beijing hospital, and I supported his choice. Unfortunately, less than a month after surgical resection the tumor recurred, larger than before. After that he chose chemotherapy, and later tried immunotherapy, using domestic PD-1 combined with chemotherapy (the regimen being liposomal doxorubicin + dacarbazine). Treatment began in early 2021, and he passed away in less than a year.
I do not know why he died so quickly; his condition should not have progressed this fast, nor do I know whether PD-1 side effects appeared before his death, because after he changed his treatment regimen he no longer communicated with me. Another Hunan liposarcoma patient who sought treatment from me at about the same time used pure TCM treatment and is still alive, with the tumor basically unchanged; I previously wrote an article "An Experience in Relieving Liposarcoma Cancer Pain with a Chinese Herbal Decoction", which is that patient's medical case.
Many people at home promoting PD-1 immunotherapy strike me as overdoing it; now case after case of serious PD-1 side effects is emerging. Yesterday a family member of a patient who had used ipilimumab pushed another article to me, "Clinical Research—The Forgotten Corner: Late-Onset Immune-Related Adverse Events", which explores late-onset adverse reactions caused by immunotherapy. From this article we can see that adverse reactions to immunotherapy are very common.
From my practical experience, the side effects caused by immunotherapy are greater than those of traditional radiotherapy and chemotherapy. The side effects of chemo and radiotherapy now have mature integrated Chinese-Western countermeasures, while the side effects of immunotherapy still lack mature solutions. The real efficacy of immunotherapy is also not as good as those aggressively promoting it claim; at least the real situation seen by frontline clinicians, myself included, is not good. Excessive promotion has led many patients who could have achieved good results with traditional therapies (such as chemotherapy and Chinese medicine) to choose high-risk, highly uncertain immunotherapy, only to pay a heavy price later.
Yesterday I also discussed this with a biology postdoc researching pediatric tumors; what he saw was much like what I see. He said that science currently knows far too little about the human immune system, and the risks of immunotherapy cannot be ignored. Yet patients mostly prefer new therapies, and this tendency is very dangerous. In fact, when many patients choose an immunotherapy regimen, doctors and fellow patients do pour cold water on them, but they still cannot resist the temptation and choose immunotherapy.
In medicine, the newest regimen is not necessarily the best; medicine must ensure safety and efficacy. The safety and efficacy of a new regimen are both unknown. If there is a traditional regimen with acceptable effects, the traditional regimen should be prioritized, because it ensures safety and efficacy, and this kind of clinical-trial-style new regimen should not be promoted so aggressively.