Bold claim: Immunotherapy is moving earlier in cancer care, and that shift could change outcomes for many patients. But here’s where it gets controversial: the benefits vary by cancer type, and early treatment brings questions about side effects, costs, and whether some patients might receive more therapy than needed.
Immunotherapy Used Earlier In Several Cancer Types
Immunotherapy administered before or after surgery is increasingly used across multiple cancers. A comprehensive review published in the Journal of Internal Medicine, led by researchers at Karolinska Institutet, pools studies from seven tumor areas to show a clear trend toward earlier intervention in the disease course.
Traditionally, immunotherapy transformed the treatment of advanced cancers that were no longer removable by surgery. Today, it is being used more frequently in earlier stages as well—before surgery (neoadjuvant treatment) or after surgery (adjuvant treatment). In the new review, the researchers summarize findings from studies on seven cancer groups: skin cancer, lung cancer, breast cancer, gastrointestinal cancer, gynecological cancer, head and neck cancer, and urological cancer.
Potential benefits of pre- and post-surgical immunotherapy
- Adjuvant immunotherapy after surgery has repeatedly shown a reduced risk of cancer recurrence in several studies from the past few years.
- Neoadjuvant immunotherapy, given while the tumor is still present, often appears to prime the immune system to recognize tumor cells more effectively.
- In several cancer types, combining pre- and post-surgical immunotherapy may offer advantages over using adjuvant therapy alone.
Despite these encouraging signals, the authors emphasize that results differ across cancer types and that immunotherapy introduces challenges. Side effects can occur, and some patients may undergo more treatment than necessary if surgery alone would have sufficed.
“Immunotherapy in the early stages of disease is advancing rapidly across many tumor areas. By aggregating studies from diverse cancers, we gain a clearer view of how the field is evolving and what clinical experiences can inform other specialties,” says Hildur Helgadottir, the study’s senior author and a researcher at the Department of Oncology-Pathology, Karolinska Institutet.
How the review was conducted
Fourteen researchers from Karolinska Institutet’s Department of Oncology-Pathology collaborated on this article. All contribute to cancer care in clinical settings, and their跨-disciplinary backgrounds—from seven tumor areas—allowed the team to compile a broad, cross-cutting view of immunotherapy’s use in early disease.
“We valued the collaboration across multiple tumor types because it provides a wider understanding of how immunotherapy is applied throughout cancer care. This can support clinical decision-making and guide future research,” helgadottir notes.
The authors also highlight areas where more knowledge is needed. A key priority is developing biomarkers—measurable traits that help clinicians identify which patients are likely to benefit from immunotherapy, both before and after surgery. They also flag questions about cost, side effects, and overall resource availability, noting that current studies do not yet offer definitive answers.
Further information about funding and potential conflicts of interest can be found in the original scientific publication.
Publication
Perioperative immune checkpoint inhibitor therapy across tumors: Insights and shared lessons from a rapidly evolving field. https://pubmed.ncbi.nlm.nih.gov/41690815
Björkström K, Matikas A, Svedman FC, Björgvinsson E, Zupancic M, Villabona L, Eriksson H, Skribek M, Fernebro J, Lindskog M, Frödin JE, Ullén A, Ekman S, Helgadottir H
J Intern Med 2026 Feb;():
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