Advanced Procedures.

Immunotherapy agents such as the immune checkpoint inhibitors Opdivo, Keytruda, Yervoy and OX40 agonist have been a revolution in cancer treatment, but they still have significant limitations. Studies have shown that injecting these agents directly into a tumor may allow for more combinations, better success and less side effects than the typical intravenous administration. It is important to understand that this treatment is systemic, meaning it affects other tumors that are not directly injected. This means that it is not necessary to inject every tumor in cases where patients may have many. Also, patients already receiving intravenous immunotherapy may benefit by adding intratumoral immunotherapy to enhance their treatment. In addition, new experimental agents, such as an OX40 agonist, combined with CpG (called the Stanford cancer vaccine) have created even more excitement. This combination injected into the tumor, made worldwide news in early 2018, showing outstanding success with the idea of treating directly at a tumor site. The studies indicate that treating one or two sites can result in a whole body anti-cancer immune response. The idea is that training the immune system at the site where it actually encounters the cancer is the most important, not just all throughout the body. These trained immune cells can then attack cancer in locations throughout the body.