Cancer, checkpoint inhibitors, and confusion

[...]the immune distinction between foreign and self is not absolute, and intervention can be misdirected.1 Activated cytotoxic T cells are central to the efficacy and adverse effects of immunotherapy. 20-30% of patients2 respond to checkpoint inhibitors, but all patients are exposed to a broad spectrum of adverse events primarily involving the skin, gut, liver, and endocrine system. [...]with the growing list of unpredictable and undefined adverse events, and the importance of early detection, we suggest the inclusion of a practicing internist as an equal partner in oncology teams. [...]the serial, serious, and inexplicable setbacks in clinical trials and finances,1-5 should prompt pharmaceutical companies to rethink the research premise of immunotherapy, and explore tractable targets in alternative pathways to autoimmunity rather than pursuing combinations with outmoded drugs.