Immunotherapy has quickly become a cornerstone of cancer care, but some leaders in the field say the prevailing narrative often oversimplifies the highly diverse set of therapies — each with widely different clinical risks, operational demands and implications for health systems.
Fifteen leaders in oncology and immunotherapy shared with Becker’s the nuance hospital and health system leaders need to better understand the groundbreaking cancer treatment.
Editor’s note: Responses have been lightly edited for clarity and length.
Nabil Adra, MD. Medical Director of the Simon Comprehensive Cancer Center at IU Health (Indianapolis): One area of the immunotherapy conversation that is often oversimplified is the assumption that these agents are universally “easier” or less resource-intensive than traditional chemotherapy. While immunotherapies have transformed outcomes for many patients, they introduce unique clinical, operational and financial complexities that health system leaders must appreciate.
Immune-related adverse events can be unpredictable, multisystem and require rapid multidisciplinary coordination, specialized training and inpatient resources when severe. Newer modalities such as bispecific T-cell engagers and cellular therapies such as CAR-T involve complex workflows, prolonged monitoring and significant infrastructure investment.
Another nuance that deserves more attention is patient selection. Not all patients benefit equally from immunotherapy. Biomarkers, comorbidities and disease biology play critical roles in determining outcomes and toxicity risk. From a systems perspective, sustainable immunotherapy programs require thoughtful planning around staffing, infusion capacity, remote monitoring, pharmacy support and financial stewardship.
In short, immunotherapy is not simply a “plug-and-play” solution — it is a powerful tool that demands strategic, informed implementation to deliver safe, equitable and high-value care.
Stephen Ansell, MD, PhD. Enterprise Deputy Director at Mayo Clinic Comprehensive Cancer Center (Rochester, Minn.): The potential danger in the industry’s approach to immunotherapy seems to be the tendency to assume that “one size fits all.”
There is a risk of oversimplifying management of patients treated with novel immune treatments, including cellular therapies and bispecific antibodies.
While initial immunological treatments focused on hematological malignancies, these treatments are now becoming available for patients with other cancers and even for non-cancer indications, including autoimmune diseases and neurological diagnoses.
As these new immunological agents become available for many additional new clinical indications, the side effects and complications may differ by diagnosis.
The industry will therefore need to focus specifically on developing safe mechanisms to administer these new treatments and nimbly adjust to giving them in multiple treatment settings.
Rapid communication of toxicity concerns to the broader medical community in real time will be important to ensure patient safety. This requires focused multidisciplinary teams who routinely care for these patients and systems within healthcare facilities that offer an integrated approach to patients receiving immunotherapy.
Natalie Callander, MD. Director of the University of Wisconsin Carbone Cancer Center Myeloma Program and Professor of Medicine at the UW School of Medicine and Public Health (Madison): In the world of multiple myeloma therapy, we have been using agents considered forms of immunotherapy for many years, including drugs such as lenalidomide and daratumumab. However, the introduction several years ago of what are termed “T cell redirecting therapies” is revolutionizing care in a way we have never seen before. We have treatments that bring together immune cells with tumor cells, facilitating the destruction of the latter. We are now able to infuse T cells as part of chimeric antigen T cell receptor therapy to directly kill cancer cells.
Coming soon may be techniques to harness immune function with the use of agents that can be directly injected into the body and turn that individual into their own anti-cancer treatment producing entity, without the need of an outside manufacturing lab. Myeloma has been considered an incurable blood disorder, but we believe that the application of such innovations may provide the key to the cure.
Armin Ghobadi, MD. Bone Marrow Transplant Specialist and Medical Oncologist at Siteman Cancer Center (St. Louis): One of the over-simplified themes in the immunotherapy conversation is treating immunotherapy as a single platform or therapy. In oncology, immunotherapeutics encompass a broad and heterogeneous spectrum — from monoclonal antibodies and antibody-drug conjugates to checkpoint inhibitors, bispecific T-cell engagers, and immune-effector cell therapies such as CAR-T, TIL, TCR-T, NK cells, CAR-NK and virus-specific CTLs. Lumping these distinct modalities together obscures their fundamentally different clinical, operational and resource requirements.
This oversimplification is compounded by the notion that advanced immunotherapies — particularly IEC therapies — are “plug-and-play” products: approved, ordered, infused and completed. In reality, these are complex clinical systems, not conventional drugs. Outcomes depend as much on institutional readiness — manufacturing coordination, bridging strategies, toxicity surveillance, specialized staffing and 24/7 coverage — as on the therapy itself.
Hospital and health system leaders often underestimate the complexity of patient selection, treatment timing and site-of-care decisions. Outpatient delivery, for example, is not simply a cost-containment strategy; it requires carefully designed standard operation procedures, reliable caregiver engagement, continuous monitoring and clearly defined rapid-escalation pathways to ensure patient safety. Ultimately, successful immunotherapy programs depend on tight alignment between clinical expertise, operational authority and sustainable financial models — recognizing immunotherapy as an enduring service line rather than a one-time therapeutic event.
Douglas Johnson, MD. Associate Director of Translational Research at Vanderbilt-Ingram Cancer Center (Nashville, Tenn.): Immunotherapy, while often better tolerated than chemotherapy, still can cause severe complications. Education to oncologists and multiple subspecialities should be a priority to most effectively manage patients and to maximize the potential for immunotherapy. More effective toxicity management will also facilitate novel combinations that can further raise the bar for immunotherapy efficacy.
Frederick Locke, MD. Chair of the Blood and Marrow Transplant and Cellular Immunotherapy Department at Moffítt Cancer Center (Tampa, Fla.): The excitement around immunotherapy’s expansion beyond cancer into autoimmune and other diseases is justified. A major blind spot, however, is the tendency to treat these advances as simply a new category of drugs rather than an infrastructure platform. Modern immunotherapies, particularly CAR-T cell therapy and bispecific T cell engagers, deliver meaningful efficacy but carry distinct and sometimes severe immune-related toxicities that require specialized teams, coordinated service lines and disciplined clinical governance. Underinvestment in this capability will not age well, as demand is far more likely to expand than contract.
A second nuance is risk distribution. Newer approaches such as bispecific antibodies and emerging in vivo CAR-T strategies may improve safety per patient compared with earlier cellular therapies, but vigilance requirements do not disappear. As use spreads across more indications, serious toxicities become less frequent per case but more common in total volume. That increases, not decreases, the need for trained response systems and longitudinal follow-up models.
Finally, leaders should not assume the next platform will make operations easier. Payment models will change. Infrastructure requirements will not. Early investment is a strategic advantage.
Andy Minn, MD, PhD. Chair of the Immuno-Oncology Program at Memorial Sloan Kettering Cancer Center (New York City): Most of the therapeutic strategies for cancer immunotherapy have largely focused on how to increase an inflammatory response. For example, how to make a “cold” tumor that lacks immune cells into a “hot” tumor that is heavily infiltrated with highly activated and inflammatory immune cells. Similarly, drugs are often designed to maximize immune activation and inflammation by removing “brakes” (checkpoint inhibitors like anti-PD1) or applying “gas” (cytokines like IL2). However, there is a growing recognition that more inflammation is not always better. Just as chronic inflammation is well-recognized as a detrimental contributor to diseases like heart disease and autoimmunity, maladaptive, or “bad,” inflammation can often result from immunotherapies or can preexist before treatment. How “bad” inflammation interferes with the effectiveness of current immunotherapies is not well understood. However, if we can understand and then identify “bad” inflammation, a logical strategy would be to inhibit it. This approach would involve a radical rethinking of how to design immunotherapies because it would require the incorporation of anti-inflammatory agents into our current immunotherapy regimens.
William Oh, MD. Director of Precision Medicine at Yale Cancer Center (New Haven, Conn.) and the Jean and David W. Wallace Medical Director of the Smilow Cancer Hospital at Greenwich (Conn.) Hospital: Cancer immunotherapy has transformed the treatment of many cancers and highlighted an approach that has made oncologists rethink the treatment paradigm of advanced cancer. However, as few as 13% of all cancer patients respond to immunotherapy, according to a comprehensive review in JAMA in 2018, with a median duration of response of 10 to 20 months.
Even in highly responsive cancers such as melanoma and lung cancer, the majority of patients will not have a significant and durable response. That said, there have been many patients who have benefited from treatment, with durable responses lasting years. This variability is being addressed with a multitude of clinical trials combining checkpoint inhibitors with vaccines, bispecific antibodies and other novel ways to stimulate the immune system. In addition, immunotherapy also requires vigilance in terms of side effects, some of which can be very significant.
Angel Qin, MD. Associate Professor of Thoracic Medical Oncology at University of Michigan Health (Ann Arbor): In general, there is this feeling that immunotherapy is the cure for all cancers and is a necessary part of treatment for all cancers. The reality is that the selection of immunotherapy for any cancer patient requires a thorough understanding of the disease stage and molecular characteristics, the patient’s comorbidities and performance status, and a nuanced discussion. While immunotherapy can be effective for some cancers, the benefits are not equal across all cancers. Furthermore, immunotherapy comes with potential for significant toxicities that are life changing or life threatening and cannot be understated.
Diane Reidy-Lagunes, MD. Physician Vice President of Cancer Services for Duke University Health System (Durham, N.C.): Immunotherapy is often described as either a major breakthrough or a disappointment, which oversimplifies just how complex the field is and how much innovation has occurred and continues to occur.
Today, we are curing some advanced stage 4 cancers with immunotherapies, something that was unimaginable just a few years ago. Yet, there are thousands of diseases we call “cancer,” and it is far from a one-size-fits-all approach. Even within “breast cancer,” there are hundreds of distinct subtypes with different biology and variable responses to immunotherapy. Over the next few years, we will work to better understand which cancers are sensitive to these treatments and why, and to explore ways to make resistant cancers more responsive.
Equally important is that not all immune treatments are completely safe. Some can be life-threatening because activating the immune system can occasionally harm normal organs. Managing these toxicities requires expertise, coordination, and strong clinical infrastructure. We are improving, but it takes time. Oversimplified narratives can create unrealistic expectations for clinicians, health system leaders and patients.
Lastly, when people ask why we still use traditional chemotherapy, the answer is simple: It works and cures many types of cancer. Balancing proven therapies with innovative approaches is critical to always doing what is best for the patient.
Hospital and health system leaders need to appreciate that immunotherapy isn’t a single treatment; it’s a platform that requires sustained investment, collaboration with industry and government, and a fully integrated care and research ecosystem. The potential is enormous, but realizing it quickly depends on funding, infrastructure, and strategic support.
Padmanee Sharma, MD, PhD. Director of Scientific Programs at the James P. Allison Institute, and Professor of Genitourinary Medical Oncology and Immunology at the University of Texas MD Anderson Cancer Center (Houston): A persistent oversimplification in the immunotherapy conversation is the belief that response to immune checkpoint blockade, particularly PD-1 inhibitors, can be predicted by a single biomarker or that these therapies are broadly effective in a mechanistically uniform way. While checkpoint blockade has unquestionably transformed oncology, durable responses occur only in subsets of patients, and resistance remains common.
Immunotherapy response and resistance are driven by a complex, dynamic interaction among tumor cells, immune cells, and systemic host factors, many of which extend beyond the tumor itself. These influences vary by cancer type and patient context and evolve over time, making static or single-marker approaches to patient selection insufficient. Reliance on oversimplified predictors limits our ability to reliably identify responders and to design strategies that overcome resistance.
Hospital and health system leaders need to recognize that immunotherapy is not a one-size-fits-all modality but a precision strategy. Improving outcomes will require investment in integrated immune profiling, advanced data science, and biomarker-guided treatment approaches, along with clinical trial models that connect mechanistic insight to patient response. Building this capability is essential to delivering more reliable, personalized immunotherapy care now and in the future.
Robert Vonderheide, MD, PhD. Director of the Abramson Cancer Center at Penn Medicine (Philadelphia): Cancer immunotherapy is entering its precision phase; however, it won’t only be based on tumor mutations, but rather proteomics and cellular immunology, especially the baseline “immune health” of the patients. For example, at Penn Medicine’s Institute for Immunology and Immune Health, scientists are conducting deep profiling of individual immune systems to capture each patient’s unique immune fingerprint, a living blueprint of personal health and disease, that offers new ways of thinking about healthcare. Vendor and hospital assays that take advantage of technology to go beyond just mutational panels — or even genomic testing — of tumors will likely soon be the vanguard for immune personalized medicine for patients with cancer.
David Wald, MD, PhD. Co-Leader of the Immune Oncology Program at Case Comprehensive Cancer Center, Member of University Hospitals Wesley Center for Immunotherapy at UH Seidman Cancer Center (Cleveland): Much of the current conversation around immunotherapy is oversimplified, often treating it as a uniform solution rather than a highly context-dependent approach. In reality, there are vast differences between tumor types — and even within the same tumor — driven by patient-specific immune composition, tumor microenvironment biology and prior treatments. These factors critically determine whether immunotherapy is effective. While the clinical benefits can be transformative, there is active development underway to improve durability, safety and accessibility. In some settings, immunotherapy alone is insufficient, and rational combinations with chemotherapy, targeted agents or other therapies will be essential for optimal outcomes.
Michael Wong, MD, PhD. Physician-in-Chief at Roswell Park Comprehensive Cancer Center (Buffalo, N.Y.): The advent of therapies using monoclonal antibodies directed against cell surface receptors on the surface of lymphocytes defined the era of what became known as “immunotherapy.” However, this blanket term cannot encompass the subsequent enormous diversity of immune modulating therapies that include: CAR-T, TILs, BiTES, mRNA vaccine and cytokines. Each of these have specific indications, administration and impact on resources and costs.
Mark Yarchoan, MD. Physician-scientist and Associate Professor of Oncology in The Johns Hopkins University School of Medicine (Baltimore): Immunotherapy is often viewed as a straightforward outpatient treatment delivered by an oncologist, but that framing underestimates the complexity of delivering these therapies safely. Potent modern immunotherapies require multidisciplinary expertise, rapid toxicity recognition and, at times, inpatient management. After decades of oncology care shifting to the outpatient setting, health systems may see the pendulum swing back, with inpatient capacity and coordinated specialty care becoming critical to safe immunotherapy delivery.
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