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Scientific Frontline: Extended "At a Glance" Summary
The Core Concept: A shift in cancer treatment strategy where immunotherapy is administered at earlier stages of the disease—specifically before or after surgery—rather than being reserved solely for advanced, inoperable cases.
Key Distinction/Mechanism: The approach utilizes neoadjuvant treatment (given before surgery) to help the immune system better recognize tumor cells while the tumor is still present, and adjuvant treatment (given after surgery) to reduce the risk of the disease returning. This differs from the traditional use of immunotherapy as a last-line defense for metastatic cancer.
Origin/History: The comprehensive review highlighting this shift was published in the Journal of Internal Medicine in February 2026 by researchers at the Karolinska Institutet.
Major Frameworks/Components:
- Neoadjuvant Therapy: Pre-surgical administration intended to prime the immune response against the visible tumor.
- Adjuvant Therapy: Post-surgical administration aimed at eliminating residual microscopic disease.
- Targeted Tumor Areas: The review synthesizes findings across seven specific cancer types: skin, lung, breast, gastrointestinal, gynecological, head and neck, and urological cancers.
Immune Checkpoint Inhibitors: The primary class of drugs evaluated in these perioperative settings.
Branch of Science: Oncology, Immunology, Clinical Medicine.
Future Application: The identification of specific biomarkers to predict which patients will benefit most from early intervention, allowing for personalized treatment plans that balance efficacy with the risk of side effects.
Why It Matters: This paradigm shift aims to improve long-term survival rates by intervening when the disease is potentially curable, rather than managing it chronically. However, it also necessitates a re-evaluation of healthcare resources and treatment protocols to avoid overtreatment.
Immunotherapy given before or after surgery is increasingly used across several cancer areas. In an article published in the Journal of Internal Medicine, researchers at Karolinska Institutet present a comprehensive review of studies across seven tumor areas, showing how the field is moving towards earlier treatment.
For several years, immunotherapy has transformed the treatment of advanced cancer that can no longer be removed surgically. It is now used more frequently in earlier stages of disease as well – before surgery, known as neoadjuvant treatment, or after surgery, known as adjuvant treatment. In the new article, the researchers' summaries findings from studies on several cancer diagnoses, grouped into seven tumor areas: skin cancer, lung cancer, breast cancer, gastrointestinal cancer, gynecological cancer, head and neck cancer, and urological cancer.
Suggested benefits of treatment both before and after surgery
Several studies in recent years have shown that adjuvant immunotherapy after surgery can reduce the risk of the disease returning. Additional studies indicate that neoadjuvant treatment, given while the tumor is still in place, in many cases, can provide the immune system with better conditions to recognize tumor cells. In several tumor areas, the results also suggest that immunotherapy given both before and after surgery may offer advantages compared with adjuvant treatment alone.
At the same time, the authors emphasize that the results vary between different cancer types and that the treatment involves challenges, such as the risk of side effects and the possibility that some patients may receive more treatment than necessary if surgery alone would have been sufficient.
“We see that immunotherapy in early stages of disease is developing rapidly across many tumor areas. By bringing together studies from many cancer types, it becomes clearer how the field is evolving and what experiences can be shared between different specialties,” says last author Hildur Helgadottir, researcher at the Department of Oncology-Pathology at Karolinska Institutet.
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Hildur Helgadottir.
Photo Credit: Stefan Zimmerman
How the researchers carried out the review
The work behind the article is a collaboration between 14 researchers at the Department of Oncology-Pathology, Karolinska Institutet. All of them also work with cancer treatment in clinical care. Because the researchers come from seven different tumor areas, the article gathers experiences from many parts of cancer care.
“It is valuable that we have come together from so many different tumor areas. This gives a broader understanding of how immunotherapy is used across cancer care and can, in the long term, support both clinical decision-making and future research,” says Hildur Helgadottir.
The researchers also point to areas where more knowledge is needed. One of these is the development of biomarkers, measurable characteristics that can help healthcare determine which patients benefit from immunotherapy, both before and after surgery. They also discuss how introducing immunotherapy at earlier stages raises questions about costs, side effects, and whether healthcare resources will be sufficient, questions that current studies do not yet clearly answer.
Published in journal: Journal of Internal Medicine
Authors: Karl Björkström, Alexios Matikas, Fernanda Costa Svedman, Einar Björgvinsson, Mark Zupancic, Lisa Villabona, Hanna Eriksson, Marcus Skribek, Josefin Fernebro, Magnus Lindskog, Jan-Erik Frödin, Anders Ullén, Simon Ekman, and Hildur Helgadottir
Source/Credit: Karolinska Institutet
Reference Number: imgy021526_01