One of the pitches often used by the purveyors of cancer nostrums is that they work by “boosting the immune system.”1 The gist of this rose-colored presentation usually rests on a simplistic view that this system is one-dimensional and can be turned on or off by the simple flip of a switch, a switch such as the product being hyped.
To many patients facing advanced cancer such as melanoma, supplementing conventional treatment with complementary or alternative medicine (CAM) is a way to take an active role in managing their disease and to ward off feelings of hopelessness.2 Although the need is understandable, with CAM, as with any medical intervention, treatment should only be rendered after fully informed consent has been obtained.
A fine augmentation to this informed consent process might well be Antoni Ribas' article in this issue, which updates the status of immunotherapy for melanoma. Although undoubtedly beyond a patient's basic comprehension, the article provides a perspective on what the “immune system” means and how numerous and complex the underlying processes are. As someone new to the terms, a patient would undoubtedly be overwhelmed by just contemplating the number of approaches discussed: cytokines (including IL-2, IL-7, IL-12, IL-18, IL-21, and sargramostim), immunocytokines, whole tumor vaccines, gene-modified cells, cloned tumor antigen-specific T cells, tumor antigen naked DNA vectors, antagonistic (CTLA4,CD152) and activating (CD 40, CD 137) antibodies, heat shock proteins, recombinant virus, dentritic cell vaccines, costimulatory molecule modulation, and Toll-like receptor ligands. But what becomes truly awe-inspiring is the basic...
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Rodger J. Winn is the Editor-in-Chief of JNCCN. He is Clinical Consultant at the National Quality Forum, and his past positions include Associate Professor of Clinical Medicine at The University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.