Cancer has followed humanity for thousands of years— but how we treat it has changed dramatically. Nearly 5,000 years ago, ancient Egyptian texts described treating tumors with cauterization, a method that used heat to burn abnormal tissue. By the mid-1800s, anesthesia made surgery more feasible, and by the 1940s, the first chemotherapy drugs introduced a new way to attack cancer cells throughout the body. In the 1990s, targeted therapies began to treat cancer more precisely by focusing on specific features of cancer cells. Today, one of the most innovative advances in cancer treatment is immunotherapy, which has reshaped how we think about fighting cancer. 

What is Immunotherapy?

Immunotherapy is a type of treatment that helps a patient’s own immune system recognize, target, and destroy cancer cells. Some immunotherapies work by activating immune cells, such as T cells, so they can better attack tumors. Others, including anti-PD-1 and anti-CTLA-4 therapies, work by blocking “stop signals” that prevent T cells from staying active. In this way, these treatments help release the brakes on the immune system. 

Anti-PD-1 and anti-CTLA-4 therapies have transformed treatment for several cancers, including melanoma, lung cancer, and bladder cancer. In bladder cancer, immunotherapy has expanded treatment beyond older approaches such as platinum-based chemotherapy and Bacillus Calmette-Guérin, or BCG, therapy. Rather than only directly targeting cancer cells, immunotherapy allows clinicians to harness the patient’s own immune system to recognize and help fight cancer. 

Even with these advances, an important question remains: which features of cancer cells is the immune system recognizing? More specifically, which markers or proteins on tumor cells are T cells recognizing, and can immunotherapy change or broaden those responses? 

How Does Immunotherapy work in Bladder Cancer?

A recent study from my team at the Personalized Immunotherapy Research Lab at the University of North Carolina at Chapel Hill (pictured above) focused on this question in bladder cancer. In this study, we examined which specific tumor targets were recognized by T cells and whether immunotherapy could redirect T cells toward them. We found that immunotherapy mainly boosted T cell responses that were already present, rather than creating entirely new responses. This suggests that one reason some patients benefit from immunotherapy while others do not may depend on whether useful anti-tumor T cell responses are already in their body. 

This research highlights the need to better understand each patient’s immune response to cancer. If we can identify which tumor targets T cells already recognize, and learn how to broaden those responses, we may be able to use immunotherapy more strategically. 

Ongoing research in this area could lead to future cancer treatments that not only strengthen existing immune responses but also broaden the range of tumor features the immune system can recognize. This could lead to more effective or personalized treatments, improving outcomes for patients. 

Misha Fini is earning her PhD in the Personalized Immunotherapy Research Lab under Dr. Benjamin Vincent at the University of North Carolina, Chapel Hill.