Can immunotherapy eventually cure all major types of cancer?

How well does immunotherapy work right now?

Immunotherapy has been a game-changer for some cancers, but its success is far from universal. In advanced genitourinary cancers (kidney, bladder, prostate), durable complete responses—meaning the cancer disappears and stays gone—occur in fewer than 10% of patients [7]. A 2020 survey of 60 patients about to start immunotherapy for these cancers found that 23% had unrealistic expectations of a cure, despite counseling from their oncologists [7]. This gap between hope and reality highlights that for most patients, immunotherapy slows the disease rather than eradicates it.

For pancreatic cancer, one of the deadliest cancers, the picture is even starker. A 2022 review notes that immunotherapy has 'made few inroads' with pancreatic ductal adenocarcinoma, and a host of promising preclinical trials have failed—except for a small minority of patients with specific biomarkers [6]. Similarly, in non-small cell lung cancer, immunotherapy can improve survival, but it also carries risks: a case report describes a patient who developed a pleural effusion (fluid around the lung) from reactivated tuberculosis three months after starting pembrolizumab, a common immunotherapy drug [1]. The authors note that such infectious complications occur because the treatment activates T-cells that can also attack latent infections [1].

Why can't immunotherapy cure everyone?

The main reason is that tumors actively suppress the immune system. The tumor microenvironment is often 'immunosuppressive,' meaning it contains cells like tumor-associated macrophages and myeloid-derived suppressor cells that block T-cells from attacking the cancer [2]. A 2024 review explains that the success or failure of immunotherapy is 'closely linked to the tumor's immune microenvironment' [2]. This is why even powerful checkpoint inhibitors (drugs that release the immune system's brakes) often fail: the tumor has other ways to hide or fight back.

Another challenge is that the standard approach—boosting the immune system's killing power—may actually backfire in some cases. A 2025 paper argues that conventional immunotherapies, which focus on amplifying cytotoxic (cell-killing) activity, may 'inadvertently worsen tissue disruption, fostering conditions that promote cancer progression despite temporary tumor shrinkage' [4]. The authors propose a shift toward 'immune-driven tissue homeostasis' rather than pure destruction [4]. This is a new idea, but it underscores that our understanding of how to harness the immune system is still evolving.

What might make immunotherapy work for more cancers?

Researchers are pursuing several strategies to expand immunotherapy's reach. One promising approach is combining it with other treatments. A 2024 review on radiotherapy and immunotherapy notes that combining these two modalities can 'significantly enhance the anti-tumor response' through synergistic mechanisms, though it also increases the risk of side effects [3]. For example, in colorectal cancer, neoadjuvant immunotherapy (given before surgery) has shown 'satisfactory tumor downsizing' in early trials, especially for patients with a specific genetic signature called MSI-H/dMMR [10]. The KEYNOTE-177 trial found that pembrolizumab improved survival in metastatic colorectal cancer patients with this signature [10].

Nanotechnology is another frontier. A 2024 paper describes using nanomedicines to target immune cells in the tumor microenvironment, aiming to 'induce or enhance anti-tumor immune responses' [2]. One study created a 'programmable immune activation nanomedicine' that, when combined with an anti-PD-L1 antibody, cured 40% of mice in a colorectal cancer model [8]. While animal results don't always translate to humans, this shows the potential of smart delivery systems. Finally, neoadjuvant immunotherapy—giving treatment before surgery—is 'rapidly changing the treatment landscape' for many tumor types, with some combinations becoming standard of care [9]. The key, as one 2021 review puts it, is finding 'the right timing, right combination, right sequence, and right delivery' for each patient [5].

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