Over the past decade, there are many new advances in the management of cancers that included targeted therapies by either small molecules inhibitors or immunotherapy. Immunotherapy can further be classified into different categories such as active immunotherapy, passive immunotherapy, adoptive immunotherapy and immune check point inhibitor treatment. The active immunotherapy includes cytokines therapy and tumor vaccine. For children cancers, interferon alpha as a maintenance therapy for chronic myeloid leukemia previously and consolidation treatment for childhood nasopharyngeal cancers are examples of such approach. Tumor vaccine against GD2 for neuroblastoma is currently under clinical trial. For passive immunotherapy, use of monoclonal antibody against specific tumor associated antigen is the main strategy. This includes anti-CD20 for B-lineage acute lymphoblastic leukemia or non-Hodgkin lymphoma, anti-CD33 for acute myeloid leukemia, anti-GD2 for neuroblastoma and anti-CD30 for Hodgkin lymphomas. The newest approach is using bio-engineered bispecific antibodies that link a tumor specific antigen to cytotoxic T cells. We witnessed both success and failure of these active and passive immunotherapy approaches. They have to be used in combination with chemotherapy under most situations. For adoptive immunotherapy, it involves the use of either autologous or allogeneic immune cells. The most common forms are hematopoietic stem cells transplant (HSCT), NK cells, and CAR-T cells. In principle, the combination of both cellular and non-cellular immunotherapy can further enhance the efficacy. Finally, immune check-point inhibitors (PD-1 or PDL-1 inhibitor, CTLA-4 inhibitor) are emerging concept and PD-1 inhibitor has been used in refractory Hodgkin lymphoma with good preliminary result. Whether immune check point inhibitor can be used together with other immunotherapy remains to be explored. When using these new therapies, a totally new set of therapy-related toxicity emerged and clinicians have to be aware of these complications and know how to manage them. In summary, the new paradigm of applying immunotherapy for cancers is coming but we have to understand their respective strengths and weaknesses so they can be applied effectively. In addition, the markedly high cost of most of these therapies may limit their availability to most patients in needed. Concerted effort from both Governments and manufacturers are essential in order to improve their application to general public.
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